<qa>  What is the average rate of death or lost to follow up in SSA?Retention in Care: The high program attrition rates in SSA make achieving universal access even more complex. A meta-analysis of HIV-care programs in resource-constrained settings estimated one and two-year attrition rates defined as death or lost to follow up LTFU to be 22.6 range 7-45 and 25 11-32, respectively.23 Of these approximately 41 were confirmed dead and 59 were LTFU. Patients LTFU represent heterogeneous outcomes including death, in care elsewhere, and disengaged from care.24 Patients disengaged from care are at high risk of morbidity, mortality and transmitting HIV.25-29 Despite the desirability of providing outreach to all patients LTFU, the cost of such programs frequently comes at the expense of expanding ART access. Geographic accessibility distance to clinic and transportation costs and shortages in health care personnel excessive clinic waiting times are documented barriers to retention.24-25,30-35 As such, the optimal ART care model in resource constrained settings should minimize LTFU through reductions in transport time and costs as well as reducing clinic waiting time. 