title: Retention in care prior to antiretroviral treatment eligibility in sub-Saharan Africa: a systematic review of the literature.
abstract: OBJECTIVE
  We aimed at summarising rates and factors associated with retention in HIV care prior to antiretroviral treatment (ART) eligibility in sub-Saharan Africa.
  
  
  METHODS
  We conducted a systematic literature review (2002-2014). We searched Medline/Pubmed, Scopus and Web of Science, as well as proceedings of conferences. We included all original research studies published in peer-reviewed journals, which used quantitative indicators of retention in care prior to ART eligibility.
  
  
  METHODS
  People not yet eligible for ART.
  
  
  METHODS
  Rate of retention in HIV care prior to ART eligibility and associated factors.
  
  
  RESULTS
  10 papers and 2 abstracts were included. Most studies were conducted in Southern and Eastern Africa between 2004 and 2011 and reported retention rates in pre-ART care up to the second CD4 measurement. Definition of retention in HIV care prior to ART eligibility differed substantially across studies. Retention rates ranged between 23% and 88% based on series ranging from 112 to 10,314 individuals; retention was higher in women, individuals aged >25 years, those with low CD4 count, high body mass index or co-infected with tuberculosis, and in settings with free cotrimoxazole use.
  
  
  CONCLUSIONS
  Retention in HIV care prior to ART eligibility in sub-Saharan Africa has been insufficiently described so far leaving major research gaps, especially regarding long-term retention rates and sociodemographic, economic, clinical and programmatic logistic determinants. The prospective follow-up of newly diagnosed individuals is required to better evaluate attrition prior to ART eligibility among HIV-infected people.
authors.affiliation: Centre de recherche Inserm U897 Epidémiologie et Biostatistique, Université de Bordeaux, Bordeaux, France Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Plazy
authors.affiliation: Centre de recherche Inserm U897 Epidémiologie et Biostatistique, Université de Bordeaux, Bordeaux, France Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France.
authors.forename: Joanna
authors.initials: J
authors.lastname: Orne-Gliemann
authors.affiliation: Centre de recherche Inserm U897 Epidémiologie et Biostatistique, Université de Bordeaux, Bordeaux, France Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.affiliation: Department of Social Epidemiology, INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France Department of Social Epidemiology, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
mesh_terms: D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004608:Eligibility Determination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010352:Patient Dropouts; D018579:Patient Selection
chemical_list: D019380:Anti-HIV Agents
keywords: PRIMARY CARE; PUBLIC HEALTH