Table 3 Advantages, limitations, and programmatic practicality of six measures of retention in care for PMTCT option B+ programs
Retention definition | Advantages | Limitations | Programmatic practicality |
|---|---|---|---|
‘Point’ retention | Easy 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) |
WHO | Easy 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 |
MOH | Easy 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 above | Programmatic definition of retention Achievable with simple health information systems (e.g. paper-based registers) Cohort based approach for calculation |
IATT | Considers 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’ retention | Considers 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’ retention | Considers 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 |