July 20, 2011
Only One-Third Of HIV-Positive Patients Remain In Care Before Starting Treatment
In sub-Saharan Africa, only about one third of patients who test positive for HIV but are not yet eligible for antiretroviral treatment remain in care until they become eligible and start treatment. Some patients never return for the results of their initial CD4 count (a prognostic and treatment eligibility biomarker); some disappear between having their initial CD4 count taken and becoming eligible for HIV treatment; and others with CD4 counts that indicate that they are eligible for treatment do not return to start receiving medications.
These findings from a study by Sydney Rosen and Matthew Fox, based at Boston University in the USA, highlight one of the challenges of improving outcomes for patients in HIV/AIDS programs in resource-limited settings. Earlier initiation of treatment, which is one of the most important ways to improve patient outcomes, requires that all individuals who test positive for HIV enroll and remain in pre-treatment care and be monitored regularly to ensure that antiretroviral therapy is initiated as soon as they become eligible for treatment.
The authors conclude: "Studies of retention in pre-[treatment] care report substantial loss of patients at every step, starting with patients who do not return for their initial CD4 count results and ending with those who do not initiate [antiretroviral therapy] despite eligibility."
They continue: "Better health information systems that allow patients to be tracked between service delivery points are needed to properly evaluate pre-[treatment] loss to care, and researchers should attempt to standardize the terminology, definitions, and time periods reported."
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