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dc.contributor.authorFont, Helene
dc.contributor.authorRollins, Nigel
dc.contributor.authorEssajee, Shaffiq
dc.contributor.authorBecquet, Renaud
dc.contributor.authorFoster, Geoff
dc.contributor.authorMangwiro, Alexio-Zambezio
dc.contributor.authorMwapasa, Victor
dc.contributor.authorOyeledun, Bolanle
dc.contributor.authorPhiri, Sam
dc.contributor.authorSam-Agudu, Nadia A
dc.contributor.authorBellare, Nita B
dc.contributor.authorOrne-Gliemann, Joanna
dc.date.accessioned2020-10-26T19:33:57Z
dc.date.available2020-10-26T19:33:57Z
dc.date.issued2020-10-08
dc.identifier.urihttp://hdl.handle.net/10713/13947
dc.description.abstractINTRODUCTION: Definitions of retention-in-care in Prevention of Mother-to-Child Transmission of HIV (PMTCT) vary substantially between studies and programmes. Some definitions are based on visits missed/made, others on a minimum total number of visits, or attendance at a final clinic visit at a specific time. An agreed definition could contribute to developing evidence-based interventions for improving retention-in-care. In this paper, we estimated retention-in-care rates according to different definitions, and we quantified and visualized the degree of agreement between definitions. METHODS: We calculated retention in care rates using nine definitions in the six INSPIRE PMTCT intervention studies, conducted in three sub-Saharan African countries between 2013 and 2017. With data from one of the studies (E4E), we estimated the agreement between definitions using Gwet's agreement coefficient (AC1) and concordance. We calculated positive predictive values (PPV) and negative predictive values (NPV) for all definitions considering successively each definition as the reference standard. Finally, we used a Multiple Correspondence Analysis (MCA) to examine clustering of the way different definitions handle retention-in-care. RESULTS: Retention-in-care rates among 5107 women ranged from 30% to 76% in the complete dataset with Gwet's AC1 being 0.56 [0.53; 0.59] indicating a moderate agreement between all definitions together. Two pairs of definitions with high inner concordance and agreement had either very high PPV or very high NPV, and appeared distinct from the other five definitions on the MCA figures. These pairs of definitions were also the ones resulting in the lowest and highest estimates of retention-in-care. The simplest definition, that only required a final clinic visit to classify women as retained in care, and classified 55% of women as retained in care, had a PPV ranging from 0.7 to 1 and a NPV ranging from 0.69 to 0.98 when excluding the two pairs afore-mentioned; it resulted in a moderate to substantial agreement and a 70% to 90% concordance with all other definitions. CONCLUSIONS: Our study highlights the variability of definitions in estimating retention-in-care. Some definitions are very stringent which may be required in some instances. A simple indicator such as attendance at a single time point may be sufficient for programme planning and evaluation.en_US
dc.description.urihttps://doi.org/10.1002/jia2.25609en_US
dc.language.isoenen_US
dc.publisherWiley-Blackwellen_US
dc.relation.ispartofJournal of the International AIDS Societyen_US
dc.rights© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.en_US
dc.subjectAfricaen_US
dc.subjectHIV care continuumen_US
dc.subjectPMTCTen_US
dc.subjectoutcome assessmenten_US
dc.subjectretentionen_US
dc.subjectwomenen_US
dc.titleRetention-in-care in the PMTCT cascade: definitions matter! Analyses from the INSPIRE projects in Malawi, Nigeria and Zimbabween_US
dc.typeArticleen_US
dc.identifier.doi10.1002/jia2.25609
dc.identifier.pmid33030306
dc.source.volume23
dc.source.issue10
dc.source.beginpagee25609
dc.source.endpage
dc.source.countryInternational
dc.source.countrySwitzerland


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