Since 2003, 3.9 million people have initiated antiretroviral treatment in sub-Saharan Africa. Despite this remarkable achievement, retaining patients in treatment remains a challenge and non-retention rates are particularly high in the first six to twelve months of treatment. One report found that 14 percent of patients were not retained in the first six months, while 20 percent of patients dropped off 12 months after treatment began.
A recent study conducted by ICAP assessed whether non-retention rates of HIV/AIDS patients in sub-Saharan Africa have changed over time with the scale-up of HIV/AIDS services supported largely by ministries of health and the U.S. President’s Emergency Plan for AIDS Relief. In addition to putting more people on treatment, this scale up has increased accessibility of services, enhanced health provider expertise, and resulted in earlier initiation of HIV treatment in sub-Saharan Africa.
Results from the study show that non-retention rates in the nine countries assessed at 6- and 12-month periods remained stable as HIV/AIDS programs and clinics became more experienced over the course of scale-up. These results were found by analyzing patient data from 656 ICAP-supported clinics in nine countries over the course of five years (2005-2010) and included 316,762 patients. The data incorporated a large number of clinics and patients from diverse contexts, however the study could not account for undocumented transfers of patients to other clinics. The results are similar to smaller studies conducted in Africa and in larger U.S. programs, but contradict reports questioning increased non-retention rates since the scale-up.
“Many would agree that these are welcome findings especially as they indicate that, when examined across multiple countries, non-retention rates have not increased over time as has been reported in smaller analyses in the scientific literature and discussed in the policy narrative around the sustainability of scale-up,” said ICAP Strategic Information Director Batya Elul.
Improving retention rates in sub-Saharan Africa is possible, demonstrated by the fact that the nine countries that were evaluated varied by overall retention rates, and one country–Ethiopia—had decreased non-retention rates. ICAP researchers continue to analyze factors that contribute to non-retention in effort to understand the impact of scale-up initiatives and develop strategies for improving the likelihood that patients remain in care over the long term.