Keeping people in HIV care

Images from the presentation of Dr Rachel Baggaley 

of the World Health Organisation.

Community-based support increases the likelihood that HIV-positive people will be retained in care, research conducted in South Africa shows.

Less than a third of people who start HIV therapy in southern Africa stay in HIV care. This is of serious concern. It means that the majority of people with HIV are not receiving the health benefits that come from specialist treatment and care. A high drop-out rate from care also seriously undermines the use of HIV treatment as prevention.

A speaker from the World Health Organization (WHO) presented findings from research in more than 20 countries about why people fall out of care at some point in the ‘cascade’ of HIV care (that is, the different stages of care from first being tested to being on effective treatment ). Reasons include the fear of stigma, denial about their condition, anxiety, poor links with the care available, inadequate clinic facilities and problems with travel.

But a South African study showed that providing community-based adherence support increased the chances that people starting HIV treatment would stay in care.

A new healthcare role of ‘patient advocates’ was introduced in 2004. These workers help support adherence and also provide counselling and psychosocial support.

Only 6% of people who had an advocate dropped out of care, compared to 10% of individuals who did not receive this kind of support.

Separate research showed that contact tracing could help reduce drop-out rates among children after starting HIV treatment.

Following the introduction of active contact tracing, rates of loss-to-follow-up were reduced from 22.7% to 8.5%.

The WHO report recommends the involvement of lay health workers to help ensure people move from one stage of the care ‘cascade’ to the next, and therefore stay in care.