Patient retention at key milestones after HIV diagnosis at a primary healthcare clinic offering early antiretroviral therapy initiation in Johannesburg, South Africa Public Deposited

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  • March 22, 2019
Creator
  • Clouse, Kate
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • A significant challenge to the impact of South Africa's national ART program is poor patient retention. We report retention in early HIV care among patients at Witkoppen Health and Welfare Centre in Johannesburg, South Africa, using data obtained via file review and electronically. We look first at multiple stages of early HIV care among newly-diagnosed, non-pregnant adults (N=842). Retention from HIV testing to CD4 staging was 69.8% (95%CI 66.7-72.9%). For patients initially ART-ineligible (n=221), 57.4% (95%CI 49.5-65.0%) returned for a repeat CD4 within 12 months. Among those ART-eligible (n=589), 73.5% (95%CI 69.0-77.6%) were retained between CD4 staging and ART initiation. Retention increased with time on ART, from 80.2% (95%CI 75.3-84.5%) at 6 months to 95.3% (95%CI 91.7-97.6%) between 6-12 months. Cumulative retention from HIV diagnosis to 12 months on ART was 36.9% (95%CI 33.0-41.1%) for those ART-eligible and 43.0% (95%CI 36.4-49.8%) from diagnosis to repeat CD4 testing within one year among those ART-ineligible. We examined loss to follow-up (LTFU) before and after delivery among pregnant women newly-diagnosed with HIV (N=273). Of 139 (51.3%) ART-eligible patients, 66.9% (95%CI 58.8-74.3%) initiated ART prior to delivery and overall, 40.5% (32.3-49.0%) were cumulative retained through six months on ART. Of those ART-ineligible at HIV diagnosis, only 21.1% (95%CI 14.6-29.0%) were retained through a repeat CD4 test after delivery. LTFU (≥1 month late) before delivery was 20.5% (95%CI 16.0-25.6%) and, among those still in care, 47.9% (95%CI 41.2-54.6%) within six months after delivery. The study clinic has offered ART initiation at CD4 & ≤350 cells/μl since 2010. We compared 12-month patient outcomes for those who presented and initiated ART at baseline CD4 values & ≤200 versus 201-350 cells/μl (N=1430). Among men and non-pregnant women, initiating at 201-350 cells/μl was associated with 26-42% reduced LTFU (≥3 months late) compared to those initiating at ≤200. We found no CD4 effect among pregnant women. As countries expand HIV testing and ART programs, success will depend on linkage to and retention in care, especially during the period prior to ART initiation. Our findings highlight the additional challenge of continuity of care among HIV-positive pregnant women and adults ineligible for ART.
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  • In Copyright
Advisor
  • Pettifor, Audrey
Degree
  • Doctor of Philosophy
Graduation year
  • 2012
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