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Interventions to Reduce Loss to Follow-up During All Stages of the HIV Care Continuum in Sub-Saharan Africa: A Systematic Review

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Abstract

The continuum of care for successful HIV treatment includes HIV testing, linkage, engagement in care, and retention on antiretroviral therapy (ART). Loss to follow-up (LTFU) is a significant disruption to this pathway and a common outcome in sub-Saharan Africa. This review of literature identified interventions that have reduced LTFU in the HIV care continuum. A search was conducted utilizing terms that combined the disease state, stages of the HIV care continuum, interventions, and LTFU in sub-Saharan Africa and articles published between January 2010 and July 2015. Thirteen articles were included in the final review. Use of point of care CD4 testing and community-supported programs improved linkage, engagement, and retention in care. There are few interventions directed at LTFU and none that span across the entire continuum of HIV care. Further research could focus on devising programs that include a series of interventions that will be effective through the entire continuum.

Resumen

La continuidad de la atención para el éxito del tratamiento del VIH incluye la prueba del VIH, la vinculación y el compromiso en el cuidado y mantenimiento de la terapia antirretroviral (TAR). Las pérdidas durante el seguimiento (LTFU) es una alteración significativa de esta vía y un resultado común en el África subsahariana. Esta revisión de la literatura identificó intervenciones que han reducido LTFU en el continuo de la atención del VIH. Se realizó una búsqueda utilizando términos que combinaban el estado de la enfermedad, las etapas del continuo de la atención del VIH, las intervenciones y LTFU en el África subsahariana y los artículos publicados entre enero de 2010 y julio de 2015. Trece artículos fueron incluidos en la revisión final. El uso del punto de atención pruebas de CD4 y los programas apoyados por la comunidad mejorar la articulación, compromiso, y la retención de los pacientes. Hay pocas intervenciones dirigidas a LTFU y ninguno que se extienden a lo largo de todo el continuo de la atención del VIH. La investigación adicional podría centrarse en la elaboración de programas que incluyen una serie de intervenciones que serán efectivas a través de toda la cadena.

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Acknowledgments

For her help in suggesting search terminology and more efficient ways to search databases, the authors wish to acknowledge Xan Goodman.

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Authors and Affiliations

  1. School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV, 89154, USA

    Justin Keane, Jennifer R. Pharr, Mark P. Buttner & Echezona E. Ezeanolue

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Correspondence to Jennifer R. Pharr.

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Funding

The study was partly funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Mental Health (NIMH), the President’s Emergency Plan for AIDS Relief (PEPFAR) under award number R01HD075050 and R01HD087994.

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The authors state that there are no competing interests to declare.

Research Involving Human Subjects or Animals

This research is a systematic review of published literature and deemed excluded by the UNLV IRB.

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Informed consent was not obtained as this was a systematic review of published literature.

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Keane, J., Pharr, J.R., Buttner, M.P. et al. Interventions to Reduce Loss to Follow-up During All Stages of the HIV Care Continuum in Sub-Saharan Africa: A Systematic Review. AIDS Behav 21, 1745–1754 (2017). https://doi.org/10.1007/s10461-016-1532-5

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