title: Missed opportunities for retention in pre-ART care in Cape Town, South Africa.
abstract: BACKGROUND
  Few studies have evaluated access to and retention in pre-ART care.
  
  
  OBJECTIVE
  To evaluate the proportion of People Living With HIV (PLWH) in pre-ART and ART care and factors associated with retention in pre-ART and ART care from a community cohort.
  
  
  METHODS
  A cross sectional survey was conducted from February - April 2011. Self reported HIV positive, negative or participants of unknown status completed a questionnaire on their HIV testing history, access to pre-ART and retention in pre-ART and ART care.
  
  
  RESULTS
  872 randomly selected adults who reported being HIV positive in the ZAMSTAR 2010 prevalence survey were included and revisited. 579 (66%) reconfirmed their positive status and were included in this analysis. 380 (66%) had initiated ART with 357 of these (94%) retained in ART care. 199 (34%) had never initiated ART of whom 186 (93%) accessed pre-ART care, and 86 (43%) were retained in pre-ART care. In a univariable analysis none of the factors analysed were significantly associated with retention in care in the pre-ART group. Due to the high retention in ART care, factors associated with retention in ART care, were not analysed further.
  
  
  CONCLUSIONS
  Retention in ART care was high; however it was low in pre-ART care. The opportunity exists, if care is better integrated, to engage with clients in primary health care facilities to bring them back to, and retain them in, pre-ART care.
authors.affiliation: Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: du Toit
authors.affiliation: The South African Department of Science and Technology/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Cari
authors.initials: C
authors.lastname: van Schalkwyk
authors.affiliation: Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa.
authors.forename: Rory
authors.initials: R
authors.lastname: Dunbar
authors.affiliation: City of Cape Town Health Directorate, Cape Town, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Jennings
authors.affiliation: Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa.
authors.forename: Blia
authors.initials: B
authors.lastname: Yang
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Coetzee
authors.affiliation: Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa.
authors.forename: Nulda
authors.initials: N
authors.lastname: Beyers
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000187:drug effects / Q000472:pathogenicity; D015658:HIV Infections / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012153:Retention, Psychology; D013019:South Africa; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents