Retention in care among HIV-infected patients in resource-limited settings: emerging insights and new directions.
In resource-limited settings--where a massive scale-up of HIV services has occurred in the last 5 years--both understanding the extent of and improving retention in care presents special challenges. First, retention in care within the decentralizing network of services is likely higher than existing estimates that account only for retention in clinic, and therefore antiretroviral therapy services may be more effective than currently believed. Second, both magnitude and determinants of patient retention vary substantially and therefore encouraging the conduct of locally relevant epidemiology is needed to inform programmatic decisions. Third, socio-structural factors such as program characteristics, transportation, poverty, work/child care responsibilities, and social relations are the major determinants of retention in care, and therefore interventions to improve retention in care should focus on implementation strategies. Research to assess and improve retention in care for HIV-infected patients can be strengthened by incorporating novel methods such as sampling-based approaches and a causal analytic framework.
Geng
Elvin H
EH
Division of HIV/AIDS at San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA 94110, USA. genge@php.ucsf.edu
Nash
Denis
D
Kambugu
Andrew
A
Zhang
Yao
Y
Braitstein
Paula
P
Christopoulos
Katerina A
KA
Muyindike
Winnie
W
Bwana
Mwebesa Bosco
MB
Yiannoutsos
Constantin T
CT
Petersen
Maya L
ML
Martin
Jeffrey N
JN
D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D003906:Developing Countries; D015658:HIV Infections / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D059012:Lost to Follow-Up; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D011203:Poverty; D057545:Social Stigma; D012944:Social Support
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