title: Retention in pre-antiretroviral treatment care in a district of Karnataka, India: how well are we doing?
abstract: METHODS
  Antiretroviral treatment (ART) Centre in Tumkur district of Karnataka State, India. There is no published information about pre-ART loss to follow-up from India.
  
  
  OBJECTIVE
  To assess the proportion lost to follow-up (defined as not visiting the ART Centre within 1 year of registration) and associated socio-demographic and immunological variables.
  
  
  METHODS
  Retrospective cohort study involving a review of medical records of adult HIV-infected persons (aged ⩾15 years) registered in pre-ART care during January 2010-June 2012.
  
  
  RESULTS
  Of 3238 patients registered, 2519 (78%) were eligible for ART, while 719 (22%) were not. Four of the latter were transferred out; the remaining 715 individuals were enrolled in pre-ART care, of whom 290 (41%) were lost to follow-up. Factors associated with loss to follow-up on multivariate analysis included age group ⩾45 years, low educational level, not being married, World Health Organization Stage III or IV and rural residence.
  
  
  CONCLUSIONS
  About four in 10 individuals in pre-ART care were lost to follow-up within 1 year of registration. This needs urgent attention. Routine cohort analysis in the national programme should include those in pre-ART care to enable improved review, monitoring and supervision. Further qualitative research to ascertain reasons for loss to follow-up is required to design future interventions.
authors.affiliation: Antiretroviral Treatment Centre (ART), District Hospital, Tumkur, Karnataka, India.
authors.forename: D
authors.initials: D
authors.lastname: Shankar
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: National AIDS Control Organization, New Delhi, India.
authors.forename: B
authors.initials: B
authors.lastname: Rewari
authors.affiliation: National AIDS Control Organization, New Delhi, India ; Karnataka State AIDS Prevention Society, Bengaluru, India.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Lady Willingdon State TB Centre, Bengaluru, India.
authors.forename: S
authors.initials: S
authors.lastname: Shastri
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
authors.affiliation: Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India.
authors.forename: R
authors.initials: R
authors.lastname: Ananthakrishnan
authors.affiliation: Employees' State Insurance Corporation (ESIC) Medical College and Post Graduate Institute of Medical Sciences & Research (PGIMSR), Bengaluru, India.
authors.forename: S B
authors.initials: SB
authors.lastname: Nagaraja
authors.affiliation: Antiretroviral Treatment Centre (ART), District Hospital, Tumkur, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Devi
authors.affiliation: Antiretroviral Treatment Centre (ART), District Hospital, Tumkur, Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Bhargava
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Das
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
keywords: ART centre; India; NACP; loss to follow-up; operational research; pre-ART