||Starting and Staying on Course: HIV Linkage and Retention in Care
Oral Abstract Session : Track E
||Session Room 8
||25.07.2012, 11:00 - 12:30
Rachel Baggaley, Switzerland
Matthew Fox, United States
|An introduction to the cascade of care|
M. Fox, United States
|A laboratory-based approach to reduce loss to follow-up of HIV-positive clients|
C.O. Nwuba1, T. Dagunduro1, C. Umenyi1, B. Peters2, F. Afolayan3, O. Abolarin4
1Management Sciences for Health, Prevention Organizational Systems, AIDS, Care and Treatment, Ilorin, Nigeria, 2Children Specialist Hospital, Laboratory Unit, Ilorin, Nigeria, 3General Hospital, Laboratory Unit, Omuaran, Nigeria, 4Specialist Hospital, Laboratory Unit, Offa, Nigeria
C. Nwuba, Nigeria
|Risk factors and true outcomes of children lost to follow-up from antiretroviral therapy in Lilongwe, Malawi|
C. Ardura Garcia1, H. Tweya2, C. Feldacker2, S. Phiri2, R. Weigel3,4
1Liverpool School of Topical Medicine, Liverpool, United Kingdom, 2Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi, 3Liverpool School of Topical Medicine, Disease Control Strategy Group, Liverpool, United Kingdom, 4Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
H. Tweya, Malawi
|Community-based adherence support associated with improved virological suppression in adults receiving antiretroviral treatment: five-year outcomes from a multicentre cohort study in South Africa|
G. Fatti1, A. Grimwood1, J. Shea2
1Kheth'Impilo, Cape Town, South Africa, 2University of Cape Town, Child Health Unit, School of Child & Adolescent Health, Cape Town, South Africa
A. Grimwood, South Africa
|Outcomes of antiretroviral treatment programs in rural Lesotho: health centers and hospitals compared|
N.D. Labhardt1, M. Sello2, M. Mohlaba3, O. Keiser4, K. Pfeiffer5, M. Egger4, J. Ehmer5, G. Wandeler4,6
1SolidarMed, Seboche Hospital, Botha-Bothe, Lesotho, 2SolidarMed, Thaba-Tseka, Lesotho, 3Seboche Hospital, Primary Health Care Department, Botha-Bothe, Lesotho, 4University of Bern, Institute of Social and Preventive Medicine (ISPM), Bern, Switzerland, 5SolidarMed, Lucerne, Switzerland, 6University Hospital and University of Bern, Clinic for Infectious Diseases, Bern, Switzerland
G. Wandeler, Switzerland
|High rates of loss to follow-up during first year of pre-antiretroviral therapy for HIV at primary health care level in rural Uganda|
F.J.B. Scheibe1,2, L. Muhamadi3,4,5, P. Waiswa4,5,6, O. Mueller1, H.W.F. Neuhann1
1University of Heidelberg, Institute of Public Health, Heidelberg, Germany, 2University of Heidelberg, Surgical Clinic, Heidelberg, Germany, 3Iganga General Hospital, Iganga, Uganda, 4Karolinska Institutet, Department of Public Health Sciences, Division of Global Health, Stockholm, Sweden, 5Makerere University, School of Public Health, Kampala, Uganda, 6Makerere University, Iganga/Mayuge Health and Demographic Surveillance System, Iganga, Uganda
|Improving retention at all points in the HIV care cascade: the WHO perspective|
R. Baggaley, Switzerland
|An introduction to the cascade of care - Matthew Fox|
|A laboratory-based approach to reduce loss to follow-up of HIV-positive clients - Chioma Onyinye Nwuba|
|Risk factors and true outcomes of children lost to follow-up from antiretroviral therapy in Lilongwe, Malawi - Hannock Tweya|
|Community-based adherence support associated with improved virological suppression in adults receiving antiretroviral treatment: five-year outcomes from a multicentre cohort study in South Africa - Ashraf Grimwood|
|Outcomes of antiretroviral treatment programs in rural Lesotho: health centers and hospitals compared - Gilles Wandeler|
|Improving retention at all points in the HIV care cascade: the WHO perspective - Rachel Baggaley|
Track E report by Colby Donn
The HIV Linkage and Retention in Care session included a number of presentations from the north and the south. M Fox from the USA gave an overview of the topic and concluded that it is difficult to track patients from HIV testing to long-term care. Better information systems and long-term follow-up data are needed. The WHO had a special meeting on retention in care in 2011 and will continue to work on the issue in the future.
Two abstracts presented data on retention in care in rural African settings. In Lesotho, ND Labhardt reported that retention in care was better in local health centers than in hospitals. In Uganda, there was only 19% retention in pre-ART care after 2 years. Furthermore, 21% of patients were eligible for ART but had not yet started.
Three abstracts evaluated interventions designed to improve retention in care. CO Nwuba presented a laboratory-based intervention in Nigeria that increased availability, accessibility, and speed of CD4 testing at a hospital. The result was an increase in CD4 testing from 53% to 93% of patients, pregnant women accessing ART increased from 50% to 83% and LTFU decreased from 59% to 11%. In Malawi, an outreach system successfully traced 79% patients who had missed appointments and resulted in decreased LTFU and increased accuracy of their mortality data.
In South Africa, A Grimwood presented data on a Community based adherence support (CBAS) program using Patient Advocates (PAs) in a large clinic system. Patients receiving CBAS had significantly increased virological suppression at 6 months, fewer deaths, and lower LTFU.
In conclusion, it is recognized that retention in care is an important issue throughout the world. Recommendations for improvement from the presenters and audience included the need for better data and information systems and more support for patients at every stage after being diagnosed with HIV infection. Suggestions ranged from systems issues (faster and more accessible laboratory testing) to the use of dedicated treatment supporters or patient advocates to help patients navigate through complex health care systems.