Browna, L.B., Havlira, D.V., Ayiekoc, J., et al. AIDS (August 2016), 30:2855–2864. doi:1097/QAD.0000000000001250.
This study examined non-retention factors among clients enrolled in a “test and treat” trial in Uganda and Kenya. Study participants (n=5,683) received “streamlined care” which included antiretroviral treatment (ART) at first visit, reduced wait times, quarterly visits for clinically stable patients, patient-friendly services, call-in center services for clients with medical or appointment questions, text reminders, and viral load results. In cases where clients missed appointments, “trackers” followed up at home to optimize retention. At 12-month follow-up, nearly 88.6 percent of clients were retained at their initiating site; 4.6 percent transferred to an alternative site; 1.1 percent died; 1.9 percent were residing in the same community (but not in treatment); and 1.1 percent transferred to a different site without documentation. Fifteen to twenty-four-year-olds and those without a cell phone were less likely to be retained in care. Clients who were newly linked to services and lived in Eastern Uganda, and clients who took longer than 30 days to link to care, were also less likely to be retained in care. Retention tracking to stay in care was more often required among Ugandans, young clients, and those with pre-ART CD4 cell counts above country guidelines before enrollment. The authors concluded that as test-and-treat services roll out, retention barriers must be addressed, particularly among young people, to optimize treatment outcomes.