CitationClouse, Kate; Pettifor, Audrey E.; Maskew, Mhairi; Bassett, Jean F.; Van Rie, Annelies T.; Behets, Frieda M.-T. F.; Gay, Cynthia L.; Sanne, Ian; & Fox, Matthew P. (2013). Patient Retention from HIV Diagnosis through One Year on Antiretroviral Therapy at a Primary Health Care Clinic in Johannesburg, South Africa. Journal of Acquired Immune Deficiency Syndromes, 62(2), e39-46. PMCID: PMC3548953
AbstractOBJECTIVE: To compare patient retention at three stages of pre-antiretroviral (ART) care and two stages of post-ART care to identify when greatest attrition occurs. DESIGN: An observational cohort study.
METHOD:: We reviewed files of all adult, non-pregnant individuals testing HIV-positive January 1 - June 30, 2010, at a primary health clinic in Johannesburg, South Africa (N=842). We classified retention in pre-ART stage 1 (HIV diagnosis to CD4 results notification in =3 months), pre-ART stage 2 (initially ineligible for ART with repeat CD4 test =1 year of prior CD4), pre-ART stage 3 (initiating ART =3 months after first eligible CD4 result), as well as at 0-6 and 6-12 months post-ART.
RESULTS: Retention among all patients during pre-ART stage 1 was 69.8% (95%CI 66.7-72.9%). For patients initially ART-ineligible (n=221), 57.4% (95%CI 49.5-65.0%) returned for a repeat CD4 during pre-ART stage 2. Among those ART-eligible (n=589), 73.5% (95%CI 69.0-77.6%) were retained during pre-ART stage 3. Retention increased with time on ART, from 80.2% (95%CI 75.3-84.5%) at 6 months to 95.3% (95%CI 91.7-97.6%) between 6-12 months. Cumulative retention from diagnosis to 12 months on ART was 36.9% (95%CI 33.0-41.1%) for those ART-eligible and 43.0% (95%CI 36.4-49.8%) from diagnosis to repeat CD4 testing within one year among those ART-ineligible.
CONCLUSIONS: Patient attrition in the first year following HIV diagnosis was greatest prior to ART initiation: over 25% at each of three pre-ART stages. As countries expand HIV testing and ART programs, success will depend on linkage to care, especially prior to ART eligibility and initiation.
Reference TypeJournal Article
Journal TitleJournal of Acquired Immune Deficiency Syndromes
Pettifor, Audrey E.
Bassett, Jean F.
Van Rie, Annelies T.
Behets, Frieda M.-T. F.
Gay, Cynthia L.
Fox, Matthew P.