title: Trends in retention on antiretroviral therapy in national programs in low-income and middle-income countries.
abstract: OBJECTIVE
  To document regional and global trends for patients retained on antiretroviral therapy (ART) 12-48 months after treatment initiation, in low-income and middle-income countries.
  
  
  METHODS
  Data reported by national programs to WHO/UNICEF/UNAIDS in 2008 were aggregated to produce regional and global estimates. The proportion of patients on ART at 12, 24, 36, and 48 months is derived from cohort monitoring systems in ART dispensing facilities.
  
  
  RESULTS
  Of 149 countries, 70 (47%) reported on retention at 12 months, 54 (36%) at 24 months, 38 (26%) at 36 months, and 30 (20%) at 48 months. Regional and global trends showed that the majority of attrition from ART programs occurred within the first year and declined thereafter. Among countries in sub-Saharan Africa, retention on ART was estimated at 75.2% at 12 months, 66.8% at 24 months, and remained at a similar level up to 48 months.
  
  
  CONCLUSIONS
  After high attrition in the first year, retention on ART tends to stabilize. In the literature, attrition in the first year was related to early mortality. Earlier presentation for diagnosis of HIV infection, timely screening, and access to ART are fundamental to reduce it. Countries need support in reporting on outcomes on ART.
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland. tassiej@who.int
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Tassie
authors.forename: Parijat
authors.initials: P
authors.lastname: Baijal
authors.forename: Marco A
authors.initials: MA
authors.lastname: Vitoria
authors.forename: Abdikamal
authors.initials: A
authors.lastname: Alisalad
authors.forename: Siobhan P
authors.initials: SP
authors.lastname: Crowley
authors.forename: Yves
authors.initials: Y
authors.lastname: Souteyrand
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics / Q000517:prevention & control*; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D001208:Asia; D017691:Caribbean Region; D005060:Europe; D005500:Follow-Up Studies; D007182:Income; D008877:Middle East; D011203:Poverty; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents