Retention in HIV Care among Patients Testing Positive for HIV and Ineligible to Start Antiretroviral Therapy

Abstract

Background: The failure to monitor and link patients from HIV testing to HIV care and retain them in care until they are eligible for ART is a major barrier to early ART initiation. This study evaluated the retention in pre-ART care of HIV-positive patients who are ineligible to start ART in Nigeria. Methods: Out of 1766 ART-ineligible HIV-positive patients enrolled into pre-ART care (during 1st March to 31st December 2007), 1,098 patients were randomly selected for a five-year (ending 30th April 2012) retrospective cohort assessment using routine data in two health facilities. Retention was defined as remaining connected to pre-ART care once entered until ART initiation or transfer-out to continue care elsewhere. Probability of retention was estimated using Kaplan-Meier survival method and log-rank test. Cox proportional hazards model was used for attrition and P P P P = 0.000]. Socio-demographic characteristics, CD4 cells count and WHO clinical stage at pre-ART enrolment were not associated with attrition (P > 0.05). Conclusion: Retention in pre-ART care was somewhat poor. Uptake of CPT significantly improved retention. Majority of attrition occurred in first year of pre-ART care. Close monitoring and tracking of patients during this period is recommended.