Retention in pre-ART care among patients who are not yet eligible for antiretroviral therapy (ART)
| Country (reference) | Period when retention was studied | Definition of retention | Retention time point | Rate of retention (%) | Consideration of deaths and transfers for calculating the rate | Factors associated with retention in pre-ART care | Factors investigated but not associated with retention in pre-ART care |
|---|---|---|---|---|---|---|---|
| Papers | |||||||
| Kenya, Malawi, Uganda12 | From enrolment in the HIV programme to end of the study regardless of the number of CD4 measurements | Having missed an appointment for more than 6 months | Median: 18.4 months (IQR=8.5–32.2) | 68.4 | Deaths excluded Transfers excluded when reported | Being old, female gender, BMI >18.5, low CD4 cell count, being diagnosed with TB, entry in VCT or PMTCT vs inpatient or outpatient services or medical referral, not eligible for ART at enrolment | |
| South Africa13 | Between the 1st and the 2nd CD4 measurements | Receiving a repeat CD4 count after delivery | 12 months | 23.2 | Transfers excluded when reported No deaths reported | ||
| South Africa14 | Between the 1st and the 2nd CD4 measurements | Receiving a second CD4 test within one year after the first CD4 staging | 12 months | 57.4 | Transfers excluded when reported Deaths not excluded | ≥30 years old, female gender, receiving TB treatment | Nationality, being employed, CD4 cell count |
| Kenya15 | Between the 1st and the 2nd CD4 measurements | Not being more than 60 days late for the scheduled appointment | Undefined | 81.9 | Deaths excluded Transfers excluded when reported | Living ≤5 km from the main road, Not being single | Gender, age, entry point in care, religion, education level, season, population density, WHO staging, BMI |
| After the 2nd CD4 measurement | Not being more than 60 days late for the scheduled appointment after the second visit | Undefined | 63.2 | Deaths excluded Transfers excluded when reported | Low education level, living ≤5 km from the main road, wet season | Gender, age, marital status, entry point, religion, population density, WHO staging, BMI, CD4, Hb | |
| Guinea-Bissau16 | Between the 1st and the 2nd CD4 measurements | Being less than 1 month late for the scheduled appointment | Median: 147 days (IQR=7–653) | 27.2 | Deaths excluded Transfers excluded when reported | >30 years old, having anaemia, attending school, being infected by HIV-1 (vs HIV-2) | Sex, BMI, marital status, religion |
| Kenya17 | Undefined | Returning to clinic less than 30 days after the next scheduled pharmacy or clinic appointment | 12 months | 75.5 | Transfers excluded when reported Deaths not systematically taken into account | Being older, high BMI, enrolled after free cotrimoxazole provision | Sex, TB status, baseline CD4 count |
| South Africa18 | Between the 1st and the 2nd CD4 measurements | Having a repeat CD4 count before 2009 | Undefined | 46.3 | Undefined | ≥30 years old | Sex, year of HIV test |
| South Africa19 | Between the 1st and the 2nd CD4 measurements | Repeating CD4 count within 13 months of the initial test | 13 months | 44.9 | No exclusion of deaths and transfers | Female gender, >25 years old, ≤350 CD4 cells/µL, not out-migrant, not full-time employed, not living in a household size >10 | |
| Mozambique21 | Undefined | Having less than 12 months elapsed since the last documented clinic visit | 12 months | 37.6 | Transfers and deaths excluded | Non-pregnant female, >25 years old, having at least finished primary school, weight >56 kg, no WHO stage I | Marital status, number of children, socioeconomic status, CD4 count, |
| Uganda20 | From enrolment in the HIV programme to the end of the study regardless of the number of CD4 measurements | Having seen an HIV provider in the 6 months before the interview | 30 months | 88.2 | Using of a weighing method for correcting the rate, taking into account all outcomes (transfers, deaths) after tracking | High income, employment, high weight, urban setting | Age, sex, CD4 level, education level, marital status, calendar date at enrolment |
| Conference abstracts | |||||||
| Nigeria22 | From enrolment in the HIV programme to the end of the study regardless of the number of CD4 measurements | No clinic appointment missed for three consecutive times | Undefined | 52.8 | No exclusion | Intervention package: provision of free cotrimoxazole prophylaxis, harmonised pharmacy and laboratory appointments, task-shifting to nurses and data-clerks, same-day CD4 monitoring and receipt of results, integrated clinic services | |
| Zambia23 | From enrolment in the HIV programme to the end of the study regardless of the number of CD4 measurements | No fail to return for an appointment on two and more occasion | 12 months | 51 | No details provided | ≥30 years old, >20 km from the hospital | Gender, marital status, education level, monthly outcome, partner's HIV status, WHO clinical stage, CD4 cell count |
Twelve studies in sub-Saharan Africa.
BMI, body mass index; Hb, haemoglobin; LTFU, loss to follow-up; PMTCT, prevention of mother-to-child transmission of HIV; TB, tuberculosis; VCT, voluntary counselling and testing.