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Table 3 Advantages, limitations, and programmatic practicality of six measures of retention in care for PMTCT option B+ programs

From: Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programs: the Mozambique experience

Retention definitionAdvantagesLimitationsProgrammatic practicality
‘Point’ retentionEasy to measure
Assessed at a single time point
Provide a transversal picture of retention
Does not consider visit consistency of the MIP
Does not consider whether the women fully adhered to the 12-month visit schedule
Not aligned with important PMTCT milestones (i.e. delivery, EID, or final HIV testing)
Programmatic definition of retention
Achievable with simple health information systems (e.g. paper-based registers)
WHOEasy to measure
Assessed at a single time point
Provide a transversal picture of retention
More specific in detecting patients adhering to the 12-month visit (up to 15-months only)
Does not consider visit consistency of the MIP
Not aligned with important PMTCT milestones (i.e. delivery, EID, or the end of breastfeeding)
As above
MOHEasy to measure
Assessed at a single time point
Provides a transversal picture of retention
Considers whether the women fully adhered to the 12-month visit schedule
As aboveProgrammatic definition of retention
Achievable with simple health information systems (e.g. paper-based registers)
Cohort based approach for calculation
IATTConsiders whether the women fully adhered to the 12-month visit schedule
Captures visit consistency
Can be adapted to align with the follow-up of the MIP
More complex to measure (ideally requires an ePLD or POC EMR)
Not systematically aligned with national PMTCT follow-up guidelines but can be modified accordingly
Probable need of data triangulation with other data sources (e.g. pharmacy, laboratory) and linkage with unique IDN
Relevant in capturing visit consistency of the MIP, can be aligned with important PMTCT milestones
Ideal if integrated POC testing services for the MIP are available
Better alternative than single time point estimations
‘Appointment adherence’ retentionConsiders whether the women truly adhered to the 12-month visit schedule
Capture visit consistency
Measurable with paper-based longitudinal cohort based registers (total # of completed visits done/total scheduled visits)
Does not capture the regularity or timeliness of completed visits
Not aligned with important PMTCT milestones for the MIP
Highly dependent on data completeness of denominator (# of scheduled visits)
Need of data triangulation with other data sources (e.g. pharmacy, laboratory) and linkage with unique IDN
Achievable with simple health information systems
Better alternative than single time point estimations
‘On-time adherence’ retentionConsiders whether the women fully adhered to the 12-month visit schedule
Ideal to capture correct levels of engagement in care for PMTCT (regularity and timeliness)
Aligned with important milestones of PMTCT follow-up for the MIP
More complex to measure (requires an ePLD or POC EMR)
Highly dependent on data completeness of denominator (# of scheduled visits)
Need of data triangulation with other data sources (e.g. pharmacy, laboratory) and linkage with unique IDN
Time consuming activity not compatible with one-stop model PMTCT services in the absence of electronic databases
Adapted for research purposes
Not compatible with routine monitoring of retention in care of MIPs
  1. EID early infant diagnosis, EMR electronic medical record, ePLD electronic patient-level database, IATT Inter-Agency Task Team, IDN identification number, MIP mother-infant pair, MOH Ministry of Health, POC point-of-care, PMTCT for prevention of mother-to-child transmission, WHO World Health Organization