Cohort profile: the Right to Care Clinical HIV Cohort, South Africa

Fox, Matthew P.; Maskew, Mhairi; Brennan, Alana T.; Evans, Denise; Onoya, Dorina; Malete, Given; MacPhail, Patrick; Bassett, Jean; Ebrahim, Osman; Mabotja, Dikeledi; Mashamaite, Sello; Long, Lawrence; Sanne, Ian

doi:10.1136/bmjopen-2016-015620

Cited by 16 publications

(17 citation statements)

References 46 publications

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“…The oldest paediatric patients had increased hazards of all outcomes (though single‐drug substitution was not significant), and female patients had a trend towards increased hazards for all outcomes. This is consistent with previous research in adults, which demonstrated increase risk of single‐drug substitution for females and higher risk of toxicity/side effects for women on stavudine . Differences in risk of toxicity between genders, and therefore increased risk of single‐drug substitution, may be related to better adherence in women than men .…”

Section: Discussionsupporting

confidence: 92%

Regimen durability in HIV‐infected children and adolescents initiating first‐line antiretroviral therapy in a large public sector HIV cohort in South Africa

Bonawitz

Brennan

Long

et al. 2018

Tropical Med Int Health

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Section: Discussionsupporting

confidence: 92%

Regimen durability in HIV‐infected children and adolescents initiating first‐line antiretroviral therapy in a large public sector HIV cohort in South Africa

Bonawitz

Brennan

Long

et al. 2018

Tropical Med Int Health

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“…Site one is a public health clinic operated by the City of Johannesburg that serves the Ivory Park region of eastern Johannesburg. Care is provided free of charge . Site one participants were recruited during routine antenatal care if they were pregnant, HIV positive, and able to speak and understand English.…”

Section: Methodsmentioning

confidence: 99%

“I will leave the baby with my mother”: Long‐distance travel and follow‐up care among HIV‐positive pregnant and postpartum women in South Africa

Clouse

Fox

Mongwenyana³

et al. 2018

J Intern AIDS Soc

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IntroductionIt is common in urban African settings for postpartum women to temporarily return to family in distant settings. We sought to explore mobility among peripartum HIV‐positive women to understand the timing and motivation of travel, particularly vis‐à‐vis delivery, and how it may affect healthcare access.MethodsUsing the same mobility measurements within three different studies, we examined long‐distance travel of mother and infant before and after delivery in three diverse clinics within greater Johannesburg, South Africa (n = 150). Participants were interviewed prior to delivery at two sites (n = 125) and after delivery at one (n = 25). Quantitative and qualitative results are reported.ResultsAmong 150 women, median age was 29 years (IQR: 26 to 34) and 36.3% were employed. Overall, 76.7% of the participants were born in South Africa: 32.7% in Gauteng Province (Johannesburg area) and 44.0% in other South African provinces, but birthplace varied greatly by site. Almost half (44.0%) planned to travel around delivery; nearly all after delivery. Median duration of stay was 30 days (IQR: 24 to 90) overall, but varied from 60 days at two sites to just 7 days at another. Participants discussed travel to eight of South Africa's nine provinces and four countries. Travel most frequently was to visit family, typically to receive help with the new baby. Nearly all the employed participants planned to return to work in Johannesburg after delivery, sometimes leaving the infant in the care of family outside of Johannesburg. All expressed their intent to continue HIV care for themselves and their infant, but few planned to seek care at the destination site, and care for the infant was emphasized over care for the mother.ConclusionsWe identified frequent travel in the peripartum period with substantial differences in travel patterns by site. Participants more frequently discussed seeking care for the infant than for themselves. HIV‐exposed children often were left in the care of family members in distant areas. Our results show the frequent mobility of women and infants in the peripartum period. This underscores the challenge of ensuring a continuity of HIV care in a fragmented healthcare system that is not adapted for a mobile population.

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“…Our sample size calculations used alpha = 0.05, power = 80% and a coefficient of variation = 0.1. We based the sample size calculation on data from South African health facilities where we conduct research [17,[26][27][28]. For EAC, we anticipated 52% of patients with an elevated viral load resuppress after one counselling session.…”

Section: Analytic Methodsmentioning

confidence: 99%

Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster‐randomised evaluation

Fox

Pascoe

Huber

et al. 2018

Tropical Med Int Health

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Background As loss from HIV care is an ongoing challenge globally, interventions are needed for patients who don't achieve or maintain ART stability. The 2015 South African National Adherence Guidelines (AGL) for Chronic Diseases include two interventions targeted at unstable patients: early tracing of patients who miss visits (TRIC) and enhanced adherence counselling (EAC). Methods As part of a cluster‐randomised evaluation at 12 intervention and 12 control clinics in four provinces, intervention sites implemented the AGL interventions, while control sites retained standard care. We report on outcomes of EAC for patients with an elevated viral load (>400 copies/ml) and for TRIC patients who missed a visit by >5 days. We estimated risk differences (RD) of 3 and 12‐month viral resuppression (<400 copies/ml) and 12‐month retention with cluster adjustment using generalised estimating equations and controlled for imbalances using difference‐in‐differences compared to all eligible in 2015, prior to intervention roll‐out. Results For EAC, we had 358 intervention and 505 control site patients (61% female, median ART initiation CD4 count 154 cells/μl). We found no difference between arms in 3‐month resuppression (RD: −1.7%; 95%CI: −4.3% to 0.9%), but <20% of patients had a repeat viral load within 3 months (19.8% intervention, 13.5% control). Including the entire clinic population eligible for EAC with a repeat viral load at all evaluation sites (n = 934), intervention sites showed a small increase in 3‐month resuppression (28% vs. 25%, RD 3.0%; 95%CI: −2.7% to 8.8%). Adjusting for baseline differences increased the RD to 8.1% (95% CI: −0.1% to 17.2%). However, we found no differences in 12‐month suppression (RD: 1.5%; 95% CI: −14.1% to 17.1% but suppression was low overall at 40%) or retention (RD: 2.8%; 95% CI: −7.5% to 13.2%). For TRIC, we enrolled 155 at intervention sites and 248 at control sites (44% >40 years, 67% female, median CD4 count 212 cells/μl). We found no difference between groups in return to care by 12 months (RD: −6.8%; 95% CI: −17.7% to 4.8%). During the study period, control sites continued to use tracing within standard care, however, potentially masking intervention effects. Conclusions Enhanced adherence counselling showed no benefit over 12 months. Implementation of the tracing intervention under the new guidelines was similar to the standard of care. Interventions that aim to return unstable patients to care should incorporate active monitoring to determine if the interventions are effective.

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Cohort profile: the Right to Care Clinical HIV Cohort, South Africa

Cited by 16 publications

References 46 publications

Regimen durability in HIV‐infected children and adolescents initiating first‐line antiretroviral therapy in a large public sector HIV cohort in South Africa

Regimen durability in HIV‐infected children and adolescents initiating first‐line antiretroviral therapy in a large public sector HIV cohort in South Africa

“I will leave the baby with my mother”: Long‐distance travel and follow‐up care among HIV‐positive pregnant and postpartum women in South Africa

Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster‐randomised evaluation

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