High Retention in Care Among HIV-Infected Patients Entering Care With CD4 Levels %26gt; 350 cells/mu L Under Routine Program Conditions in Uganda

作者：Namusobya Jennifer; Semitala Fred C; Amanyire Gideon; Kabami Jane; Chamie Gabriel; Bogere John; Jain Vivek; Clark Tamara D; Charlebois Edwin; Havlir Diane V; Kamya Moses; Geng Elvin H^*

来源：Clinical Infectious Diseases, 2013, 57(9): 1343-1350.

DOI：10.1093/cid/cit490

• HIV
• Africa
• retention
• CD4

Background. In Africa, human immunodeficiency virus (HIV)-infected patients who present to care with CD4 levels %26gt;350 cells/mu L (ie, current antiretroviral treatment thresholds) are often thought to be poorly retained in care, but most estimates do not account for outcomes among patients lost to follow-up. %26lt;br%26gt;Methods. We evaluated HIV-infected adults who had made a visit in the last 2.5 years in a program in Uganda. We identified a random sample of patients lost to follow-up (9 months without a visit). Ascertainers sought patients in the community in this sample and outcomes were incorporated into revised survival estimates of mortality and retention for the clinic population using a probability weight. %26lt;br%26gt;Results. Of 6473 patients, (29% male, median age 29 years, median CD4 count 550 cells/mu L), 1294 (20%) became lost to follow-up over 2.5 years. Two hundred seven (16%) randomly selected lost patients were sought, and in 175 (85%) vital status was ascertained. In 19 of 175 (11%), the patient had died. Of the 156 (89%) alive, 74 (47%) were interviewed in person, and 38 of 74 (51%) reported HIV care elsewhere, whereas 36 of 74 (49%) were not in care. Application of weights derived from sampling found that at 2.5 years, retention among patients who enrolled with CD4 levels %26gt;350 cells/mu L was 88.2% and mortality was 2.5%. Lower income, unemployment, and rural residence were associated with failure to be retained. %26lt;br%26gt;Conclusions. Retention in patients entering care with high CD4 counts under routine program conditions in Africa is high in a Ugandan care program and may be systematically underestimated in many other settings.

• 出版日期2013-11-1