Missed opportunities for retention in pre-ART care in Cape Town, South Africa

PLoS One. 2014 May 7;9(5):e96867. doi: 10.1371/journal.pone.0096867. eCollection 2014.


Background: Few studies have evaluated access to and retention in pre-ART care.

Objectives: To evaluate the proportion of People Living With HIV (PLWH) in pre-ART and ART care and factors associated with retention in pre-ART and ART care from a community cohort.

Methods: A cross sectional survey was conducted from February - April 2011. Self reported HIV positive, negative or participants of unknown status completed a questionnaire on their HIV testing history, access to pre-ART and retention in pre-ART and ART care.

Results: 872 randomly selected adults who reported being HIV positive in the ZAMSTAR 2010 prevalence survey were included and revisited. 579 (66%) reconfirmed their positive status and were included in this analysis. 380 (66%) had initiated ART with 357 of these (94%) retained in ART care. 199 (34%) had never initiated ART of whom 186 (93%) accessed pre-ART care, and 86 (43%) were retained in pre-ART care. In a univariable analysis none of the factors analysed were significantly associated with retention in care in the pre-ART group. Due to the high retention in ART care, factors associated with retention in ART care, were not analysed further.

Conclusion: Retention in ART care was high; however it was low in pre-ART care. The opportunity exists, if care is better integrated, to engage with clients in primary health care facilities to bring them back to, and retain them in, pre-ART care.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Cross-Sectional Studies
  • Female
  • HIV / drug effects
  • HIV / pathogenicity
  • HIV Infections / epidemiology*
  • HIV Infections / pathology
  • HIV Infections / therapy*
  • HIV Infections / virology
  • Humans
  • Male
  • Middle Aged
  • Retention, Psychology*
  • South Africa
  • Young Adult


  • Anti-HIV Agents

Grant support

This research was supported by a United States Agency for International Development (USAID) Cooperative Agreement (TREAT TB – Agreement No. GHN-A-00-08-00004-00). The contents are the responsibility of the author(s) and do not necessarily reflect the views of USAID. Funders URL: www.usaid.gov/south-africa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.