Loss to Care and Death Before Antiretroviral Therapy in Durban, South Africa

Abstract

Objective To examine the loss to care and mortality rates before starting antiretroviral therapy (ART) among ART eligible HIV-infected patients in Durban, South Africa. Design Retrospective cohort study. Methods We reviewed data from ART eligible adults (≥18 years) at an urban HIV clinic that charges a monthly fee from July to December 2006. ART eligibility was based on CD4 count ≤200 cells per microliter or clinical criteria and a psychosocial assessment. Patients who did not start ART and were lost within 3 months were phoned. Correlates of loss to care were evaluated using logistic regression. Results During the study period, 501 patients registered for ART training. Mean time from initial CD4 count to first ART training was 3.6 months (interquartile range 2.3−3.9 months). Four hundred eight patients (81.4%) were in care and on ART at 3-month follow-up, and 11 (2.2%) were in care but had not initiated ART. Eighty-two ART eligible patients (16.4%) were lost before ART initiation. Of these, 28 (34.1%) had died; two thirds of deaths occurred before or within 2 months after the first ART training. Despite multiple attempts, 32 patients (39%) were unreachable by phone. Lower baseline CD4 counts (≤100 cells/μL) and unemployment were independently associated with being lost. Conclusions Loss to care and death occur frequently before starting ART at an HIV clinic in Durban, South Africa. This delay from CD4 count to ART training, even among those with the lowest CD4 counts, highlights the need for interventions that improve linkage to care and prioritize ART initiation for those with low baseline CD4 counts.

Pérdida de seguimiento y factores asociados en pacientes inscritos en el programa de HIV/sida del Hospital Universitario San Ignacio, Colombia, 2012-2013

“…En otro estudio se observó la relación entre el desempleo, los bajos ingresos y la pérdida de seguimiento (24,25 (27), encontraron que las dificultades financieras de la población fueron la causa principal para no retomar los controles médicos; otras razones expuestas en este mismo estudio fueron sociales, y se relacionaban con la toma de los medicamentos y con factores ocupacionales como la carga laboral y la distancia del lugar de residencia al centro de atención del programa de HIV. Una de las razones por las que los pacientes considerados como perdidos en el seguimiento retornaron a los centros de atención, fue haber encontrado trabajo (28).…”

Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

“…Some of these individual are likely to have died, given that some patients who are known to be eligible for ART die before initiating therapy. 12 To increase substantially the proportion of patients who initiate ART as soon as they are eligible, a large proportion of patients need to complete CD4 testing before they become eligible (i.e. while CD4 cells are still > 200/μl).…”

Barriers to Utilization of HIV Care Services Among Adolescents and Young Adults in Rakai, Uganda: the Role of Economic Strengthening

“…There is a need for all HIV-positive persons to access care and preventive interventions in a timely manner (UNAIDS 2013;Mermin et al 2006;Graham et al 2010;Granich et al 2010) to prevent morbidity and mortality (Amuron et al 2009;Losina et al 2010;Bassett et al 2009). However, uptake of free HIV care services after diagnosis remains suboptimal.…”