Objectives: To determine retention in HIV care for individuals not
yet eligible for antiretroviral therapy (ART) and to explore factors
associated with retention in a rural public health HIV program.
Methods: HIV-infected adults ($16 years) not yet eligible for ART,
with CD4 cell count .200 cells per microliter from January 2007 to
December 2007 were included in the analysis. Retention was defined by
repeat CD4 count within 13 months. Factors associated with retention
were assessed using logistic regression with clustering at clinic level.
Results: Four thousand two hundred twenty-three were included in
the analysis (83.9% female). Overall retention was 44.9% with
median time to return 201 days [interquartile range (IQR): 127?274].
Retention by initial CD4 count 201?350, 351?500, and .500 cells
per microliter was 51.6% [95% confidence interval (CI): 49.1 to
54.0], 43.2% (95% CI: 40.5 to 45.9), and 34.9% (95% CI: 32.4 to
37.4), respectively. Compared with CD4 201?350 cells per microliter,
higher initial CD4 count was significantly associated with lower
odds of retention [CD4: 351?500 cells/mL adjusted odds ratio (aOR):
0.72, 95% CI: 0.62 to 0.84; CD4.500 cells/mL aOR: 0.51, 95% CI: 0.44
to 0.60]. Male sex was independently associated with lower odds (aOR:
0.80, 95% CI: 0.67 to 0.96), and older age with higher odds of retention
(for each additional year of age aOR: 1.03, 95% CI: 1.03 to 1.04).
Conclusions: Retention in HIV care before eligibility for ART is
poor, particularly for younger individuals and those at an earlier stage.