BOSTON, MASS – A discussion launched by findings from researchers working in Africa and India Tuesday focused on the quest to keep people living with HIV in care, and on measures to improve their outcomes.
Elvin Geng and colleagues looked at more than 35,000 patients in 14 clinics operated by 5 programs in East Africa and tried to understand what happened to the 17 percent of patients lost to follow up. A significant number of patients had died, and researchers noted that deaths between appointments were more common than deaths after missed appointments. Importantly, they found that treatment effectiveness between programs differed markedly, flagging the urgency to focus on improving services.
William Reidy and colleagues looked at outcomes for adults enrolled in HIV services in Kenya and also found many deaths, largely among patients not yet receiving antiretroviral therapy.
Shruti Mehta reported on her work in examining the HIV care cascade in India among men who have sex with men and injection drug users. With 14,481 injection drug users and 12,000 men who have sex with men in the study, the biggest barrier these patients faced was actually HIV diagnosis itself. Despite the fact that many of them accessed services in TB clinics and sexually transmitted disease clinics, many were never diagnosed or tested for HIV.
Aima Ahonkhai and Charles Holmes conducted studies looking at interruptions in HIV patient populations on antiretroviral therapy in Nigeria and Zambia respectively. In the Nigerian study, the highest risk factors for unplanned care interruptions were patients in the first year of their HIV treatment and individuals with higher CD4 counts. Ahonkhai argued that these care interruptions were so common that programs must plan for them because early intervention is critical. Holmes noted that in their efforts to track patients down and explore the causes of the many patient deaths researchers discovered that patients who dropped out of care had more active tuberculosis, more pregnancies, higher body mass indices and not surprising, more evidence of HIV disease progression.
A number of the speakers highlighted increased health services integration as one potent response to the alarming numbers of patients who are lost to clinics and to lifesaving care. The need for data systems that can effectively track patients who move from one clinic to another and may not be lost to follow-up at all was also identified. Holmes pointed out that while a number of interventions to help patients remain in care have been identified and piloted—from the use of SMS phone messaging to the deployment of community health workers to provide patient support—scale-up of these interventions has remained an elusive goal and is essential to improve outcomes for these patients.