| Description |
The success of national and global efforts to scale up access to HIV diagnosis and HIV/AIDS treatment in resource-constrained countries has created a challenge for health systems in providing appropriate care for millions of HIV-positive people who are not yet eligible for antiretroviral therapy (ART). These challenges have been magnified by newer findings about the importance of early treatment initiation, the value of prophylaxis for opportunistic infections, and the potential prevention value of test-and-treat strategies. Available research suggests that only about a third of those who test HIV-positive are successfully linked to an HIV care program and retained continuously in care, such that they can initiate ART as soon as they are eligible. Current programs generally compartmentalize services and patients, lack consistent patient information systems, and rely on poorly-developed referral networks to ensure that HIV-positive patients enroll in pre-ART care after and receive timely and appropriate services at each stage until they are eligible to initiate ART. Research generally mirrors this compartmentalization, making it difficult to develop a comprehensive strategy for long-term patient management. This presentation will first review what is known about linkages between points of care (testing, staging, pre-ART care, ART initiation) and retention of patients at each stage, using data from sub-Saharan Africa. It will then look at interventions that may improve retention in pre-ART care. Finally, it will suggest future research questions that should be answered if health systems are to meet the challenges of providing care to an ever-expanding number of patients. |
