Cargando…

Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review

BACKGROUND: Improving the outcomes of HIV/AIDS treatment programs in resource-limited settings requires successful linkage of patients testing positive for HIV to pre–antiretroviral therapy (ART) care and retention in pre-ART care until ART initiation. We conducted a systematic review of pre-ART ret...

Descripción completa

Detalles Bibliográficos
Autores principales: Rosen, Sydney, Fox, Matthew P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139665/
https://www.ncbi.nlm.nih.gov/pubmed/21811403
http://dx.doi.org/10.1371/journal.pmed.1001056
_version_ 1782208489341321216
author Rosen, Sydney
Fox, Matthew P.
author_facet Rosen, Sydney
Fox, Matthew P.
author_sort Rosen, Sydney
collection PubMed
description BACKGROUND: Improving the outcomes of HIV/AIDS treatment programs in resource-limited settings requires successful linkage of patients testing positive for HIV to pre–antiretroviral therapy (ART) care and retention in pre-ART care until ART initiation. We conducted a systematic review of pre-ART retention in care in Africa. METHODS AND FINDINGS: We searched PubMed, ISI Web of Knowledge, conference abstracts, and reference lists for reports on the proportion of adult patients retained between any two points between testing positive for HIV and initiating ART in sub-Saharan African HIV/AIDS care programs. Results were categorized as Stage 1 (from HIV testing to receipt of CD4 count results or clinical staging), Stage 2 (from staging to ART eligibility), or Stage 3 (from ART eligibility to ART initiation). Medians (ranges) were reported for the proportions of patients retained in each stage. We identified 28 eligible studies. The median proportion retained in Stage 1 was 59% (35%–88%); Stage 2, 46% (31%–95%); and Stage 3, 68% (14%–84%). Most studies reported on only one stage; none followed a cohort of patients through all three stages. Enrollment criteria, terminology, end points, follow-up, and outcomes varied widely and were often poorly defined, making aggregation of results difficult. Synthesis of findings from multiple studies suggests that fewer than one-third of patients testing positive for HIV and not yet eligible for ART when diagnosed are retained continuously in care, though this estimate should be regarded with caution because of review limitations. CONCLUSIONS: Studies of retention in pre-ART care report substantial loss of patients at every step, starting with patients who do not return for their initial CD4 count results and ending with those who do not initiate ART despite eligibility. Better health information systems that allow patients to be tracked between service delivery points are needed to properly evaluate pre-ART loss to care, and researchers should attempt to standardize the terminology, definitions, and time periods reported. Please see later in the article for the Editors' Summary
format Online
Article
Text
id pubmed-3139665
institution National Center for Biotechnology Information
language English
publishDate 2011
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-31396652011-08-02 Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review Rosen, Sydney Fox, Matthew P. PLoS Med Research Article BACKGROUND: Improving the outcomes of HIV/AIDS treatment programs in resource-limited settings requires successful linkage of patients testing positive for HIV to pre–antiretroviral therapy (ART) care and retention in pre-ART care until ART initiation. We conducted a systematic review of pre-ART retention in care in Africa. METHODS AND FINDINGS: We searched PubMed, ISI Web of Knowledge, conference abstracts, and reference lists for reports on the proportion of adult patients retained between any two points between testing positive for HIV and initiating ART in sub-Saharan African HIV/AIDS care programs. Results were categorized as Stage 1 (from HIV testing to receipt of CD4 count results or clinical staging), Stage 2 (from staging to ART eligibility), or Stage 3 (from ART eligibility to ART initiation). Medians (ranges) were reported for the proportions of patients retained in each stage. We identified 28 eligible studies. The median proportion retained in Stage 1 was 59% (35%–88%); Stage 2, 46% (31%–95%); and Stage 3, 68% (14%–84%). Most studies reported on only one stage; none followed a cohort of patients through all three stages. Enrollment criteria, terminology, end points, follow-up, and outcomes varied widely and were often poorly defined, making aggregation of results difficult. Synthesis of findings from multiple studies suggests that fewer than one-third of patients testing positive for HIV and not yet eligible for ART when diagnosed are retained continuously in care, though this estimate should be regarded with caution because of review limitations. CONCLUSIONS: Studies of retention in pre-ART care report substantial loss of patients at every step, starting with patients who do not return for their initial CD4 count results and ending with those who do not initiate ART despite eligibility. Better health information systems that allow patients to be tracked between service delivery points are needed to properly evaluate pre-ART loss to care, and researchers should attempt to standardize the terminology, definitions, and time periods reported. Please see later in the article for the Editors' Summary Public Library of Science 2011-07-19 /pmc/articles/PMC3139665/ /pubmed/21811403 http://dx.doi.org/10.1371/journal.pmed.1001056 Text en Rosen, Fox. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Rosen, Sydney
Fox, Matthew P.
Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review
title Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review
title_full Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review
title_fullStr Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review
title_full_unstemmed Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review
title_short Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review
title_sort retention in hiv care between testing and treatment in sub-saharan africa: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139665/
https://www.ncbi.nlm.nih.gov/pubmed/21811403
http://dx.doi.org/10.1371/journal.pmed.1001056
work_keys_str_mv AT rosensydney retentioninhivcarebetweentestingandtreatmentinsubsaharanafricaasystematicreview
AT foxmatthewp retentioninhivcarebetweentestingandtreatmentinsubsaharanafricaasystematicreview