Missed Opportunities for Retention in Pre-ART Care in Cape Town, South Africa

Toit, E. Du; Schalkwyk, Cari van; Dunbar, Rory; Jennings, Karen; Yang, Blia; Coetzee, David; Beyers, Nulda

doi:10.1371/journal.pone.0096867

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…Antiretroviral treatment (ART) initiation when HIV disease is advanced is associated with poor treatment outcomes and high mortality rates [1, 2]. Current international guidelines call for universal test and treat (UTT), ART initiation irrespective of CD4 count [3].…”

Section: Introductionmentioning

confidence: 99%

Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa

et al. 2019

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PurposeTo quantify costs to patients of accessing HIV care prior to ART initiation.Materials and methodsUsing a cross-sectional study design, costs incurred by HIV-positive patients prior to ART initiation were estimated at urban primary healthcare facilities in South Africa. Costs included direct costs, indirect (productivity) costs, carer and coping costs (value of assets sold and money borrowed). The percentage of individual income spent on healthcare was calculated and compared by patient income tertiles and CD4 count strata.Results289 patients (69% female, mean age 37 (SD: 10) years, median CD4 317 (IQR: 138–494) cells/mm3) were interviewed. The total mean monthly cost of pre-ART care was US$15.71. Indirect costs accounted for $2.59 (16.49%) of this when time was valued using the patient’s reported income. The mean monthly patient costs were $31.61, $12.78, $12.65 and $11.93 for those with a CD4 count <100, 101–350, 351–500 and >500 cells/mm3 respectively. The percentage of individual income spent on healthcare was 7.25% for those with a CD4 count <100 cells/mm3 and 4.05% for those with a CD4 count >500 cells/mm3.ConclusionsDespite the provision of charge-free services at public clinics, care prior to ART initiation can be costly, particularly for the poor and unemployed. Our study adds to the growing body of evidence that highlights the need to consider policies to reduce the economic barriers to HIV service access, particularly for low income or unwell patient groups, such as improving access to disability grants.

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Section: Introductionmentioning

confidence: 99%

Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa

et al. 2019

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“…Thirty‐nine studies reported on initiation of ART [2,21,23,28,33,34,37,40‐42,44‐47,49‐54,23,55‐62,64,66,67‐75], with 25 (64%) defining numerators and denominators. Thirty‐two were longitudinal, four of mixed design and three were cross‐sectional.…”

Section: Resultsmentioning

confidence: 99%

“…Overall 46 studies [2,20‐24,26‐30,32,40,43,45,49‐51,53,61,63,65,68,69,72,74‐94] reported on retention on ART or being on ART and 34 (74%) provided clear definitions of numerators and denominators. The majority of studies were longitudinal (29 studies, 63%), 13 were cross‐sectional and four of mixed design.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty‐eight studies reported on this step [ 20 , 23 , 24 , 26 , 27 , 28 , 31 , 33 , 34 , 35 , 37 , 38 , 39 , 41 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]: 15 cohort studies, 10 cross‐sectional and three of mixed design. Twenty‐four studies (86%) provided a clear definition of the step (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies reported on retention in pre‐ART care [ 2 , 20 , 26 , 27 , 34 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], with 12 defining numerators and denominators. Six studies were cross‐sectional and 13 longitudinal.…”

Section: Resultsmentioning

confidence: 99%

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The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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Introduction:The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. Methods: We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. Results and discussion: Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013(IQR to 2019. The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. Conclusions: The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.

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Mixed-Methods Evaluation of a Novel, Structured, Community-Based Support and Education Intervention for Individuals with HIV/AIDS in KwaZulu-Natal, South Africa

Kemp

Gerth‐Guyette²,

Dube³

et al. 2016

AIDS Behav

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People living with HIV in Sub-Saharan Africa face significant challenges accessing care. Community-based peer support groups can increase linkage to treatment, though the effectiveness of structured, scalable groups has not been demonstrated. This study aimed to measure the impact of the structured Integrated Access to Care and Treatment intervention on clients' knowledge, attitudes, and practice regarding HIV/AIDS, including their experiences of stigma, in KwaZulu-Natal, South Africa. Data collection involved pre-/post-tests and client interviews. Pre-/post-test data from 66 clients were collected. 17 participants were interviewed. Paired t-tests did not detect significant changes in the main outcomes. Qualitative results suggested a psychosocial benefit as participants connected with their peers, expressed themselves openly, and re-engaged with their communities. Unfortunately, this study did not quantitatively measure psychosocial changes, and the results have limited generalizability to men. I ACT may be an effective complement to clinic-based support services, though further study should quantify the psychosocial benefit.

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Missed Opportunities for Retention in Pre-ART Care in Cape Town, South Africa

Cited by 7 publications

References 6 publications

Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa

Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

Mixed-Methods Evaluation of a Novel, Structured, Community-Based Support and Education Intervention for Individuals with HIV/AIDS in KwaZulu-Natal, South Africa

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