Ten year retention among HIV infected individuals initiated on ART in a programme clinic at Pune, India: Analysis by changes in the national guidelines for ART initiation

Abstract

Background: Retention in care is important for optimal clinical outcomes in HIV infected individuals. The data on retention of patients with changing ART initiation guidelines based on CD4 cut offs in India are scanty. Material and Methods: This retrospective study was conducted among HIV infected individuals registered between December 2005 and July 2016 in a programme clinic. The changes in the CD4 cut offs of 200 cells/ mm3, 250 cells/mm3 and 350 cells/mm3 for ART initiation, as per the national guidelines were considered for retention. Kaplan-Meier survival analysis was used to estimate the time to death, loss to follow up (LTFU) and opting out of the treatment (opted out). Results: The median CD4 counts at the time of registration (linkage) showed significant increase (p<0.001) with the changes in the national guidelines from 200 cells/mm3 to 350 cells/mm3. The survival probability increased significantly with the increase in CD4 cut offs for ART initiation (p=0.018). However, there was no significant difference in time to LTFU and opting out of the treatment for patients initiated on ART in 10 years (p=0.699 and 0.195 respectively). Conclusion: Though the median CD4 count at registration showed upward trend, early linkage to HIV care is important. Efforts should be taken for preventing patients from opting out of the programme in addition to intensified LTFU tracking, by planning effective interventions. It will be important to analyze the factors affecting retention, over a decade. Counseling guidelines should be revised accordingly.