Retention in care prior to antiretroviral treatment eligibility in sub-Saharan Africa: a systematic review of the literature

Abstract

Objective: We aimed at summarising rates and factors associated with retention in HIV care prior to antiretroviral treatment (ART) eligibility in sub-Saharan Africa.

Design: We conducted a systematic literature review (2002-2014). We searched Medline/Pubmed, Scopus and Web of Science, as well as proceedings of conferences. We included all original research studies published in peer-reviewed journals, which used quantitative indicators of retention in care prior to ART eligibility.

Participants: People not yet eligible for ART.

Primary and secondary outcomes: Rate of retention in HIV care prior to ART eligibility and associated factors.

Results: 10 papers and 2 abstracts were included. Most studies were conducted in Southern and Eastern Africa between 2004 and 2011 and reported retention rates in pre-ART care up to the second CD4 measurement. Definition of retention in HIV care prior to ART eligibility differed substantially across studies. Retention rates ranged between 23% and 88% based on series ranging from 112 to 10,314 individuals; retention was higher in women, individuals aged >25 years, those with low CD4 count, high body mass index or co-infected with tuberculosis, and in settings with free cotrimoxazole use.

Conclusions: Retention in HIV care prior to ART eligibility in sub-Saharan Africa has been insufficiently described so far leaving major research gaps, especially regarding long-term retention rates and sociodemographic, economic, clinical and programmatic logistic determinants. The prospective follow-up of newly diagnosed individuals is required to better evaluate attrition prior to ART eligibility among HIV-infected people.

Keywords: PRIMARY CARE; PUBLIC HEALTH.

Figure 1

Search strategy for the systematic literature review on retention in HIV care in sub-Saharan Africa (January 2014).

Figure 2

Flow chart of literature search on retention in HIV care prior to antiretroviral therapy (ART) eligibility in sub-Saharan Africa (January 2014).

Figure 3

Rates of retention in HIV care prior to antiretroviral therapy (ART) eligibility in sub-Saharan Africa. Twelve studies in sub-Saharan Africa. Bubble size proportional to population size.