Utility of Patient Retention for Evaluation of Antiretroviral Treatment Programs in Sub-Saharan Africa

Abstract

Evaluation of: Rosen S, Fox MP, Gill CJ: Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. Plos Med. 4(10), E298 (2008). A systematic review was performed of patient retention in 32 published reports describing 74,192 patients enrolled in nonresearch sub-Saharan antiretroviral treatment (ART) programs between 2000 and 2007. Retention was defined as the proportion of individuals known to be alive and receiving ART at the end of each follow-up period. Attrition was the proportion of those not retained and was a composite measure comprising of losses due to death (40%), loss to follow-up (56%) and discontinuation of ART within the program (4%). Weighted mean retention rates were 79.1, 75.0 and 61.6% at 6, 12 and 24 months, respectively. Of those programs reporting 24 months of follow-up, the best retained 85% and the worst retained 46% of patients. However, attrition was noted to be higher in those studies with shorter reporting periods indicating that reported patient retention may have been overestimated in the published reports. The main conclusion of the review was that overall attrition in African ART programs is very high (40%) and is predominantly due to loss to follow-up and, to a lesser degree, death.