Background: A significant challenge to South Africa’s national ART program is poor retention among HIV-positive patients. Studies investigating retention typically focus on post-ART retention, or isolated periods of pre-ART care (i.e. CD4 staging), but do not follow a cohort from testing through time on treatment to measure retention throughout early HIV care. We report patient retention at three stages of pre-ART care and two stages of post-ART care to identify when greatest attrition occurs. Methods: We conducted a retrospective cohort (N=844) of all adult, non-pregnant patients testing HIV-positive January 1 -June 30, 2010, at Witkoppen Health and Welfare Centre, a primary health clinic in Johannesburg, South Africa. We report retention in pre-ART stage 1 (HIV diagnosis to CD4 results notification in ≤3 months), pre-ART stage 2 (initially ineligible for ART with repeat CD4 test ≤1 year of prior CD4), pre-ART stage 3 (initiating ART ≤3 months after first eligible CD4 result), as well as at 0-6 and 6-12 months post-ART initiation. Results: Retention among all patients during pre-ART stage 1 was 72.5% (95% CI:69.3-79.5%), and for those ART-eligible, 73.4% (95% CI:68.9-77.5%) were retained during pre-ART stage 3. For patients ART-ineligible at HIV testing, 57.4% (95% CI:49.5-65.0%) returned for a repeat CD4 during pre-ART stage 2, the lowest retention of all stages. Retention improved post-ART initiation, with 80.1% retained (95% CI:75.2-84.5%) at 6 months, and 95.7% (95% CI:92.3-97.9%) between 6-12 months. For those ART-eligible at HIV testing (n=589), cumulative retention from diagnosis to 12 months on ART was 36.8% (95% CI:32.8-40.9%). Conclusions: Patient attrition in the first year following HIV diagnosis was substantial and greatest prior to ART initiation: over 25% at each of three pre-ART stages. As South Africa expands ART provision, retention must be improved, particularly linkage to care prior to ART eligibility and initiation.
Conference: AIDS 2012, Washington DC, USA