Improving retention in ART programmes

In sub-Saharan Africa, the numbers accessing antiretroviral treatment (ART) have steadily increased over time, but there is growing concern over failure to retain patients in care.

Looking at results from ART programmes that were not research-based or donor-supported, a weighted analysis of programmes for which there was information available found that programme retention was 79% at six months, 75% at one year, and 62% at two years. Using sensitivity analyses, estimated retention rates ranged from 24 to 77%.1 

Suggestions for retaining patients in treatment programmes include:

  • An uninterrupted supply of antiretrovirals, so that the time, cost, effort, and distance travelled to reach a clinic is worthwhile.
  • Simple, non-toxic, and cost-free ART.
  • Reducing the number of clinic visits for stable patients and providing care at decentralised clinics so that the cost of transportation is lessened.
  • Providing community support with peer groups, home-care treatment programmes, family care support, referral systems, adherence counselling, and follow-up on missed appointments.
  • Developing mechanisms to support adherence, such as radio reminders to take medication, ART stations at the workplace, and pre-packaging ART for collection at local schools or shops.2 

In one Ugandan study, 44% of persons eligible for ART did not return for treatment because of transportation costs. Pre-treatment mortality was also high, due to late diagnosis.3  

Another Ugandan study found that 15 to 40% of patients were lost to follow-up in the first year of ART. Reasons given included lack of transportation (50%) and distance from clinic (42%). Poverty, child care, and employment were other reasons for not returning to the clinic.4

Earlier awareness of HIV status, timely and affordable provision of ART, community/social support, and continuity of care medication supply are factors that play a large role in adherence to treatment in resource-limited areas; much more so than personal motivation and behaviour.

References

  1. Rosen S et al. Patient retention in antiretroviral therapy programs in Sub-Saharan Africa: a systematic review. PLoS Med 4(10): e298. doi:10.1371/journal.pmed.0040298, 2007
  2. Harries AD et al. Improving access and retention in ART programmes. Fifth IAS HIV Conference on Pathogenesis, Treatment and Prevention Symposium, Cape Town, 2009
  3. Amuron B et al. Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda. BMC Public Health 9: 290, 2009
  4. Geng EH et al. Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach. J Acquir Immune Defic Syndr, advance online publication 10 sept doi: 10.1097/QAI.0b013e3181b843f0., 2009
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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