Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review

Monika Roy, Nancy Czaicki, Charles Holmes, Saurabh Chavan, Apollo Tsitsi, Thomas Odeny, Izukanji Sikazwe, Nancy Padian, Elvin Geng

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations


Sustained retention represents an enduring and evolving challenge to HIV treatment programs in Africa. We present a theoretical framework for sustained retention borrowing from ecologic principles of sustainability and dynamic adaptation. We posit that sustained retention from the patient perspective is dependent on three foundational principles: (1) patient activation: the acceptance, prioritization, literacy, and skills to manage a chronic disease condition, (2) social normalization: the engagement of a social network and harnessing social capital to support care and treatment, and (3) livelihood routinization: the integration of care and treatment activities into livelihood priorities that may change over time. Using this framework, we highlight barriers specific to sustained retention and review interventions addressing long-term, sustained retention in HIV care with a focus on Sub-Saharan Africa.

Original languageEnglish
Pages (from-to)177-185
Number of pages9
JournalCurrent HIV/AIDS Reports
Issue number3
StatePublished - Jun 1 2016


  • Community-based care
  • HIV care and treatment
  • Health maintenance
  • Patient activation
  • Retention
  • Social capital
  • Social network
  • Sustainability
  • Treatment literacy


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