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African AIDS Program Retains Sixty Percent of Patients

Loss to follow-up most common reason for incomplete treatment

FRIDAY, Oct. 26 (HealthDay News) -- Large-scale antiretroviral therapy programs in sub-Saharan Africa have retained about 60 percent of patients for two years since they were introduced early this decade, according to a report published in the October issue of PLoS Medicine.

Sydney Rosen, of Boston University School of Public Health, and colleagues conducted a literature search of published material from 2000 through 2007 to calculate the estimated retention rates at six, 12 and 24 months. In all, they reviewed 32 publications and 33 patient cohorts comprising 74,192 patients in 13 countries.

At six, 12 and 24 months, the weighted mean retention rates were 79.1 percent, 75 percent and 61.6 percent, respectively. While loss to follow-up accounted for 56 percent of attrition, death accounted for 40 percent. The best reported two-year follow-up rate was 85 percent and the worst was 46 percent. However, given that studies with shorter reporting periods had high attrition rates and the monthly rate was 3.3 percent, 1.9 percent and 1.6 percent for studies reporting six, 12 and 24 months of follow-up, respectively, the published reports may over-estimate overall patient retention.

"Better patient tracing procedures, better understanding of loss to follow-up, and earlier initiation of antiretroviral therapy to reduce mortality are needed if retention is to be improved," the authors conclude.

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