title: Situational analysis of varying models of adherence support and loss to follow up rates; findings from 27 treatment facilities in eight resource limited countries.
abstract: OBJECTIVE
  Large-scale provision of ART in the absence of viral load monitoring, resistance testing, and limited second-line treatment options places adherence support as a vital therapeutic intervention. We aimed to compare patient loss to follow up rates with the degree of adherence support through a retrospective review of patients enrolled in the AIDSRelief program between August 2004 and June 2005.
  
  
  METHODS
  Loss to follow up data were analysed and programs were categorised into one of four tiered levels of adherence support models: Tier I, II, III, and IV which increase from lowest to highest support. Bivariate and t-test analyses were used to test for significant differences between the models.
  
  
  RESULTS
  13,391 patients at 27 treatment facilities from six African and two Caribbean countries began antiretroviral therapy within the first year of the AIDSRelief program. The mean loss to follow up within the first year was 7.5%. Eight facilities were Tier I, three (Tier II), nine (Tier III), and seven (Tier IV). Facilities in Tier I had a loss to follow up rate of 14%, Tier II (10%), Tier III (5%), and Tier IV (1%). The proportion of loss to follow up for Tier I and Tier III were significantly different from each other (P < 0.02), as were Tier I and Tier IV (P < 0.006). There were differences between Tier II and Tier IV (P < 0.009) as well as Tier III and Tier IV (P < 0.017).
  
  
  CONCLUSIONS
  These data strongly support the use of proactive adherence support programs, beyond routine patient counselling and defaulter tracking to support the'public health approach'to ART.
authors.affiliation: Institute of Human Virology of the University of Maryland School of Medicine, Baltimore, MD, USA. metienne@ihv.umaryland.edu
authors.forename: M
authors.initials: M
authors.lastname: Etienne
authors.forename: L
authors.initials: L
authors.lastname: Burrows
authors.forename: B
authors.initials: B
authors.lastname: Osotimehin
authors.forename: T
authors.initials: T
authors.lastname: Macharia
authors.forename: B
authors.initials: B
authors.lastname: Hossain
authors.forename: R R
authors.initials: RR
authors.lastname: Redfield
authors.forename: A
authors.initials: A
authors.lastname: Amoroso
mesh_terms: D000349:Africa; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000458:organization & administration; D003906:Developing Countries; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D059012:Lost to Follow-Up; D008507:Medically Underserved Area; D017146:Models, Organizational; D012189:Retrospective Studies; D014900:West Indies; D016903:Drug Monitoring