Correlates of Patient Retention in HIV Care and Treatment Programs in Nigeria.

Background: Long-term retention is a crucial component of HIV care because treatment success can only be measured among retained patients. Understanding determinants of retention will inform retention strategies. We evaluated the correlates of retention in a large HIV program in Nigeria.

Methods: We reviewed quality of care data for 5320 randomly selected HIV-positive adults aged ≥15 years enrolled in 37 treatment facilities in Nigeria between 2005 and 2009. Retention was described as having one or more clinic visits in the one year (2010) review period. Patient-related correlates of retention were determined using logistic regression.

Results: 144 patients exited the program through deaths or transferrals. Of the 5176 with no documented exits, 3231 (62.4%) were retained (65.6% female; median age: 35.6 years). 2938 (75.8%) patients on ART, and 286 (23.4%) pre-ART patients were retained. Being on ART (OR=10.3, p<0.001), Age 30-60 years (30 - 45 years: OR=1.36, p<0.001 and >45 - 60 years: OR=1.47, p<0.001) compared to patients <30 years; Female gender (OR=1.18, p=0.006), baseline CD4 cell count (100-350 cells/mm(3): OR=1.24, p=0.006) vs <100 cells/mm(3) and lower WHO stage at baseline (WHO Stage IV, III, II: OR=0.50,0.51,0.77 respectively) vs Stage I were associated with retention. Among patients on ART, recent ART initiation 2008-09 (OR=1.73, p<0.001) vs 2005-07, being on ART for >6 months (p<0.001) vs <6 month and initiating ART on non-Stavudine based regimen (p<0.001) were also associated with retention.

Conclusion: 3 out of 4 pre-ART patients and 1-in-4 ART patients were not retained in 37 HIV treatment facilities in Nigeria. These findings provide insight that enables HIV programs integrate retention strategies at all stages of the HIV care continuum.