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Retention in Care among HIV-Infected Patients in Resource-Limited Settings: Emerging Insights and New Directions

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Abstract

In resource-limited settings—where a massive scale up of HIV services has occurred in the last 5 years—both understanding the extent of and improving retention in care presents special challenges. First, retention in care within the decentralizing network of services is likely higher than existing estimates that account only for retention in clinic, and therefore antiretroviral therapy services may be more effective than currently believed. Second, both magnitude and determinants of patient retention vary substantially and therefore encouraging the conduct of locally relevant epidemiology is needed to inform programmatic decisions. Third, socio-structural factors such as program characteristics, transportation, poverty, work/child care responsibilities, and social relations are the major determinants of retention in care, and therefore interventions to improve retention in care should focus on implementation strategies. Research to assess and improve retention in care for HIV-infected patients can be strengthened by incorporating novel methods such as sampling-based approaches and a causal analytic framework.

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Acknowledgments

From University of California, San Francisco, United States (E.H.G., K.A.C., J.N.M); International Center for AIDS Care and Treatment Programs, Columbia University, New York, United States (D.N.); Infectious Diseases Institute, Kampala, Uganda (A.K.); Division of Treatment and Care, National Center for AIDS/STD, Chinese Center of Disease Control and Prevention, Beijing, People’s Republic of China (Z.Y); Mbarara University of Science and Technology, Mbarara, Uganda (W.M., M.B.B.); Indiana University, Indianapolis, United States (C.T.Y.); Department of Biostatistics, University of California, Berkeley, United States (M.L.P); and the East Africa International Databases to Evaluate AIDS (E.H.G., D.N., A.K., P.B., W.M., M.B.B., C.T.Y., M.L.P., J.N.M).

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Geng, E.H., Nash, D., Kambugu, A. et al. Retention in Care among HIV-Infected Patients in Resource-Limited Settings: Emerging Insights and New Directions. Curr HIV/AIDS Rep 7, 234–244 (2010). https://doi.org/10.1007/s11904-010-0061-5

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