title: High retention in care among HIV-infected patients entering care with CD4 levels >350 cells/μL under routine program conditions in Uganda.
abstract: BACKGROUND
  In Africa, human immunodeficiency virus (HIV)-infected patients who present to care with CD4 levels >350 cells/µL (ie, current antiretroviral treatment thresholds) are often thought to be poorly retained in care, but most estimates do not account for outcomes among patients lost to follow-up.
  
  
  METHODS
  We evaluated HIV-infected adults who had made a visit in the last 2.5 years in a program in Uganda. We identified a random sample of patients lost to follow-up (9 months without a visit). Ascertainers sought patients in the community in this sample and outcomes were incorporated into revised survival estimates of mortality and retention for the clinic population using a probability weight.
  
  
  RESULTS
  Of 6473 patients, (29% male, median age 29 years, median CD4 count 550 cells/µL), 1294 (20%) became lost to follow-up over 2.5 years. Two hundred seven (16%) randomly selected lost patients were sought, and in 175 (85%) vital status was ascertained. In 19 of 175 (11%), the patient had died. Of the 156 (89%) alive, 74 (47%) were interviewed in person, and 38 of 74 (51%) reported HIV care elsewhere, whereas 36 of 74 (49%) were not in care. Application of weights derived from sampling found that at 2.5 years, retention among patients who enrolled with CD4 levels >350 cells/µL was 88.2% and mortality was 2.5%. Lower income, unemployment, and rural residence were associated with failure to be retained.
  
  
  CONCLUSIONS
  Retention in patients entering care with high CD4 counts under routine program conditions in Africa is high in a Ugandan care program and may be systematically underestimated in many other settings.
authors.affiliation: Makerere University Joint AIDS Program.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Namusobya
authors.forename: Fred C
authors.initials: FC
authors.lastname: Semitala
authors.forename: Gideon
authors.initials: G
authors.lastname: Amanyire
authors.forename: Jane
authors.initials: J
authors.lastname: Kabami
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chamie
authors.forename: John
authors.initials: J
authors.lastname: Bogere
authors.forename: Vivek
authors.initials: V
authors.lastname: Jain
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Clark
authors.forename: Edwin
authors.initials: E
authors.lastname: Charlebois
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
authors.forename: Moses
authors.initials: M
authors.lastname: Kamya
authors.forename: Elvin H
authors.initials: EH
authors.lastname: Geng
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D014454:Uganda; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: Africa; CD4; HIV; retention
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