Abnormal But Nonetheless , Potential AZD6244 Procedures

This literature review highlights several gaps in the knowledge on Telomerase retention in HIV care prior to ART eligibility. First, 10 of the 12 studies identified were conducted in eastern and southern Africa; reports from West Africa, where healthcare systems have been described as less efficient, are lacking. Second, three of these studies reported that, among patients with a second CD4 measurement, about 70% of individuals were still not ART-eligible at that time.14 19 21 However, only one paper focused on retention in HIV care beyond the second CD4 measurement,15 and three others reported retention in HIV care prior to ART eligibility regardless of the number of CD4 measurements.12 20 22 As the consensus is that individuals should be diagnosed as early as possible in the course of HIV infection before becoming eligible for ART,11 and bearing in mind that the CD4 threshold for ART initiation has been recently enlarged,10 the period between HIV diagnosis and ART initiation is a critical one for optimising the care plan. Longer term retention in HIV care prior to ART eligibility should thus be further documented. Third, further methods, such as tracking by peer educators and use of mobile technologies, could contribute to better retention and more correct estimations of retention,20 accounting for people who are retained in care in the overall health system, but outside a given study clinic. Lastly, the 12 studies included in our review showed that retention in pre-ART care was associated with sociodemographic and clinical individual factors. However, the role of programmatic and logistic factors (such as time/distance to clinic, waiting time in clinic, costs for transportation or looking after the children) was very rarely studied, as well as perceptions on HIV care at individual and community levels. Nevertheless, as discussed by Boyles et al,8 reasons for low retention in pre-ART care may include the lack of availability of comprehensive HIV care services and the perception that ART is only necessary in individuals who become sick, suggesting that these factors should be further explored as potential barriers to retention in pre-ART care. The results of our review highlight the urgent need to continue designing and evaluating interventions aimed at improving retention in HIV care, especially for people not yet eligible for ART. To date, several interventions have targeted the improvement of ART adherence, for example, reminder services (such as mobile phones, text messaging and diary cards)29 30 and treatment supporters.30 These interventions should now be adapted for improving retention in pre-ART care, and especially before ART eligibility, too.