title: Patient retention from HIV diagnosis through one year on antiretroviral therapy at a primary health care clinic in Johannesburg, South Africa.
abstract: OBJECTIVE
  To compare patient retention at 3 stages of pre-antiretroviral (ART) care and 2 stages of post-ART care to identify when greatest attrition occurs.
  
  
  METHODS
  An observational cohort study.
  
  
  METHODS
  We reviewed files of all adult nonpregnant individuals testing HIV-positive January 1-June 30, 2010, at a primary health clinic in Johannesburg, South Africa (N = 842). We classified retention in pre-ART stage 1 (HIV diagnosis to CD4 results notification in ≤3 months), pre-ART stage 2 (initially ineligible for ART with repeat CD4 test ≤1 year of prior CD4), pre-ART stage 3 (initiating ART ≤3 months after first eligible CD4 result), and at 0-6 and 6-12 months post-ART.
  
  
  RESULTS
  Retention among all patients during pre-ART stage 1 was 69.8% [95% confidence interval (CI): 66.7% to 72.9%]. For patients initially ART ineligible (n = 221), 57.4% (95% CI: 49.5% to 65.0%) returned for a repeat CD4 during pre-ART stage 2. Among those who were ART eligible (n = 589), 73.5% (95% CI: 69.0% to 77.6%) were retained during pre-ART stage 3. Retention increased with time on ART, from 80.2% (95% CI: 75.3% to 84.5%) at 6 months to 95.3% (95% CI: 91.7% to 97.6%) between 6 and 12 months. Cumulative retention from diagnosis to 12 months on ART was 36.9% (95% CI: 33.0% to 41.1%) for those ART eligible and 43.0% (95% CI: 36.4% to 49.8%) from diagnosis to repeat CD4 testing within one year among those ART ineligible.
  
  
  CONCLUSIONS
  Patient attrition in the first year after HIV diagnosis was greatest before ART initiation: more than 25% at each of 3 pre-ART stages. As countries expand HIV testing and ART programs, success will depend on linkage to care, especially before ART eligibility and initiation.
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. kclouse@unc.edu
authors.forename: Kate
authors.initials: K
authors.lastname: Clouse
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Pettifor
authors.forename: Mhairi
authors.initials: M
authors.lastname: Maskew
authors.forename: Jean
authors.initials: J
authors.lastname: Bassett
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gay
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D013019:South Africa; D013997:Time Factors; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents