@article{gosset_retention_2019, title = {Retention in {Care} {Trajectories} of {HIV}-{Positive} {Individuals} {Participating} in a {Universal} {Test}-and-{Treat} {Program} in {Rural} {South} {Africa} ({ANRS} 12249 {TasP} {Trial})}, volume = {80}, copyright = {All rights reserved}, issn = {1525-4135}, url = {https://journals.lww.com/jaids/Fulltext/2019/04010/Retention_in_Care_Trajectories_of_HIV_Positive.2.aspx}, doi = {10.1097/qai.0000000000001938}, abstract = {Objective: To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral therapy (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012–2016). Design: A cluster-randomized trial whereby individuals identified HIV positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control). Methods: Exiting care was defined as ≥3 months late for a clinic appointment, transferring elsewhere, or death. Group-based trajectory modeling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients. Results: Four RIC trajectory groups were identified: (1) group 1 “remained” in care (reference, n = 554, 71.3\%), (2) group 2 exited care then “returned” after [median (interquartile range)] 4 (3–9) months (n = 40, 5.2\%), (3) group 3 “exited care rapidly” [after 4 (4–6) months, n = 98, 12.6\%], and (4) group 4 “exited care later” [after 11 (9–13) months, n = 85, 10.9\%]. Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young ({\textless}29 years), without a regular partner, and to have a CD4 count {\textgreater}350 cells/mm3. Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged 39 years or younger. Conclusions: High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed patients with HIV are needed to maximize RIC.}, language = {en-US}, number = {4}, urldate = {2019-02-27}, journal = {JAIDS Journal of Acquired Immune Deficiency Syndromes}, author = {Gosset, Andréa and Protopopescu, Camelia and Larmarange, Joseph and Orne-Gliemann, Joanna and McGrath, Nuala and Pillay, Deenan and Dabis, François and Iwuji, Collins and Boyer, Sylvie}, month = apr, year = {2019}, pages = {375}, }