amfAR, The Foundation for AIDS Research

Study Shows Inadequate Retention Rates in Sub-Saharan Africa ART Programs

Nov. 9, 2007—The recent study, “Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review,”[1] found that only slightly more than 60 percent of patients enrolled in antiretroviral treatment (ART) programs in sub-Saharan Africa continued treatment two years after treatment initiation. In addition, findings indicated that 40 percent of patients who stopped ART died within two years.

The study, which collected data on 13 sub-Saharan African countries, provides insights into program initiation and retention rates. It also raises concerns regarding future policies, program implementation, and resource allocation for ART protocols in resource-poor settings.

Of those who did not maintain their treatment regimens, more than half (56 percent) were lost to a lack of provider follow-up. The study found that death typically occurred among those patients who began ART at advanced stages of their infection. Stigma, discrimination, and poverty are critical barriers to testing in many sub-Saharan African nations, and they place limitations on early detection and treatment.

Global HIV treatment and prevention funders among private, governmental, and nongovernmental organizations have provided resources and research opportunities to mitigate the scourge of HIV/AIDS by supporting in-country programs. But the findings highlight a need for thorough evaluation of geographic obstacles to treatment access, as well as any barriers that may interrupt a steady supply of treatment commodities. Development of an effective tracking system to reduce the proportion of patients lost to a lack of follow-up is also severely needed. Furthermore, improvements in the development and integration of community-based approaches and national strategies for testing, treatment, and care[2] need to be made to ensure the success—that is, increased patient retention rates and continued funding—of ART programs in sub-Saharan Africa.

Click here for amfAR's Policy Statement on Routine HIV Testing.