Predictors of Retention among Men Attending STI Clinics in HIV Prevention Programs and Research: A Case Control Study in Pune, India

Seema Sahay,Radhika G Brahme,Robert C Bollinger,Amit Nirmalkar,Nikhil Gupte,Shilpa Bembalkar,Sanjay Mehendale,Rupert Kaul

doi:10.1371/journal.pone.0017448

Abstract

BackgroundRetention is critical in HIV prevention programs and clinical research. We studied retention in the three modeled scenarios of primary prevention programs, cohort studies and clinical trials to identify predictors of retention.Methodology/Principal FindingsMen attending Sexually Transmitted Infection (STI) clinics (n = 10, 801) were followed in a cohort study spanning over a ten year period (1993–2002) in Pune, India. Using pre-set definitions, cases with optimal retention in prevention program (n = 1286), cohort study (n = 940) and clinical trial (n = 896) were identified from this cohort. Equal number of controls matched for age and period of enrollment were selected. A case control analysis using conditional logistic regression was performed.Being employed was a predictor of lower retention in all the three modeled scenarios. Presence of genital ulcer disease (GUD), history of commercial sex work and living away from the family were predictors of lower retention in primary prevention, cohort study and clinical trial models respectively. Alcohol consumption predicted lower retention in cohort study and clinical trial models. Married monogamous men were less likely to be retained in the primary prevention and cohort study models.Conclusions/SignificancePredicting potential drop-outs among the beneficiaries or research participants at entry point in the prevention programs and research respectively is possible. Suitable interventions might help in optimizing retention. Customized counseling to prepare the clients properly may help in their retention.

Highlights

With an estimated 2.3 million HIV infected persons, India has the third largest HIV burden in any country in the world [1]
We present three possible scenarios in the area of HIV prevention and research wherein retention is crucial: 1) Primary prevention through Voluntary Counseling and Testing (VCT): We hypothesized that high uptake of voluntary counseling and testing services for HIV, an important primary prevention strategy of the National AIDS Control Program of India, would contribute to reliable estimation of HIV burden in various sub-populations and may guide in deciding strategies for secondary prevention and control of AIDS
Of all the 10, 801 screened male Sexually Transmitted Infection (STI) patients, 8631 (80%) were found to be HIV uninfected who were enrolled in the parent cohort study

Summary

Introduction

With an estimated 2.3 million HIV infected persons, India has the third largest HIV burden in any country in the world [1]. One of the goals of the current third phase of National AIDS Control Program (NACP-III) in India is to halt and reverse the HIV epidemic by 2012 by implementing an integrated strategy focusing on prevention, care and treatment of HIV/ AIDS [2] This goal can be achieved by maintaining the primary prevention continuum, effectively tracking the HIV incidence in various sub-populations and implementing appropriately evaluated prevention and therapeutic interventions. Projections for the year 2031 marking 50 years of AIDS pandemic have indicated that almost three times the current resources will be required to control the epidemic by focusing on high impact tools, efforts to attain behavior-change and efficient and effective treatment [3]. We studied retention in the three modeled scenarios of primary prevention programs, cohort studies and clinical trials to identify predictors of retention

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Results

Conclusion