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.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/28013 |
| Date | January 2022 |
| Creators | Rehman, Nadia |
| Contributors | Mbuagbaw, Lawrence, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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