Retention of patients on antiretroviral therapy in the highlands of Papua New Guinea

Over 4 million HIV positive people are on antiretroviral therapy (ART) worldwide; the gap in access remains steep with over 20 million in need of life saving treatment. With proper access to HIV care and treatment services, HIV is no longer a life ending condition and can be managed as a chronic illness. This, however, requires a high level of adherence to an ART regimen for the rest of a patient's life making retention in ART programs of critical importance. While a myriad of programs exist to improve patient retention in the developing world, very little research has been undertaken to examine the effectiveness of case management to address patient lost to follow-up. In Papua New Guinea (PNG), the epicenter of HIV in the Asia Pacific Region, there is a dearth of research related to HIV services, despite over 10,000 people currently on ART. Through a comprehensive chart review of patient data from two Government operated ART clinics, this study examined the efficacy of a Case Management system in the Highlands of PNG. The Eastern Highlands have been implementing Case Management for ART patients since 2006 while Case Management is not being implemented the Western Highlands. Results indicate patients in the Eastern Highlands have a higher likelihood of survival at 12, 24, 36, and 48 months. It is important to note that the Case Management intervention occurred simultaneously amidst the challenge of decentralizing services to nine District sites. Case Management appears to be a promising intervention though it is inextricably linked to the limitations posed by a resource constrained health system. The complexity of HIV care, the need to reach patients closer to where they live, and the commitment by the Government of PNG to providing free anti retroviral treatment have merged to create a unique window of opportunity. A novel time has emerged for HIV-related resources to be used to strengthen primary health systems for the rural poor in PNG. This study provides an evidence-based foundation for launching an effort to reduce inequity while bringing voice to some of the world's most poor and most remote communities.Doctor of Public Healt