{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:00:36Z","timestamp":1789923636400,"version":"4.0.1"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T00:00:00Z","timestamp":1602115200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. AIDS Soc."],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Definitions of retention\u2010in\u2010care in Prevention of Mother\u2010to\u2010Child 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\u2010based interventions for improving retention\u2010in\u2010care. In this paper, we estimated retention\u2010in\u2010care rates according to different definitions, and we quantified and visualized the degree of agreement between definitions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We calculated retention in care rates using nine definitions in the six INSPIRE PMTCT intervention studies, conducted in three sub\u2010Saharan African countries between 2013 and 2017. With data from one of the studies (E4E), we estimated the agreement between definitions using Gwet\u2019s 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\u2010in\u2010care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Retention\u2010in\u2010care rates among 5107 women ranged from 30% to 76% in the complete dataset with Gwet\u2019s 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\u2010in\u2010care. 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\u2010mentioned; it resulted in a moderate to substantial agreement and a 70% to 90% concordance with all other definitions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study highlights the variability of definitions in estimating retention\u2010in\u2010care. 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25609","type":"journal-article","created":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T12:08:01Z","timestamp":1602158881000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Retention\u2010in\u2010care in the PMTCT cascade: definitions matter! Analyses from the INSPIRE projects in Malawi, Nigeria and Zimbabwe"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9179-7259","authenticated-orcid":false,"given":"Helene","family":"Font","sequence":"first","affiliation":[{"name":"ISPED, Inserm Bordeaux Population Health Research Center UMR 1219 University of Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Rollins","sequence":"additional","affiliation":[{"name":"Department of Maternal, Newborn, Child and Adolescent Health World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaffiq","family":"Essajee","sequence":"additional","affiliation":[{"name":"Data and Analytics Section Unicef New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Becquet","sequence":"additional","affiliation":[{"name":"ISPED, Inserm Bordeaux Population Health Research Center UMR 1219 University of Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoff","family":"Foster","sequence":"additional","affiliation":[{"name":"Family AIDS Caring Trust World Health Organization Mutare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexio\u2010Zambezio","family":"Mangwiro","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Mwapasa","sequence":"additional","affiliation":[{"name":"Department of Public Health College of Medicine University of Malawi Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bolanle","family":"Oyeledun","sequence":"additional","affiliation":[{"name":"Centre for Integrated Health Programs Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Phiri","sequence":"additional","affiliation":[{"name":"Lighthouse Trust Lilongwe Malawi"},{"name":"Department of Medicine University of North Carolina School of Medicine Chapel Hill NC USA"},{"name":"Department of Public Health School of Public Health and Family Medicine College of Medicine University of Malawi Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5052-7730","authenticated-orcid":false,"given":"Nadia A","family":"Sam\u2010Agudu","sequence":"additional","affiliation":[{"name":"International Research Center of Excellence Institute of Human Virology Nigeria Abuja Nigeria"},{"name":"Division of Epidemiology and Prevention Institute of Human Virology University of Maryland School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nita B","family":"Bellare","sequence":"additional","affiliation":[{"name":"Strategic Information Department UNAIDS Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Orne\u2010Gliemann","sequence":"additional","affiliation":[{"name":"ISPED, Inserm Bordeaux Population Health Research Center UMR 1219 University of Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the INSPIRE group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)00018-7"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600693"},{"key":"e_1_2_10_4_1","unstructured":"World Health Organization.Programmatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: executive summary[cited 2019 Oct 20]. 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