Federal HIV/AIDS Prevention and Control Office, Addis Ababa, Ethiopia.
PLoS One. 2012;7(6):e38555. doi: 10.1371/journal.pone.0038555. Epub 2012 Jun 11.
Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care.
Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier.
We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier.
The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.
患者在治疗中的保留率是抗逆转录病毒治疗项目面临的一个重大挑战。这主要是因为在治疗中保留率与患者对治疗的坚持和生存有关。因此，卫生机构和项目必须衡量患者的保留率。然而，目前可用于衡量保留率的工具（如 Kaplan-Meier）存在很多实际限制。本研究的目的是开发衡量保留率的简化工具。
从埃塞俄比亚 9 个卫生机构的患者登记处收集回顾性队列数据。保留率是本研究的主要结果。为了衡量特定时间段内特定“ART 年龄组”的“当前保留率”和过去“Y”年接受 ART 治疗的患者的“队列保留率”，开发了工具。基于“队列保留率”工具的“保留率概率”与 Kaplan-Meier 进行了比较。
我们发现，新工具可以衡量“当前保留率”和“队列保留率”。我们还发现，这些工具易于使用，不需要高级统计技能。在最初的两个“ART 年龄组”和“ART 年龄队列”中，患者的“当前保留率”和“队列保留率”均低于随后的“ART 年龄组”和“ART 年龄队列”。基于新工具的“保留率概率”与基于 Kaplan-Meier 的“保留率概率”相似。
“当前保留率”和“队列保留率”的简化工具将使从业者和项目管理者能够轻松、恰当地衡量和监测保留率。因此，我们建议卫生机构和项目开始使用这些工具，以努力提高保留率和患者结果。
