High levels of retention in care with streamlined care and universal test-and-treat in East Africa

Abstract

We sought to measure retention in care and identify predictors of nonretention among patients receiving antiretroviral therapy (ART) with streamlined delivery during the first year of the ongoing Sustainable East Africa Research on Community Health (SEARCH) ‘test-and-treat’ trial (NCT 01864603) in rural Uganda and Kenya.

Design: Prospective cohort of patients in the intervention arm of the SEARCH study.

Methods : We measured retention in care at 12 months among HIV-infected adults who linked to care and were offered ART regardless of CD4+ cell count, following community-wide HIV-testing. Kaplan–Meier estimates and Cox proportional hazards modeling were used to calculate the probability of retention at 1 year and identify predictors of nonretention.

Results: Among 5683 adults (age ≥15) who linked to care, 95.5% [95% confidence interval (CI): 92.9–98.1%] were retained in care at 12 months. The overall probability of retention at 1 year was 89.3% (95% CI: 87.6–90.7%) among patients newly linking to care and 96.4% (95% CI: 95.8–97.0%) among patients previously in care. Younger age and pre-ART CD4+ cell count below country treatment initiation guidelines were predictors of nonretention among all patients. Among those newly linking, taking more than 30 days to link to care after HIV diagnosis was additionally associated with nonretention at 1 year. HIV viral load suppression at 12 months was observed in 4227 of 4736 (89%) of patients retained with valid viral load results.

Conclusion: High retention in care and viral suppression after 1 year were achieved in a streamlined HIV care delivery system in the context of a universal test-and-treat intervention.