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OBJECTIVE: We report rates and risk factors for attrition in the first cohort of patients followed through all stages from HIV testing to antiretroviral therapy (ART) initiation. DESIGN: Cohort study of all patients diagnosed with HIV between January and June 2009. METHODS: We calculated the proportion of patients who completed CD4 cell counts and initiated ART or remained in pre-ART care during 2 years of follow-up and assessed predictors of attrition. RESULTS: Of 1427 patients newly diagnosed with HIV, 680 (48%) either initiated ART or were retained in pre-ART care for the subsequent 2 years. One thousand eighty-three patients (76%) received a CD4 cell count, and 973 (90%) returned for result; 297 (31%) had CD4 cell count 350 cells per microliter, 215 (50%) started ART or were retained in pre-ART care. Active tuberculosis was associated with not only lower odds of attrition before CD4 cell count odds ratio (OR): 0. 08; 95% confidence interval (CI): 0. 03 to 0. 25 but also higher odds of attrition before ART initiation (OR: 2. 46; 95% CI: 1. 29 to 4. 71). Lower annual income (≤US 125) was associated with higher odds of attrition before CD4 cell count (OR: 1. 65; 95% CI: 1. 25 to 2. 19) and before ART initiation among those with CD4 cell count >350 cells per microliter (OR: 1. 74; 95% CI: 1. 20 to 2. 52). After tracking patients through a national database, the retention rate increased to only 57%. CONCLUSIONS: Fewer than half of patients newly diagnosed with HIV initiate ART or remain in pre-ART care for 2 years in a clinic providing comprehensive services. Additional efforts to improve retention in pre-ART are critically needed.
Noel et al. (Tue,) studied this question.