Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review


Roy M, Czaicki N, Holmes C, Chavan S, Tsitsi A, Odeny T, Sikazwe I, Padian N, Geng E.


Curr HIV/AIDS Rep. 2016 May 17. [Epub ahead of print]


Sustained retention represents an enduring and evolving challenge to HIV treatment programs in Africa. We present a theoretical framework for sustained retention borrowing from ecologic principles of sustainability and dynamic adaptation. We posit that sustained retention from the patient perspective is dependent on three foundational principles: (1) patient activation: the acceptance, prioritization, literacy, and skills to manage a chronic disease condition, (2) social normalization: the engagement of a social network and harnessing social capital to support care and treatment, and (3) livelihood routinization: the integration of care and treatment activities into livelihood priorities that may change over time. Using this framework, we highlight barriers specific to sustained retention and review interventions addressing long-term, sustained retention in HIV care with a focus on Sub-Saharan Africa.

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