Retention and Attrition from HIV Care

With the rapid expansion of access to antiretroviral therapy (ART) in sub-Saharan Africa, the number of HIV-positive people on treatment has increased dramatically. In South Africa, scale-up of services has put pressure on the ability of treatment programs to maintain care for existing patients while continuing to expand access to new patients. With increased demand and limited capacity, many HIV-positive patients never access care, and many who do discontinue treatment.

HE2RO staff, partners, and collaborators are conducting epidemiologic analyses of several cohorts including the Themba Lethu Clinical HIV Treatment Cohort—one of the largest clinical HIV treatment databases in South Africa, which includes demographic, clinical, and laboratory data on over 23,000 patients initiated on ART collected as part of routine HIV care. The goal is to evaluate interventions aimed at improving retention in care and reducing late presentation for treatment and to generate program-relevant information to improve the ART treatment scale-up in South Africa. We have also conducted a series of highly influential systematic reviews of retention in HIV care and treatment programs throughout sub-Saharan Africa.

The results of our work on loss to follow-up have been influential in demonstrating both that the rates of retention in HIV care programs in sub-Saharan Africa are improving over time, but also that many patients are still being lost from treatment programs leading to increased mortality.