title: Trends in CD4 Count Testing, Retention in Pre-ART Care, and ART Initiation Rates over the First Decade of Expansion of HIV Services in Haiti.
abstract: BACKGROUND
  High attrition during the period from HIV testing to antiretroviral therapy (ART) initiation is widely reported. Though treatment guidelines have changed to broaden ART eligibility and services have been widely expanded over the past decade, data on the temporal trends in pre-ART outcomes are limited; such data would be useful to guide future policy decisions.
  
  
  METHODS
  We evaluated temporal trends and predictors of retention for each step from HIV testing to ART initiation over the past decade at the GHESKIO clinic in Port-au-Prince Haiti. The 24,925 patients >17 years of age who received a positive HIV test at GHESKIO from March 1, 2003 to February 28, 2013 were included. Patients were followed until they remained in pre-ART care for one year or initiated ART.
  
  
  RESULTS
  24,925 patients (61% female, median age 35 years) were included, and 15,008 (60%) had blood drawn for CD4 count within 12 months of HIV testing; the trend increased over time from 36% in Year 1 to 78% in Year 10 (p<0.0001). Excluding transfers, the proportion of patients who were retained in pre-ART care or initiated ART within the first year after HIV testing was 84%, 82%, 64%, and 64%, for CD4 count strata ≤200, 201 to 350, 351 to 500, and >500 cells/mm3, respectively. The trend increased over time for each CD4 strata, and in Year 10, 94%, 95%, 79%, and 74% were retained in pre-ART care or initiated ART for each CD4 strata. Predictors of pre-ART attrition included male gender, low income, and low educational status. Older age and tuberculosis (TB) at HIV testing were associated with retention in care.
  
  
  CONCLUSIONS
  The proportion of patients completing assessments for ART eligibility, remaining in pre-ART care, and initiating ART have increased over the last decade across all CD4 count strata, particularly among patients with CD4 count ≤350 cells/mm3. However, additional retention efforts are needed for patients with higher CD4 counts.
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.|Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
authors.forename: Serena P
authors.initials: SP
authors.lastname: Koenig
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Daphne
authors.initials: D
authors.lastname: Bernard
authors.affiliation: AIDS Prevention Program, Florida International University, Miami, FL, United States of America.
authors.forename: Jessy G
authors.initials: JG
authors.lastname: Dévieux
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
authors.forename: Sidney
authors.initials: S
authors.lastname: Atwood
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNairy
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Patrice
authors.initials: P
authors.lastname: Severe
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Adias
authors.initials: A
authors.lastname: Marcelin
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Pierrot
authors.initials: P
authors.lastname: Julma
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Apollon
authors.affiliation: Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.|Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America.
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006205:Haiti; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents