title: Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review.
abstract: Sustained retention represents an enduring and evolving challenge to HIV treatment programs in Africa. We present a theoretical framework for sustained retention borrowing from ecologic principles of sustainability and dynamic adaptation. We posit that sustained retention from the patient perspective is dependent on three foundational principles: (1) patient activation: the acceptance, prioritization, literacy, and skills to manage a chronic disease condition, (2) social normalization: the engagement of a social network and harnessing social capital to support care and treatment, and (3) livelihood routinization: the integration of care and treatment activities into livelihood priorities that may change over time. Using this framework, we highlight barriers specific to sustained retention and review interventions addressing long-term, sustained retention in HIV care with a focus on Sub-Saharan Africa.
authors.affiliation: University of California San Francisco, San Francisco, USA. Monika.Roy@ucsf.edu.
authors.forename: Monika
authors.initials: M
authors.lastname: Roy
authors.affiliation: University of California Berkeley, Berkeley, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Czaicki
authors.affiliation: Centre for Infectious Diseases Research Zambia, Zambia, Africa.|Johns Hopkins University, Baltimore, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Holmes
authors.affiliation: University of California San Francisco, San Francisco, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chavan
authors.affiliation: Ministry of Health and Child Care, Zimbabwe, Africa.
authors.forename: Apollo
authors.initials: A
authors.lastname: Tsitsi
authors.affiliation: Kenya Medical Research Institute, Center for Microbiology Research, Nairobi, Kenya.|University of Washington, Seattle, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Odeny
authors.affiliation: Centre for Infectious Diseases Research Zambia, Zambia, Africa.
authors.forename: Izukanji
authors.initials: I
authors.lastname: Sikazwe
authors.affiliation: University of California Berkeley, Berkeley, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Padian
authors.affiliation: University of California San Francisco, San Francisco, USA.
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001071:Appointments and Schedules; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D010352:Patient Dropouts; D010358:Patient Participation; D011050:Policy Making; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: Community-based care; HIV care and treatment; Health maintenance; Patient activation; Retention; Social capital; Social network; Sustainability; Treatment literacy