Retention in care

Earlier today I went to an oral abstract presentation (MOAC03) on Access to and retention of antiretroviral treatment.

Despite improved mortality, a study from the UK (M Kall et al) found that PWLHA were still at 2 fold risk of non-AIDS mortality compared to the general population, at all age ranges. This contrasts with data from the AHOD study which demonstrated that Standard mortality ratios, particularly for those undetectable for a few years, and of older age, were not particularly increased.  A difference between these findings might be that the UK  study was not able to take into account last CD4 count before death, a possible important factor.

Another interesting study, performed in part by a Melbourne study group  (McMahon et al) looked at methods to improve retention in care; an important aspect if treatment is to be rolled out further. Specifically they performed a meta-analysis of physical patient tracing studies, in other words studies where patients were actively followed up in person (rather than by telephone call or not followed up), if they became lost to follow up. They found that of about 50 studies addressing this issue, on average lost to follow up rates were lower (7% vs 15%) if physical tracing occurred, and retention on cART was slightly better.  The cost effectiveness of this approach is yet to be tested, and apparently a randomised controlled trial is planned to address this. Many Australian clinics have SMS based reminders or follow-up processes, but unfortunately this study could not include analysis of these techniques.

On a lighter note, I was served an entire half duck in a restaurant last night, and breakfast is so large I don’t need to eat any lunch all day! Might have to go for a quick jog to burn it all off.