Estimating retention in HIV care accounting for clinic transfers using electronic medical records: evidence from a large antiretroviral treatment programme in the Western Cape, South Africa

Bengtson, Angela M.; Kirwa, Kipruto; Cornell, Morna; Lurie, Mark N.

doi:10.1111/tmi.13412

Cited by 14 publications

(12 citation statements)

References 25 publications

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“…However, our estimates of retention are consistent with previously published literature on retention in ART programs in South Africa’ s Western Cape during PEPFAR (74.2%; 95% CI: 73.2%–75.2%) (30) and post-PEFAR 54.3% (95% CI:52.4%-56.1%) at 36 months follow up that used individual patient level data in their analysis (31). Third, we could have unmeasured confounding due to the inability to control for potential confounders due to missing information at the facility level (i.e., transfers, employee turnover rate).…”

Section: Limitationssupporting

confidence: 90%

Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape

Chiliza

Brennan

Laing

et al. 2023

Preprint

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Background: Research on the impact of the PEPFAR transition in South Africa (SA) in 2012 found varying results in retention in care (RIC) of people living with HIV (PLWH). Objectives: We investigated the factors that impacted RIC during the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) transition in Western Cape, South Africa in 2012. Methods: We used aggregate data from 61 facilities supported by four non-governmental organizations from to 2007-2015. The main outcome was RIC at 12-months after antiretroviral therapy initiation for two time periods. We used quantile regression to estimate the effect of the PEPFAR pull-out and other predictors on RIC. The models were adjusted for various covariates. Results: Regression models (50th quantile) for 12-month RIC showed a 4.6% (95%CI: -8.4, -0.8%) decline in RIC post direct service. Facilities supported by Anova/Kheth'impilo fared worst post PEFPAR; a decline in RIC of (-5.8%; 95% CI: -9.7, -1.8%), while that'sit fared best (6.3% increase in RIC; 95% CI:2.5,10.1%). There was a decrease in RIC when comparing urban to rural areas (-5.8%; 95% CI: -10.1, -1.5%). City of Cape town combined with Western Cape Government Health facilities showed a substantial decrease (-9.1%; 95% CI: -12.3, -5.9%), while community health clinic (vs. primary health clinic) declined slightly (-4.4; 95% CI: -9.6, 0.9%) in RIC. We observed no RIC difference by facility size and a slight increase when two or more human resources transitioned from PEPFAR to the government. Conclusions: When PEPFAR funding decreased in 2012, there was a decrease in RIC. To ensure the continuity of HIV care when a major funder withdraws sufficient and stable transition resources, investment in organizations that understand the local context, joint planning, and coordination are required.

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Section: Limitationssupporting

confidence: 90%

Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape

Chiliza

Brennan

Laing

et al. 2023

Preprint

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“…Although the findings of this study are encouraging, we conclude with caution due to limitations inherent to the observational study design. In this study, we used the routine data collection system TIER.net, and did not account for silent transfers, which may be misclassified as LTFU, leading to underestimates of retention in DMOC and on ART [58,59]. Nevertheless, we invested a significant amount of resources to verify last visits of DMOC patients by reviewing relevant registers at the clinics and the CCMDD registers.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa

Gcwensa¹,

Ndlovu²,

Ntumase³

et al. 2022

PLOS Glob Public Health

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Differentiated models of HIV care (DMOC) aim to improve health care efficiency. We describe outcomes of five DMOC in KwaZulu-Natal, South Africa: facility adherence clubs (facility AC) and community adherence clubs (community AC), community antiretroviral treatment (ART) groups (CAG), spaced fast lane appointments (SFLA), and community pick up points (PuP). This retrospective cohort study included 8241 eligible patients enrolled into DMOC between 1/1/2012 and 31/12/2018. We assessed retention in DMOC and on ART, and viral load suppression (<1000 copies/mL). Kaplan-Meier techniques were applied to describe crude retention. Mixed effects parametric survival models with Weibull distribution and clustering on health center and individual levels were used to assess predictors for ART and DMOC attrition, and VL rebound (≥1000 copies/mL). Overall DMOC retention was 85%, 80%, and 76% at 12, 24 and 36 months. ART retention at 12, 24 and 36 months was 96%, 93%, 90%. Overall incidence rate of VL rebound was 1.9 episodes per 100 person-years. VL rebound rate was 4.9 episodes per 100 person-years among those enrolled in 2012–2015, and 0.8 episodes per 100 person-years among those enrolled in 2016–2018 (RR 0.12; 95% CI, 0.09–0.15, p<0.001). Prevalence of confirmed virological failure was 0.6% (38/6113). Predictors of attrition from DMOC and from ART were male gender, younger age, shorter duration on ART before enrollment. Low level viremia (>200–399 copies/mL) was associated with higher hazards of VL rebound and attrition from ART. Concurrent implementation of several DMOC in a large ART program is feasible and can achieve sustained retention on ART and VL suppression.

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“…These data were linked by the PHDC using a unique patient identifier number, which permits consistent identification of individuals across visits and facilities within all districts of the Province. This data linkage effort has been described elsewhere 24 25. A deterministic linkage algorithm that relies on civil identification numbers as well as text-edit-distance fuzzy comparisons was used to reliably link patients’ visits across health facilities and remove duplicate identities 24…”

Section: Methodsmentioning

confidence: 99%

“…This data linkage effort has been described elsewhere. 24 25 A deterministic linkage algorithm that relies on civil identification numbers as well as text-edit-distance fuzzy comparisons was used to reliably link patients' visits across health facilities and remove duplicate identities. 24…”

Section: Data Sources Clinicalmentioning

confidence: 99%

Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis

et al. 2021

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ObjectivesFor persons living with HIV (PLWH) in long-term care, clinic transfers are common and influence sustained engagement in HIV care, as they are associated with significant time out-of-care, low CD4 count, and unsuppressed viral load on re-entry. Despite the geospatial nature of clinic transfers, there exist limited data on the geospatial trends of clinic transfers to guide intervention development. In this study, we investigate the geospatial characteristics and trends of clinic transfers among PLWH on antiretroviral therapy (ART) in the Western Cape Province of South Africa.DesignRetrospective spatial analysis.SettingPLWH who initiated ART treatment between 2012 and 2016 in South Africa’s Western Cape Province were followed from ART initiation to their last visit prior to 2017. Deidentified electronic medical records from all public clinical, pharmacy, and laboratory visits in the Western Cape were linked across space and time using a unique patient identifier number.Participants4176 ART initiators in South Africa (68% women).MethodsWe defined a clinic transfer as any switch between health facilities that occurred on different days and measured the distance between facilities using geodesic distance. We constructed network flow maps to evaluate geospatial trends in clinic transfers over time, both for individuals’ first transfer and overall.ResultsTwo-thirds of ART initiators transferred health facilities at least once during follow-up. Median distance between all clinic transfer origins and destinations among participants was 8.6 km. Participant transfers were heavily clustered around Cape Town. There was a positive association between time on ART and clinic transfer distance, both among participants’ first transfers and overall.ConclusionThis study is among the first to examine geospatial trends in clinic transfers over time among PLWH. Our results make clear that clinic transfers are common and can cluster in urban areas, necessitating better integrated health information systems and HIV care.

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Estimating retention in HIV care accounting for clinic transfers using electronic medical records: evidence from a large antiretroviral treatment programme in the Western Cape, South Africa

Cited by 14 publications

References 25 publications

Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape

Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape

Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa

Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis

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