Patient Retention in Antiretroviral Therapy Programs; A Retrospective Cohort Study in a Triangular HIV Clinic

  • Azadeh Khalatbari Limaki
  • Behnam Farhoudi
  • Mehrnaz Rasoolinejad
  • Mehrnaz Rasoolinejad
  • Saeed Safari Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Keywords: Antiretroviral Therapy, Highly Active, Human Immunodeficiency Virus, Withholding Treatment, Survival Rate


Background: High rate of adherence to antiretroviral therapy (ART) is critical for the optimized outcome. The present study aimed to determine the rate of retention in ART programs and its’ associated factors in a triangular clinic. Materials and Methods: The present retrospective cohort study was conducted on people living with HIV receiving care in a triangular clinic affiliated with Iranian research center for HIV/AIDS, Tehran, Iran, from 2003 to 2008. Baseline variables, duration of ART, and cause of treatment discontinuation were gathered using patients’ profile and analyzed by SPSS 21 and STATA 11. Results: Three hundred and seventeen cases with the mean age of 37.69 ± 10.63 (2–76) years were included (83.9% male). Treatment discontinuation had happened in 142 (45.2%) cases. Cause of treatment discontinuation was death in 20 (13.7%) cases and personal preference in 126 (86.3%) individuals. 6, 12, 18, 24, 36, and 60 months retention rates were 81.1%, 58.4%, 48.3%, 35.6%, 22.9%, and 6.3%, respectively. The results of multivariate logistic regression analysis showed a significant association between treatment retention and female sex (OR: 4.10; 95% CI: 1.59–10.56, P=0.003), addiction/drug use (OR: 0.39; 95% CI: 0.21– 0.77, P=0.007), and lamivudine+ zidovudine+ indinavir treatment regimen (OR: 0.63; 95% CI: 0.46 -0.87, P= 0.005). Conclusion: Based on the findings, male sex, addiction/drug use, and type of treatment regimen were among the most important risk factors for ART attrition in HIV-infected patients. [GMJ.2017;6(2):110-117]


Mannheimer S, Friedland G, Matts J, Child C, Chesney M, Beirn T. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for Human Immunodeficiency Virus—infected persons in clinical trials. Clin Infect Dis. 2002;34(8):1115-21.

Giordano TP, Gifford AL, White AC, Almazor MES, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493-9.

Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18(Suppl 1):S19.

Penedo FJ, Gonzalez JS, Dahn JR, Antoni M, Malow R, Costa P, et al. Personality, quality of life and HAART adherence among men and women living with HIV/AIDS. J Psychosom Res. 2003;54(3):271-8.

Johnson MO, Dilworth SE, Neilands TB. Partner reports of patients’ HIV treatment adherence. J Acquir Immune Defic Syndr. 2011;56(4):e117.

Lessells RJ, Mutevedzi PC, Cooke GS, Newell M-L. Retention in HIV care for individuals not yet eligible for antiretroviral therapy: rural KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2011;56(3):e79.

Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med. 2011;8(7):e1001056.

Ulett KB, Willig JH, Lin H-Y, Routman JS, Abroms S, Allison J, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS. 2009;23(1):41-9.

Eshrati B, Asl RT, Dell CA, Afshar P, Millson PM, Kamali M, et al. Preventing HIV transmission among Iranian prisoners: initial support for providing education on the benefits of harm reduction practices. Harm Reduct J. 2008;5(1):1.

Nissaramanesh B, Trace M, Roberts M. The rise of harm reduction in the Islamic Republic of Iran. Beck Found Drug. 2005;8:1-7.

Islamic Republic of Iran AIDS Progress Report. March 2015(

Fox MP, Rosen S. Retention of Adult Patients on Antiretroviral Therapy in Low-and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013. J Acquir Immune Defic Syndr. 2015;69(1):98-108.

Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007–2009: systematic review. Trop Med Int Health. 2010;15(s1):1-15.

Stringer JS, Zulu I, Levy J, Stringer EM, Mwango A, Chi BH, et al. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA. 2006;296(7):782-93.

Group ISS. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;2015(373):795-807.

Mills EJ, Ford N, Mugyenyi P. Expanding HIV care in Africa: making men matter. The Lancet. 2009;374(9686):275-6.

Lucas GM, Gebo KA, Chaisson RE, Moore RD. Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS. 2002;16(5):767-74.

Palepu A, Tyndall MW, Joy R, Kerr T, Wood E, Press N, et al. Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy. Drug Alcohol Depend. 2006;84(2):188-94.

Squires K, Lazzarin A, Gatell JM, Powderly WG, Pokrovskiy V, Delfraissy J-F, et al. Comparison of once-daily atazanavir with efavirenz, each in combination with fixed-dose zidovudine and lamivudine, as initial therapy for patients infected with HIV. J Acquir Immune Defic Syndr. 2004;36(5):1011-9.

Van Leth F, Phanuphak P, Ruxrungtham K, Baraldi E, Miller S, Gazzard B, et al. Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomised open-label trial, the 2NN Study. The Lancet. 2004;363(9417):1253-63.

Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS (London, England). 2004;18(Suppl 1):S19.

Becker S, Dezii C, Burtcel B, Kawabata H, Hodder S. Young HIV-infected adults are at greater risk for medication nonadherence. Med Gen Med. 2002;4(3):21-2.

Wutoh AK, Brown CM, Kumoji EK, Daftary MS, Jones T, Barnes NA, et al. Antiretroviral adherence and use of alternative therapies among older HIV-infected adults. J Natl Med Assoc. 2001;93(7-8):243.

Siddall JW, Conway GL. Interactional variables associated with retention and success in residential drug treatment. Int J Addict. 1988;23(12):1241-54.

Goudge J, Gilson L, Russell S, Gumede T, Mills A. The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor. Trop Med Int Health. 2009;14(4):458-67.

Bernklev T, Jahnsen J, Henriksen M, Lygren I, Aadland E, Sauar J, et al. Relationship between sick leave, unemployment, disability, and health‐related quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2006;12(5):402-12.

Hassan AS, Fielding KL, Thuo NM, Nabwera HM, Sanders EJ, Berkley JA. Early loss to follow‐up of recently diagnosed HIV‐infected adults from routine pre‐ART care in a rural district hospital in Kenya: a cohort study. Trop Med Int Health. 2012;17(1):82-93.

Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med. 1999;14(5):267-73.

Hallett TB, Gregson S, Dube S, Garnett GP. The impact of monitoring HIV patients prior to treatment in resource-poor settings: insights from mathematical modelling. PLoS Med. 2008;5(3):e53.

Bendavid E, Young SD, Katzenstein DA, Bayoumi AM, Sanders GD, Owens DK. Cost-effectiveness of HIV monitoring strategies in resource-limited settings: a southern African analysis. Arch Intern Med. 2008;168(17):1910-8.

Wang B, Losina E, Stark R, Munro A, Walensky RP, Wilke M, et al. Loss to follow-up in a community clinic in South Africa: roles of gender, pregnancy and CD4 count. S Afr Med J. 2011;101(4):253-7.

Cornell M, Myer L, Kaplan R, Bekker LG, Wood R. The impact of gender and income on survival and retention in a South African antiretroviral therapy programme. Trop Med Int Health. 2009;14(7):722-31.

Massaquoi M, Zachariah R, Manzi M, Pasulani O, Misindi D, Mwagomba B, et al. Patient retention and attrition on antiretroviral treatment at district level in rural Malawi. Trans R Soc Trop Med Hyg. 2009;103(6):594-600.

How to Cite
Khalatbari Limaki, A., Farhoudi, B., Rasoolinejad, M., Rasoolinejad, M., & Safari, S. (2017). Patient Retention in Antiretroviral Therapy Programs; A Retrospective Cohort Study in a Triangular HIV Clinic. Galen Medical Journal, 6(2), 110-117.
Original Article