HIV treatment retention study indicates weight of distance barriers, opportunity costs, value of peer-based interventions

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A study exploring why people enrolled in antiretroviral treatment programs across three African countries are “lost to follow-up” reveals obstacles to reaching the third “90” of UNAIDS recipe for success against the global HIV pandemic, and points to answers that can lie within communities where rates of HIV are high.

The study, Retention in Care and Patient-Reported Reasons for Undocumented Transfer or Stopping Care Among HIV-Infected Patients On Antiretroviral Therapy in Eastern Africa, released last week in Clinical Infectious Diseases, was led by Elvin Geng of San Francisco General Hospital’s Division of HIV/AIDS, and carried out across 14 sites in Uganda, Tanzania, and Kenya.

Looking at a population of more than 18,000 patients, and following available information on the 18 percent, or 3150 patients, who were lost to follow-up, researchers found nearly 70 percent were alive and confirmed the care status of 278.

Of those in care at a new site the majority reported that barriers that included long distances and transportation had left them to leave their previous care site. But among those who had not continued care at another site, psychological and social barriers predominated — including denial of their diagnosis and of the value of medical treatment.

The findings highlight the importance of peer support groups and peer counseling, researchers note.

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