OBJECTIVES: To determine retention in HIV care for individuals not yet eligible for antiretroviral therapy (ART) and to explore factors associated with retention in a rural public health HIV programme.
METHODS: HIV-infected adults (≥16 years) not yet eligible for ART, with CD4 cell count >200cells/μl January 2007 - December 2007 were included in the analysis. Retention was defined by repeat CD4 count within 13 months. Factors associated with retention were assessed using logistic regression with clustering at clinic level.
RESULTS: 4,223 were included in the analysis (83.9% female). Overall retention was 44.9% with median time to return 201 days (interquartile range [IQR] 127-274). Retention by initial CD4 count 201-350, 351-500, and >500 cells/μl was 51.6% (95% confidence interval [CI] 49.1-54.0), 43.2% (95% CI 40.5-45.9), and 34.9% (95% CI 32.4-37.4) respectively. Compared to CD4 201-350 cells/μl, higher initial CD4 count was significantly associated with lower odds of retention (CD4 351-500 cells/μl adjusted odds ratio [aOR] 0.72, 95% CI 0.62-0.84; CD4 >500 cells/μl aOR 0.51, 95% CI 0.44-0.60). Male sex was independently associated with lower odds (aOR 0.80, 95% CI 0.67-0.96), and older age with higher odds of retention (for each additional year of age aOR 1.03, 95% CI 1.03-1.04).
CONCLUSIONS: Retention in HIV care prior to eligibility for ART is poor, particularly for younger individuals and those at an earlier stage of infection. Further work to optimise and evaluate care and monitoring strategies is required to realise the full benefits of the rapid expansion of HIV programmes in sub-Saharan Africa.