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


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 < 0.05 used to determine statistical significance. Results: The mean age of participants was 33.1 (95% CI, 32.6 - 33.6) years old; and 65.1% were female. Patients were followed up for 512.6 person-years. Of the 59.0% patients retained, 93.8% started ART, 4.6% were transferred out to continue care elsewhere and 1.6% were active in care at the end of observation period. The retention rates at 1, 2, 3, 4 and 5 years observation period were 36.1 cases per 100 person-years, 17.4 cases per 100 person-years, 9.6 cases per 100 person-years, 3.7 cases per 100 person-years and 0.6 cases per 100 person-years respectively; the differences were statistically significant (P < 0.05). The mean estimate of patients' attrition time was 1.9 (95% CI, 1.7 - 2.1) years. Patients who started cotrimoxazole prophylaxis (CPT) at enrolment had significantly higher attrition time of 2.4 (95% CI, 2.1 - 2.7) years, compared to 0.9 (95% CI, 0.7 - 1.1) years for those not on CPT (P < 0.05). There was 54.0% reduction in risk of attrition among those who started CPT compared to those who did not [HR = 0.460, 95% CI: 0.321 - 0.660; 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.

Share and Cite:

K. Anene Agu, M. Alfa Isah, D. Oqua, R. C. King and A. K. Wutoh, "Retention in HIV Care among Patients Testing Positive for HIV and Ineligible to Start Antiretroviral Therapy," World Journal of AIDS, Vol. 2 No. 4, 2012, pp. 330-337. doi: 10.4236/wja.2012.24044.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. Rosen and M. P. Fox, “Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review,” PLoS Medicine, Vol. 8, No. 7, 2011, Article ID: e1001056.
[2] Federal Ministry of Health, FMOH, “National Guidelines for HIV/AIDS Treatment and Care in Adolescents and Adults, Federal Ministry of Health Abuja, Nigeria,” October 2010.
[3] M. W. Brinkhof, F. Dabis, L. Myer, D. R. Bangsberg, A. Boulle, D. Nash, M. Schechter, C. Laurent, O. Keiser, M. May, E. Sprinz, M. Egger and X. Anglaret, “Early Loss of HIV-Infected Patients on Potent Antiretroviral Therapy Programmes in Lower Income Countries,” Bulletin of the World Health Organization, Vol. 86, 2008, pp. 559-567. doi:10.2471/BLT.07.044248
[4] R. Leisegang, S. Cleary, M. Hislop, A. Davidse, L. Regensberg, F. Little and G. Maartens, “Early and Late Direct Costs in a Southern African Antiretroviral Treatment Programme: A Retrospective Cohort Analysis,” PLoS Medicine, Vol. 6, 2009, Article ID: e1000189.
[5] K. Tayler-Smith, R. Zachariah, M. Massaquoi, M. Manzi, O. Pasulani, T. van den Akker, M. Bemelmans, A. Bauernfeind, B. Mwagomba and A. D. Harries, “Unacceptable Attrition among WHO Stages 1 and 2 Patients in a Hospital-Based Setting in Rural Malawi: Can We Retain Such Patients within the General Health System?” Transactions of the Royal Society of Tropical Medicine & Hygiene, Vol. 104, No. 5, 2010, pp. 313-319. doi:10.1016/j.trstmh.2010.01.007
[6] S. Thai, O. Koole, P. Un, S. Ros, P. De Munter, W. Van Damme, G. Jacques, R. Colebunders and L. Lynen, “Five-Year Experience with Scaling-Up Access to Antiretroviral Treatment in an HIV Care Programme in Cambodia,” Tropical Medicine & International Health, Vol. 14, No. 9, 2009, pp. 1048-1058. doi:10.1111/j.1365-3156.2009.02334.x
[7] K. Tayler-Smith, R. Zachariah, M. Manzi, W. Kizito, A. Vandenbulcke, S. Dunkley, D. von Rege, T. Reid, L. Arnould, A. Suleh and A. D. Harries, “Demographic Characteristics and Opportunistic Diseases Associated with Attrition during Preparation for Antiretroviral Therapy in Primary Health Centres in Kibera, Kenya,” Tropical Medicine & International Health, Vol. 16, No. 5, 2011, pp. 579-584. doi:10.1111/j.1365-3156.2011.02740.x
[8] R. Zachariah, K. Tayler-Smith, M. Manzia, M. Massaquoi and A. D. Harries, “Attrition of HIV-Infected Individuals Not Yet Eligible for Antiretroviral Treatment: Why Should We Care?” Transactions of the Royal Society of Tropical Medicine & Hygiene, Vol. 104, No. 10, 2010, pp. 690-693. doi:10.1016/j.trstmh.2010.07.003
[9] J. C. Nunnally, “Psychometric Theory,” McGraw-Hill, Inc., New York, 1978.
[10] P. A. Messeri, D. M. Abramson, A. A. Aidala, F. Lee and G. Lee, “The Impact of Ancillary HIV Services on Engagement in Medical Care in New York City,” AIDS Care: Psychological and Socio-Medical Aspects of AIDS/ HIV, Vol. 14, Suppl. 1, 2002, pp. S15-S29. doi:10.1080/09540120220149948
[11] D. J. Konkle-Parker and G. Barnett, “Keeping Patients in Care: A Critical Component in Controlling HIV,” HIV Clinician, Vol. 24, No. 1, 2012, pp. 1-4.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.