Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review

Abstract

Sustained retention represents an enduring and evolving challenge to HIV treatment programs in Africa. We present a theoretical framework for sustained retention borrowing from ecologic principles of sustainability and dynamic adaptation. We posit that sustained retention from the patient perspective is dependent on three foundational principles: (1) patient activation: the acceptance, prioritization, literacy, and skills to manage a chronic disease condition, (2) social normalization: the engagement of a social network and harnessing social capital to support care and treatment, and (3) livelihood routinization: the integration of care and treatment activities into livelihood priorities that may change over time. Using this framework, we highlight barriers specific to sustained retention and review interventions addressing long-term, sustained retention in HIV care with a focus on Sub-Saharan Africa.

Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study

“…Roy et al suggest that sustained retention relies on patients’ ability to successfully integrate care and treatment activities with livelihood demands [41]. While this aspect of the framework is valuable, we also believe it is necessary to re-examine it through a gender lens.…”

“…The framework posits that sustained retention is contingent upon 3 related processes: 1) patient activation, 2) social normalization and 3) livelihood routinization [41]. The process of patient activation involves a psychological shift from “passive recipients of care” to patients who accept their status, become more knowledgeable about their condition and engage with HCPs to co-manage their care.…”

Nurse-led HIV services and quality of care at health facilities in Kenya, 2014–2016

“…To reach these targets, people living with HIV need to learn their HIV status, link to appropriate treatment, achieve virological suppression and remain in care and on treatment for their lifetime. Careful attention to each step along the treatment continuum is essential, 6 as sustained retention in care remains a challenge in many HIV programmes 7 …”

Building a theory of change for community development and HIV programming: The impact of social capital, stigma reduction and community-level changes on HIV-related health outcomes for orphans and vulnerable households in Mozambique

“…Social capital, and social support more broadly, has also been shown to positively impact HIV-related health at the individual and community levels (Gibbs, Campbell, Akintola, & Colvin, 2014;Wang & Eccles, 2012). Researchers have found that social capital, social network engagement, and forms of social support can support patient retention in HIV treatments (Roy et al, 2016), lead to greater quality of life for PLHIV (Jong, Carrico, Cooper, Thompson, & Portillo, 2017), and improve mental health outcomes for children living with HIV (Sharer, Cluver, Shields, & Ahearn, 2016). Alternatively, Cau, Falcao, and Arnaldo (2016) show that social isolation worsens health perceptions among urban adults in Mozambique.…”