This is the first comprehensive systematic review of the definitions used for retention measures in HIV care. This review provides a compilation of existing definitions of retention in HIV care in randomized controlled trials. In summary, we report very little consensus regarding definitions of retention in HIV care in the research literature. We report and compare definitions of retention so researchers can weigh their definitions with the body of definitions, with the ultimate aim of motivating the research community to establish a clear and unambiguous definition. This work will provide resources for researchers to recommend a definition of retention. Future research is needed to seek practitioners’ views on the most unambiguous, explicit definition of retention. This is only a first step in research toward a standard definition of retention. / Introduction Retention in HIV care is critical for PLHIV. However, retention in HIV care is not measured uniformly across studies. The aim of this study within a review (SWAR) is to describe the diversity in definitions used for retention in HIV care in randomized controlled trials. Methods We conducted a SWAR, drawing data from an overview of systematic reviews on interventions to improve the HIV care cascade. A comprehensive and exhaustive search was conducted of the following databases: PubMed, Excerpta Medica data BASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Web of Science, and the Cochrane Library. We identified randomized controlled trials (RCTs) of interventions to improve retention in care for people living with HIV (PLHIV). First, from the included studies in systematic reviews and second using targeted searches for RCTs. Only English language systematic reviews were included, but RCTs in any language were eligible. Data were screened and extracted in duplicate using pre-set criteria, with arbitration as needed. We identified distinct components from the definitions used to measure retention. The components were further categorized based on the similarities between them. We described the components narratively and presented the definitions in tables. Results We identified 8001 records, after a duplication check, 4147 unique titles and abstracts were examined for relevancy, leaving 744 articles. Full-text screening of the articles resulted in 50 articles that measured retention and provided 59 definitions for retention in care. Of the included studies, 11(22%) were conducted in low-income countries, 12(24%) were conducted in lower-middle-income and upper-middle-income countries, and 13(26%) were conducted in high-income countries. We identified ten different components used to define retention. These components are follow-up times (83%), administrative records (8%), clinical visits (61%), gap scores (8%), group-level measures (17%), lab records (15%), pharmacy-based measures (29%), scheduled visits (27%) and visit counts (17%). The most frequently used components are follow-up times (n=49), and the easiest to measure are retention data derived from administrative records (n=5). We put the components into categories based on the similarities between them. Conclusion We identified existing definitions of retention in HIV care and the commonly used components in the definitions. This compilation of the definitions and identification of the components may provide a framework for developing the standard globally agreed-upon definition of retention in HIV care. / Thesis / Master of Health Sciences (MSc) / Globally, there are more than 37.7 million people living with HIV (PLHIV). Retention in human immunodeficiency virus (HIV) care is a common and modifiable determinant of increased adherence to antiretroviral therapy (ART), better health outcomes, and a better quality of life. There is no consensus in the literature on measures of retention in HIV care. This makes it very difficult to compare different studies and jurisdictions. This thesis review summarizes the definitions of retention used in randomized controlled trials (RCTs) and identifies the various components used to measure retention, which can be used as a reference for researchers to identify the gaps in the current definitions for HIV retention measures and identify preferred measures with the goal of reaching a standard consensus definition of retention in HIV care.

Magister Public Health - MPH / In 2018, it was estimated that 33,000 adolescent girls and 4,200 adolescent boys were HIV-positive in South Africa. The Free State province reports that 89% of people living with HIV are diagnosed; 72% of those diagnosed are receiving antiretroviral therapy (ART); of which 93% have achieved viral suppression (< 1000 RNA copies/mL). Thabo Mofutsanyane District has the highest HIV prevalence in the Free State province. A retrospective, quantitative cross-sectional study was conducted to determine the predictors of viral suppression among adolescents on ART in Thabo Mofutsanyane District Municipality, Free State province, South Africa. Data for all adolescents, aged 10–19 years, receiving ART in 2019 (N = 6 300) was extracted from Tier.net electronic database into an Excel spread sheet and exported into Statistical Package for the Social Sciences – Version 26 (SPSS v 26) for analysis.

In the last few years, engagement in medical care among individuals living with HIV has become a major priority among HIV medical providers and public health researchers. Engagement in medical care is an important concept as it involves the process of linking newly diagnosed individuals into medical care and retaining those individuals in care throughout the course of their infection. Although there have been major advances in the management of HIV, like the advent of Highly Active Antiretroviral Therapy, morbidity and mortality due to HIV cannot be fully reduced if the individual does not optimally retain in care. Retention in HIV medical care has become an emerging topic in HIV research, but there still remains a scarce amount of research on how to properly define retention, understand its predictors, and how it impacts HIV outcomes. The purpose of this dissertation was to evaluate retention in HIV medical care among individuals diagnosed with HIV and seeking care at an urban infectious disease clinic in Kentucky. The three specific aims of this dissertation were to: (1) compare methods in measuring retention in HIV medical care; (2) determine the predictors of poor retention in care and assess the effect of non-HIV related comorbidities have on retention over time; and (3) determine the impact early retention to medical care has on time to viral load suppression and rebound among individuals initiating Highly Active Antiretroviral Therapy. A retrospective cohort study was conducted employing a medical chart review, and patients who sought HIV care at the Bluegrass Care Clinic between January 1st 2003 and May 1st 2011 were eligible for the study. There were 1,358 patients included in the study and these individuals were followed until December 31st, 2011. The results suggested that individuals living with HIV should seek care at least once every six months (visit constancy) and that only 48.6% of the study population obtained optimal retention over time. Over time the rate of retention decreased among the study sample and those with optimal retention were more likely to suppress their viral loads compared to poor retainers.

Introduction: A culturally competent survey currently does not exist to characterize the burden of Adverse Childhood Experiences (ACEs) among a HIV/AIDS population receiving care at a local Center of Excellence (COE). Methods: A qualitative study was conducted including 11 interviews involving opinions on national surveillance questions to develop a culturally competent survey. Purposive sampling, reactive probing, and analysis of transcribed interviews were completed using structured coding to determine which questions were kept, modified, or removed in the final survey. Results: The final 55-question survey contained more generalized ACE questions, topics pertaining to barriers to HIV care, and a list that patients could select from to indicate what they need to improve their HIV care. Conclusion: The final survey provided the opportunity to characterize the burden of ACEs at a COE. Future directions involve piloting the survey as a quality improvement tool with the goal of increasing retention rates through more individualized HIV care.

Magister Public Health - MPH (Public Health) / Approximately 6% of all people living with HIV in 2016 are adolescents aged 10-19 years. It is reported globally that adolescents on antiretroviral therapy (ART) are at increased risk for poor retention in care, adherence and viral load suppression, compared to children and adults.

Submitted by Noeme Timbo (noeme.timbo@metodista.br) on 2017-01-18T18:23:10Z No. of bitstreams: 1 AndressaMauricio.pdf: 1450562 bytes, checksum: 719a82b7472fe6a4903ebda5e5a101b1 (MD5) / Made available in DSpace on 2017-01-18T18:23:10Z (GMT). No. of bitstreams: 1 AndressaMauricio.pdf: 1450562 bytes, checksum: 719a82b7472fe6a4903ebda5e5a101b1 (MD5) Previous issue date: 2016-08-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This project aims at identifying whether the corporate education program contributes in the retention of team leaders of an Intensive Care Unit, in a hospital, south of the state of São Paulo, Brazil. In order to do so, this research has taken a qualitative, exploratory and descriptive approach. Data collection was done by in-depth individual interviews, relying on a semi-structured script. Such approach was chosen for its relevance and the possibility of more in-depth further study. Two executives of the institution’s corporate university as well as seven of its ICU team leaders have been interviewed for this research. It has been found that the corporate education program in this specific hospital incentives practices that relate to concepts as "competitiveness", “perpetuity”, "connectivity", "availability" and "citizenship", demanding some development in the principles of "partnership" and "sustainability". This study shows considerable evidence of the impact the program has in the performance of leaders with their subordinates. The most significant contributions this program appears to have in these professionals' career development are the adoption of a performance indicator tool, the work done on interpersonal skill development and especially the leadership development program. To conclude, the corporate education program implemented in this hospital contributes effectively in the retention of its ICU team leaders. / Este estudo teve o objetivo de identificar se o processo de educação corporativa, implantado e estruturado, contribui para a retenção de líderes em uma unidade de terapia intensiva de uma instituição hospitalar do ABC paulista. Para isso, a pesquisa assumiu uma abordagem qualitativa, de caráter exploratório e descritivo. A coleta de dados foi realizada por meio de entrevistas individuais, com o suporte de roteiro semiestruturado. Tal método foi escolhido por sua relevância e possibilidade de aprofundamento. Foram entrevistadas duas gestoras da universidade corporativa (UC) e sete líderes com atuação na Unidade de Terapia Intensiva (UTI). Concluiu-se que a universidade corporativa da unidade hospitalar avaliada tem práticas relacionadas aos princípios de sucesso “competitividade”, “perpetuidade”, “conectividade”, “disponibilidade” e “cidadania” e requer algum desenvolvimento em “parceria” e “sustentabilidade”. Ficou clara a contribuição das ações da universidade corporativa para a atuação prática do líder junto às suas equipes, tendo como principais fatores de contribuição da educação corporativa para a carreira a avaliação de desempenho, os recursos para aprimoramento no relacionamento interpessoal e um forte destaque ao programa de desenvolvimento de líderes. Por fim, o estudo apontou que direta e indiretamente a UC na instituição pesquisada contribui efetivamente para a retenção dos líderes da UTI.

Master of Public Health - MPH / Background: According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) 340 000 children between 0-14years of age are living with HIV in South Africa as of 2019. Decentralization of HIV services was included in South Africa’s paediatric guidelines since 2010 in a bid to improve access to care. The current study sought to address the paucity of Eastern Cape (EC) data on the outcomes of down-referred paediatric antiretroviral therapy (ART) patients. These outcomes included retention in care (RIC) and virological suppression after 12 months Methodology: This retrospective analysis was conducted in the Buffalo City Municipality (BCM) district of the EC. The study population included HIV positive males and females, 0-14 years of age at transfer, who were initiated on ART at a tertiary or a regional hospital and subsequently down-referred, between June 2013 and June 2017. Data were collected from electronic databases at the facilities (Tier.net), patient files and patient registers. A descriptive analysis was performed using SPSS Statistics software version 26. Results: In total, 80.1% of patients successfully down-referred to a primary healthcare (PHC) facility, in a median of 42 days. Of those, 95.4% of patients were retained in care at 6 months and 93.1% at 12 months after arrival, with a median of 4 scheduled monthly visits missed. For those with results, virological suppression was maintained in 96.7% of patients at 6 months, 92.2% at 12 months and 96.2% for the entire post-transfer period of 2-14 months. In the 2-14 months post down-referral only 76.9% of patients had at least one viral load (VL) result and 50.3% had one CD4 result. For those with results, immune response (IR) to ART was maintained in 100% of patients at 6 months, 94.3% at 12 months and 97.7% in the 2-14 month period post successful down-referral. Conclusions: This study confirmed that loss to follow-up (LTFU) and treatment interruption at the point of transfer are significant risk factors for paediatric ART patients. This study also demonstrated high levels of RIC once patients had successfully down-referred. However, missed clinic visits suggest possible treatment interruptions for many patients post down-referral. While good virological and immunological responses to ART were maintained at the PHC facilities, suboptimal VL and CD4 monitoring was highlighted by the low proportion of available results. Therefore, while there are a number of issues to address, this study confirms that down-referral is a feasible option for up-scaling paediatric HIV care in the EC.

PhD (Psychology) / Department of Psychology / Background: South Africa has world’s highest prevalence of HIV-positive people with approximately 7.06 million HIV-positive people with 110 000 HIV- related deaths reported by Statistics South Africa in 2017. South Africa has expanded access to anti-retroviral therapy services, from urban centers to resource-constrained rural communities. The rate of loss, however, to follow-up for patients on anti-retroviral treatment continues to increase. Aim of the Study: The aim of this study was to determine patient and nurse perspectives on loss to follow up among HIV-positive patients in Sekhukhune District of Limpopo Province, South Africa. The findings of the study guided the development of a proposed strategy to decrease loss to follow up among HIV-positive patients. Method: A qualitative research design was used with non-probability purposive sampling and with probability systematic sampling. The sample of patients comprised 30 HIV-positive people classified as lost to follow-up from clinics with high prevalence rates of lost to follow-up patients. Eight nurses, four from clinics with high rates and four from clinics with low lost to follow-up rates comprised the sample of nurses. Semi-structured interviews were conducted using the study research questions as a guide. Eight interviews were conducted with nurse clinic managers and 30 with the patients. Content analysis was used to analyze the data. Results: The key themes that emerged from the study included patients’ and nurses` perspectives on factors contributing to loss to follow up among HIV- positive patients; and Patients’ and nurses’ perspectives on strategies that would address barriers to loss to follow up among HIV- positive patients. Sub-themes on patients’ and nurses’ perspectives on factors contributing to loss to follow up among HIV- positive patients included: Lack of understanding of anti-retroviral treatment; fearful to disclose HIV status; lack of confidentiality; negative side effects; use of traditional medicine; self-transfer from one clinic to another. Patients’ and nurses’ elicited the strategies that would assist patients to remain in care and to take antiretroviral treatment consistently. The strategies included: providing patients with health education; working as a team; implementing social support group programme; providing nurses with in-service education on ethics and ethos. Informed by various intervention models in HIV care: Information Motivational Behavioural model; Health Belief Model; Social Action Theory and Social Cognitive Theory; I proposed a strategy that may reduce the rate of non-adherence and loss to follow up among patients with HIV in Limpopo Province. / HWSETA