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Current HIV/AIDS Reports

, Volume 7, Issue 4, pp 234–244 | Cite as

Retention in Care among HIV-Infected Patients in Resource-Limited Settings: Emerging Insights and New Directions

  • Elvin H. Geng
  • Denis Nash
  • Andrew Kambugu
  • Yao Zhang
  • Paula Braitstein
  • Katerina A. Christopoulos
  • Winnie Muyindike
  • Mwebesa Bosco Bwana
  • Constantin T. Yiannoutsos
  • Maya L. Petersen
  • Jeffrey N. Martin
Article

Abstract

In resource-limited settings—where a massive scale up of HIV services has occurred in the last 5 years—both understanding the extent of and improving retention in care presents special challenges. First, retention in care within the decentralizing network of services is likely higher than existing estimates that account only for retention in clinic, and therefore antiretroviral therapy services may be more effective than currently believed. Second, both magnitude and determinants of patient retention vary substantially and therefore encouraging the conduct of locally relevant epidemiology is needed to inform programmatic decisions. Third, socio-structural factors such as program characteristics, transportation, poverty, work/child care responsibilities, and social relations are the major determinants of retention in care, and therefore interventions to improve retention in care should focus on implementation strategies. Research to assess and improve retention in care for HIV-infected patients can be strengthened by incorporating novel methods such as sampling-based approaches and a causal analytic framework.

Keywords

HIV care and treatment Retention in care Resource-limited settings Loss to follow-up Access to care 

Notes

Acknowledgments

From University of California, San Francisco, United States (E.H.G., K.A.C., J.N.M); International Center for AIDS Care and Treatment Programs, Columbia University, New York, United States (D.N.); Infectious Diseases Institute, Kampala, Uganda (A.K.); Division of Treatment and Care, National Center for AIDS/STD, Chinese Center of Disease Control and Prevention, Beijing, People’s Republic of China (Z.Y); Mbarara University of Science and Technology, Mbarara, Uganda (W.M., M.B.B.); Indiana University, Indianapolis, United States (C.T.Y.); Department of Biostatistics, University of California, Berkeley, United States (M.L.P); and the East Africa International Databases to Evaluate AIDS (E.H.G., D.N., A.K., P.B., W.M., M.B.B., C.T.Y., M.L.P., J.N.M).

Disclosure

No potential conflicts of interest relevant to this article were reported.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Elvin H. Geng
    • 1
  • Denis Nash
    • 1
  • Andrew Kambugu
    • 1
  • Yao Zhang
    • 1
  • Paula Braitstein
    • 1
  • Katerina A. Christopoulos
    • 1
  • Winnie Muyindike
    • 1
  • Mwebesa Bosco Bwana
    • 1
  • Constantin T. Yiannoutsos
    • 1
  • Maya L. Petersen
    • 1
  • Jeffrey N. Martin
    • 1
  1. 1.Division of HIV/AIDS at San Francisco General HospitalSan FranciscoUSA

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