HIV program growth in Africa is not affecting patient retention rates

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The following is a guest blog post by HIV Medicine Association Executive Director Andrea Weddle, who is live-blogging from the 19th Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

Dr. Elul's data on non-retention 12 months after ART initiation over calendar time by country.

Patient retention in HIV programs has remained stable in a number of resource-limited countries despite rapid patient caseload and program growth since 2003. According to data presented by researcher Batya Elul at a CROI abstract session Wednesday morning – aggregate six-month non-retention rates were 21 percent in 2005 and 2010, and there was no significant difference in the 12 month non-retention rates in 2005 or 2010 – which were 27 and 29 percent respectively. According to Elul, non-retention was defined as patients not having picked up antiretroviral medications within the previous three-month period.  Country-specific data indicated that non-retention rates decreased in Mozambique and Nigeria, showing promise for the development of strategies to improve program retention rates in other countries. Cote d’Ivoire, Nigeria and Rwanda had increased non-retention rates during this period.

The study was based on data from 656 clinics in nine countries that receive funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program. Data included 5,690 cohorts of patients that initiated antiretroviral therapy quarterly from January 2005 through December 2010, for a total of 316,762 patients.

Lower non-retention rates were associated with large, urban clinics and higher CD4 count at antiretroviral initiation. The data was not able to account for undocumented transfers or referrals or confounding factors at the program level, but is comparable to other published data from Africa and the United States. Although different measurements were used – last December the Centers for Disease Control and Prevention estimated that 51 percent of people with HIV linked to care in the United States remain in care.

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