Researchers Report Low Number of People Living with HIV That Adhere to HIV Treatment and Care

via AIDSmeds.com, by Tim Horn

Only one in five people living with HIV meet the criteria for being established and retained in care, according to a new analysis involving 12 clinics across the United States to be published in a forthcoming issue of the Journal of Acquired Immune Deficiency Syndromes. Though the authors warn that the data involving nearly 23,000 people enrolled in the HIV Research Network are not representative of retention rates in the country, the results nevertheless underscore a need for improvements in keeping those living with the virus connected to care.

As John Fleishman, PhD, of the Agency for Healthcare Research and Quality in Rockville, MD, and his colleagues write: HIV care is a continuum. One end reflects the estimated 1.2 million people believed to be living with HIV in the United States; the opposite end reflects the low rate (28 percent) of people living with HIV in the country who are successfully engaged in HIV care, receiving antiretroviral therapy and maintaining undetectable viral loads.

Provision of care is problematic at intermediate points in this continuum. “An estimated 21 percent of persons living with HIV in the U.S. are unaware of their infection,” the authors note. “Among those aware of their HIV infection, initial linkage to care is often delayed. After patients have been linked with a provider and have made an initial visit, they must still remain in care, with regular visits over a long time period.”

The study conducted by Fleishman’s group examined these later, but essential, stages in the HIV care continuum, notably rates of establishment and retention in care. These rates were determined using three main measurements.

“Establishment” applied to patients who made follow-up visits for longer than six months after showing up once for HIV care. “Retention” applied to patients who had been seen at least twice at HIV Research Network clinics, with visits separated by 90 days, in each year following their initial visit. The researchers also considered the rate of patients lost to follow-up—those who stopped their HIV Research Network clinic visits without notifications.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Retention of pre-ART patients poor in sub-Saharan Africa

Via AIDSMap, by Lesley Odendal.

 More than two-thirds of people who tested positive for HIV but weren't yet eligible for treatment when diagnosed were lost from care, according to a systematic review of pre-antiretroviral (pre-ART) care in sub-Saharan Africa, published this month in PLoS Medicine.

Studies included in the review report a substantial loss of patients at every step of care, starting with patients who do not return for their initial CD4 count results and ending with those who do not initiate ARVs despite eligibility, according to Sydney Rosen and Matthew Fox of the Center for Global Health and Development at Boston University, who conducted the review.

The study was conducted in order to evaluate the extent to which patients diagnosed with HIV are being lost before starting treatment.

28 studies which reported on the proportion of adult patients retained between any two points between testing positive for HIV and initiating ART in sub-Saharan African HIV/AIDS care programs were included. Results were categorised into stages of pre-ART care with ranges  reported for the proportions of patients retained in each stage.

Stages were categorised as follows:

• Stage 1: from HIV testing to receipt of CD4 count results or clinical staging
• Stage 2: from receipt of CD4 count results or clinical staging to ARV eligibility
• Stage 3: from ARV eligibility to ARV initiation

The review found that the median proportion of patients retained in Stage 1 was 59% (ranging from 35%–88%); Stage 2, 46% (31%–95%); and Stage 3, 68% (14%–84%).  'Loss to care' was defined as failing to reach the next step in the care sequence for any reason (death or discontinuation), but each study’s own criteria for determining which patients died or discontinued care were also included.

There are several key reasons for the poor retention of pre-ART care patients. As most patients are asymptomatic during the pre-ART period, they may not perceive themselves as requiring medical care. Patients may also not come to the clinic for monitoring and may choose to ‘‘wait and see what happens’’  if they "lack resources for transport, risk losing employment by taking time off work, or fear being recognised as a client of an HIV clinic," write the authors. Those presenting with a low CD4 count are likely to have died before reaching stage 3. Patient mobility may also be a factor contributing to low retention rates.

 Read the rest here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]