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Trends in CD4 Count Testing, Retention in Pre-ART Care, and ART Initiation Rates over the First Decade of Expansion

Serena P Koenig1,2, Daphne Bernard1, Jessy G Dévieux3

  • 1Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.

Plos One
|February 23, 2016
PubMed

Insights

Retention in HIV care improved significantly over a decade in Haiti, with more patients initiating antiretroviral therapy (ART). However, targeted efforts are still needed for individuals with higher CD4 counts to ensure consistent linkage to care.

Area of Science:

  • Public Health
  • Infectious Diseases
  • HIV/AIDS Research

Background:

  • High patient attrition from HIV testing to antiretroviral therapy (ART) initiation is a persistent global challenge.
  • Despite expanded services and updated treatment guidelines, temporal trends in pre-ART care retention remain under-documented, hindering policy refinement.

Purpose of the Study:

  • To evaluate temporal trends and identify predictors of patient retention at each stage from HIV testing to ART initiation.
  • To analyze data over a decade at the GHESKIO clinic in Port-au-Prince, Haiti, to inform future public health strategies.

Main Methods:

  • Retrospective analysis of 24,925 adult patients who tested HIV-positive between March 2003 and February 2013.
  • Patients were followed for one year post-testing or until ART initiation, with data stratified by CD4 count.

Main Results:

  • Significant improvements in CD4 count testing and ART initiation were observed over the decade, increasing from 36% to 78% for CD4 testing within 12 months.
  • Retention in pre-ART care or ART initiation within one year improved across all CD4 strata, notably for those with CD4 counts ≤350 cells/mm³.
  • Predictors of attrition included male gender, lower income, and lower education; older age and co-occurring tuberculosis were associated with better retention.

Conclusions:

  • Patient retention and ART initiation have markedly increased over the past decade, especially for those with lower CD4 counts.
  • While overall retention has improved, specific interventions are necessary to enhance care continuity for patients with higher CD4 counts.
Abstract

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