TITLE:
Challenges in Retention of Patients in Continuum of HIV-Care in Delhi— Experience of a Decade & Way Ahead
AUTHORS:
Anil Kumar Gupta, Vandana Dabla, Bipin Chandra Joshi, Sabyasachi Chakraborty, Jiban Jyoti Baishya, Abhinav Gupta
KEYWORDS:
Retention in HIV-Care, Pre-ART Care, Continuum of Care, Antiretroviral Treatment, Decentralization
JOURNAL NAME:
World Journal of AIDS,
Vol.4 No.4,
November
14,
2014
ABSTRACT: Retention of the patients
in HIV-care is critical for success of Anti Retroviral Treatment (ART)
programme to reduce HIV-related morbidity & mortality and prevent emergence
of drug resistance. In last decade in Delhi (April 2004 to March 2014), overall
24% HIV-positive patients were lost-to-follow-up (LTFU) at step-1 (testing to
enrolment into HIV-care), 7.8% at step-2 (enrolment to ART eligibility), 23.7%
at step-3 (eligibility to initiation of ART) and 16.6% at step-4 (initiation to
lifelong ART) of retention cascade. About 2/3rd losses at step-4 were within
1st year and 80% within 2 years. The retention of the patients in pre-ART care
was 3 times lower than those initiated ART. Only 27.4% patients were in active
pre-ART care during 2013. The intensified LTFU tracking (ILT) undertaken during
November, 2013 through March, 2014 was not successful in tracking 97% pre-ART
LTFU clients due to incomplete addresses/or migration since address proof of
patients on enrolment into HIV-care was not mandatory prior to 2009. Amongst
patients tracked, 1.5% were
alive, 0.24% had disengaged from care while 1.2% had died. After ILT overall
“On ART” and “Pre-ART” LTFU rate in the last decade was 15.5% and 45.2%,
respectively. The retention cascade of last year from April 2013 to March 2014
showed improvement through strategies adopted in Third Phase of National AIDS
Control Programme (NACP-III; 2007-2013), and “On ART” and “Pre-ART” LTFU rates
declined to 9.4% and 7.4%, respectively. However, desired at least 90%
retention at various steps of the cascade could not be achieved. National
Policy of delivering ART services through limited number of standalone ART
centers in India, despite its significant success, has limitation of leaky
treatment cascade and calls for policy makers to decentralize the programme by
its appropriate integration with general health services and task shifting to
improve continuum of care.