title: Retention of antiretroviral naïve patients registered in HIV care in a program clinic in Pune, India.
abstract: BACKGROUND
  Retention in HIV care ensures delivery of services like secondary prevention, timely initiation of treatment, support, and care on a regular basis. The data on retention in pre antiretroviral therapy (ART) care in India is scanty.
  
  
  METHODS
  Antiretroviral naïve HIV-infected adult patients registered between January 2011 and March 2012 in HIV care (pre-ART) were included in the study. The follow-up procedures were done as per the national guidelines. Patients who did not report to the clinic for 1 year were considered as pre-ART lost to follow-up (pre-ART LFU). They were contacted either telephonically or by home visits. Logistic regression analysis was done to find out factors associated with pre-ART loss to follow-up.
  
  
  RESULTS
  A total of 689 antiretroviral naïve adult patients were registered in the HIV care. Fourteen (2%) patients died and 76 (11%) were LFU till March 2013. The multivariate analysis showed that baseline CD4 count >350 cells/mm(3) (P < 0.01) and illiteracy (P = 0.044) were significantly associated with LFU. Of the total pre-ART LFUs, 35 (46.1%) informed that they would visit the clinic at their convenient time. NGOs that referred 16 female sex workers (FSWs) who were LFU (21.1%) informed that they would make efforts to refer them to the clinic.
  
  
  CONCLUSIONS
  Higher CD4 count and illiteracy were significantly associated with lower retention in pre-ART care. Developing effective "retention package" for patients and strengthening linkage strategies between key sub-population such as FSWs and ART programming will help to plug the leaky cascade in HIV care.
authors.affiliation: Department of Clinical Sciences, National AIDS Research Institute, Pune, India.
authors.forename: Manisha V
authors.initials: MV
authors.lastname: Ghate
authors.affiliation: ART Centre, Natrional AIDS Research Institute, Pune, India.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Zirpe
authors.affiliation: Department of Epidemiology and Biostatistics, National AIDS Research Institute, Pune, India.
authors.forename: Nilam P
authors.initials: NP
authors.lastname: Gurav
authors.affiliation: Programme Officer (ART), National AIDS Control Organisation, New Delhi, India.
authors.forename: Bharat B
authors.initials: BB
authors.lastname: Rewari
authors.affiliation: Department of Clinical Sciences, National AIDS Research Institute, Pune, India.
authors.forename: Raman R
authors.initials: RR
authors.lastname: Gangakhedkar
authors.affiliation: Director, National AIDS Research Institute, Pune, Maharashtra, India.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Paranjape
keywords: HIV care; pre-antiretroviral therapy; retention