High Retention in Care Among HIV-Infected Patients Entering Care With CD4 Levels > 350 cells/mu L Under Routine Program Conditions in Uganda

Makerere University Joint AIDS Program, Kampala, Uganda.
Clinical Infectious Diseases (Impact Factor: 9.42). 07/2013; 57(9). DOI: 10.1093/cid/cit490
Source: PubMed

ABSTRACT Background. In Africa, HIV-infected patients who present to care with CD4 levels>350/ul (i.e., current antiretroviral treatment thresholds) are often thought to be poorly retained in care, but most estimates do not account for outcomes among patients lost to follow-up (LTFU). Methods. We evaluated HIV-infected adults who had made a visit in the last 2.5 years in a program in Uganda. We identified a random sample of patients LTFU (nine months without a visit). Ascertainers sought patients in the community in this sample and outcomes were incorporated into revised survival estimates of mortality and retention for the clinic population using a probability weight. Results. Of 6,473 patients, (29% male, median age 29 years, median CD4 count 550/µl), 1,294 (20%) became LTFU over 2.5 years. 207 (16%) randomly selected lost patients were sought, and in 175 (85%) vital status was ascertained. In 19/175 (11%), the patient had died. Of the 156 (89%) alive, 74 (47%) were interviewed in person, and 38/74 (51%) reported HIV care elsewhere, whereas 36/74 (49%) were not in care. Application of weights derived from sampling found that at 2.5 years, retention among patients who enrolled with CD4 levels higher than 350/µl was 88.2% and mortality was 2.5%. Lower income, unemployment and rural site were associated with failure to be retained. Conclusions. Retention in patients entering care with high CD4 counts under routine program conditions in Africa is high in a Ugandan care program and may be systematically underestimated in many other settings.

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