Sushil Koirala|Keshab Deuba|Oranuch Nampaisan|Gaetano Marrone|Anna Mia Ekström
Facilitators and barriers for retention in HIV care between testing and treatment in Asia—A study in Bangladesh, Indonesia, Lao, Nepal, Pakistan, Philippines and Vietnam
Karolinska Institutet|Karolinska Institutet|Karolinska Institutet|Karolinska University Hospital
introduction need efficient retention hiv care evident ever expansion earlier art initiation shift towards test treat study assesses factors affecting participation hiv care cascade among people living hiv plhiv asiapacific region methods total 7843 plhiv aged 1850 years recruited using targeted venuebased sampling october 1 2012 may 31 2013 across 59 sites 7 countries bangladesh indonesia lao peoples democratic republic lao pdr nepal pakistan philippines vietnam statistically significant associations demographic health system determinants various steps hiv care cascade computed using generalized structural equation model results high proportion plhiv 4051 presented late hiv care delayed linkage care seven countries however plhiv enrolled care retention various steps care cascade including adherence antiretroviral treatment art satisfactory proportion still engaged hiv care 36 months post hiv diagnosis varied 78 nepal 90 lao pdr similarly proportion art initiation also adherent art ranged 91 bangladesh 95 philippines vietnam 70 lao pdr 89 philippines respectively following factors enhanced likelihood art initiation high adherence hiv care art good clientprovider communication high hiv treatment literacy referral health worker tbhiv coinfection following barriers identified young age sex work imprisonment transgender identity illiteracy rural residence alcohol injecting drug use perceived poor health status lack health insurance fear confidentiality breach selfreferral hiv testing public hospital place hiv diagnosis conclusions hiv programme planners ensure easy access hiv testing earlier linkage hiv care among plhiv addition multiple socioeconomic health systems barriers need addressed along hiv care cascade reach unaids 909090 target asiapacific region