Abstract
BackgroundPatient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs. It has been identified that suboptimal patient retention in care is one of the challenges of ART programs in many settings. ART programs have, therefore, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care.MethodsA mixed-methods study, based on the positive deviance approach, was conducted in Ethiopia in 2011/12. Quantitative data were collected to estimate and compare the levels of retention in care in nine health facilities. Key informant interviews and focus group discussions were conducted to identify a package of interventions implemented in the health facilities with relatively higher or improving levels of retention.ResultsRetention in care in the Ethiopian ART program was found to be variable across health facilities. Among hospitals, the poorest performer had 0.46 (0.35, 0.60) times less retention than the reference; among health centers, the poorest performers had 0.44 (0.28, 0.70) times less retention than the reference. Health facilities with higher and improving patient retention were found to implement a comprehensive package of interventions: (1) retention promoting activities by health facilities, (2) retention promoting activities by community-based organizations, (3) coordination of these activities by case manager(s), and (4) patient information systems by data clerk(s). On the contrary, such interventions were either poorly implemented or did not exist in health facilities with lower retention in care. A framework to improve retention in care was developed based on the evidence found by applying the positive deviance approach.ConclusionA framework for improving retention in care of patients on ART was developed. We recommend that health facilities implement the framework, monitor and evaluate their levels of retention in care, and, if necessary, adapt the framework to their own contexts.
Highlights
Patient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs
It dropped to 77% at 24 months and remained stable at 75% and 74.5% at 36 and 48 months, respectively [3]. These figures are consistent with those from an updated meta-analysis of 39 cohorts from sub-Saharan Africa in 2011 [4]. These findings indicate that retention in care remains to be a challenge for ART programs though it is improving over time [3,4]
Based on the themes that emerged from our qualitative study, we developed a framework that comprises the different interventions for improving patient retention in care in ART programs (Figure 2)
Summary
Patient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs. ART programs have, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care. Patient retention in care is one of the crucial indicators of the success of ART programs [2,3,4,5,6,7], mainly because high levels of patient retention in care are related to improved adherence to ART, slow progression to AIDS, and increased survival. Countries face the dual challenge of managing and sustaining growing cohorts of patients on ART, in addition to the need for increasing access to ART for the patients who still do not have access to it
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