Defining retention and attrition in pre-antiretroviral HIV care: proposals based on experience in Africa.

OBJECTIVE

To propose practical, standardized definitions for reporting retention for pre-ART care.

METHOD

Definitions footed on three stages: Stage 1, testing HIV-positive to initial ART eligibility assessment; Stage 2, initial assessment to ART eligibility; and Stage 3, ART eligibility to ART initiation. For each stage, negative outcomes include death, loss, or not being retained.

RESULTS

Stage 1 Retention: proportion of patients who complete initial ART eligibility assessment within 3 months of HIV testing, with reporting of cohort outcomes at 3 and 12 months after HIV testing. Patients who end Stage 1 eligible for ART move directly to Stage 3. Stage 2 Retention: proportion of patients who either: complete all possible ART eligibility re-assessments within 6 months of the site’s standard visit schedule; or had an assessment within 1 year of the time reported to and were not ART eligible at the last assessment. Retention should be reported at 12-month intervals. Stage 3 Retention: initiating ART (i.e. ARVs dispensed) within 3 months of determining ART eligibility, with reporting at 3 months after eligibility and 3 monthly intervals thereafter.

CONCLUSION

If pre-ART retention is to improve, consistent terminology is needed for collecting data, measuring and reporting outcomes, and comparing results across programs and countries. The definitions we propose offer a strategy for improving the consistency and comparability of future reports.