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

Gcwensa, Ntombi; Ndlovu, Celiwe Dlamini; Ntumase, Nosicelo; Sabela, Scelinhlanhla; Ohler, Liesbet; Triviño-Duran, Laura; Kamara, Ellie Ford; Hlophe, Khanyo; Isaakidis, Petros; Cutsem, Gilles van

doi:10.1371/journal.pgph.0000336

Cited by 5 publications

(3 citation statements)

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“…Poor HIVoutcomes persist among young adults and men, a challenge also extended to DSD contexts [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

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HIV care retention in three multi-month ART dispensing: a retrospective cohort study in Mozambique

Saura-Lázaro,

Augusto,

Fernández-Luis

et al. 2024

Aids

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Objective: Evaluate the effect of three multi-month dispensing (3MMD) of antiretroviral therapy (ART) on HIV care retention in southern Mozambique. Design: Retrospective cohort study Methods: We analysed routine health data from people living with HIV (PLHIV) ≥10 years old who started ART between January 2018 and March 2021. Individuals were followed until December 2021. Cox proportional-hazards models were used to compare attrition (lost to follow-up, death, and transfer out) between 3MMD and monthly ART dispensing. Results were stratified by time on ART before 3MMD enrolment: “early enrollers” (<6 months on ART) and “established enrollers” (≥6 months on ART), and age groups: adolescents and youth (AYLHIV) (10–24 years) and adults (≥25 years). Results: We included 7,378 PLHIV (25% AYLHIV, 75% adults), with 59% and 62% enrolled in 3MMD, respectively. Median follow-up time was 11.3 (IQR: 5.7–21.6) months for AYLHIV and 10.2 (IQR: 4.8–20.9) for adults. Attrition was lower in PLHIV enrolled in 3MMD compared to monthly ART dispensing, in both established (aHR AYLHIV = 0.65; 95%CI: 0.54–0.78 and aHR adults = 0.50; 95%CI: 0.44–0.56) and early enrollers (aHR AYLHIV = 0.70; 95%CI: 0.58–0.85 and aHR adults = 0.63; 95%CI: 0.57–0.70). Among individuals in 3MMD, male gender (aHR = 1.30; 95%CI: 1.18–1.44) and receiving care in a medium/low-volume healthcare facility (aHR = 1.18; 95%CI: 1.03–1.34) increased attrition risk. Conversely, longer ART time before 3MMD enrolment (aHR = 0.93; 95% CI: 0.92–0.94 per one-month increase) and age ≥45 years (aHR = 0.77, 95%CI: 0.67–0.89) reduced risk of attrition. Conclusions: 3MMD improves retention in care compared to monthly dispensing among established and early enrollers, although to a lesser extent among the latter.

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“…Poor HIVoutcomes persist among young adults and men, a challenge also extended to DSD contexts [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, male gender and younger age were identified as predictors of a higher risk of attrition. Poor HIV outcomes persist among young adults and men, a challenge also extended to DSD contexts [ 35 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

HIV care retention in three multi-month ART dispensing: a retrospective cohort study in Mozambique

Saura-Lázaro,

Augusto,

Fernández-Luis

et al. 2024

Aids

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“…Similarly, another study conducted in Maputo, Mozambique, highlighted positive outcomes among patients on second- and third-line ART enrolled in adherence clubs [ 3 ]. While adherence clubs have shown potential in reducing healthcare system costs [ 8 ], concerns have been raised regarding stigma, lack of familial or peer support, and common mental health disorders as barriers to sustained adherence [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Understanding health outcome drivers among adherence club patients in clinics of Gauteng, South Africa: a structural equation modelling (SEM) approach

Tshuma,

Ngbede,

Nyengerai

et al. 2023

AIDS Res Ther

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Background There has been growing interest in understanding the drivers of health outcomes, both in developed and developing countries. The drivers of health outcomes, on the other hand, are the factors that influence the likelihood of experiencing positive or negative health outcomes. Human Immunodeficiency Virus (HIV) continues to be a significant global public health challenge, with an estimated 38 million people living with the aim of this study was therefore to develop and empirically test a conceptual research model using SEM, aimed at explaining the magnitude of various factors influencing HIV and other health outcomes among patients attending Adherence Clubs. Method This was a cross sectional survey study design conducted in 16 health facilities in the City of Ekurhuleni in Gauteng Province, South Africa. A total of 730 adherence club patients were systematically sampled to participate in a closed ended questionnaire survey. The questionnaire was assessed by Cronbach's alpha coefficient for internal consistency. The proposed model was tested using structural equation modelling (AMOS software: ADC, Chicago, IL, USA). Results A total of 730 adherence club members participated in the study. Of these, 425 (58.2%) were female and 305 (41.8%) were male. The overall results indicated a good reliability of all the scale involved in this study as Cronbach alphas ranged from 0.706 to 0.874, and composite reliability from 0.735 to 0.874. The structural model showed that the constructs health seeking behavior (β = 0.267, p = 0.000), health care services (β = 0.416, p = 0.000), stigma and discrimination (β = 0.135, p = 0.022) significantly predicted health outcomes and explained 45% of its variance. The construct healthcare service was the highest predictor of health outcomes among patients in adherence clubs. Conclusion Patient health seeking behaviour, healthcare services, stigma and discrimination were associated with perceived health outcomes. Since adherence clubs have been found to have a significant impact in improving patient outcomes and quality of life, there is a need to ensure replication of this model.

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Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis

Kitenge,

Fatti,

Eshun-Wilson

et al. 2023

BMC Infect Dis

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Background Despite the significant progress made in South Africa in getting millions of individuals living with HIV into care, many patients still present or re-enter care with Advanced HIV Disease (AHD). We aimed to estimate the prevalence of AHD among ART-naive and ART-experienced patients in South Africa using studies published between January 2010 and May 2022. Methods We searched for relevant data on PubMed, CINAHL, Scopus and other sources, with a geographical filters limited to South Africa, up to May 31, 2022. Two reviewers conducted all screening, eligibility assessment, data extraction, and critical appraisal. We synthesized the data using the inverse-variance heterogeneity model and Freeman-Tukey transformation. We assessed heterogeneity using the I2 statistic and publication bias using the Egger and Begg’s test. Results We identified 2,496 records, of which 53 met the eligibility criteria, involving 11,545,460 individuals. The pooled prevalence of AHD among ART-naive and ART-experienced patients was 43.45% (95% CI 40.1–46.8%, n = 53 studies) and 58.6% (95% CI 55.7 to 61.5%, n = 2) respectively. The time trend analysis showed a decline of 2% in the prevalence of AHD among ART-naive patients per year. However, given the high heterogeneity between studies, the pooled prevalence should be interpreted with caution. Conclusion Despite HIV’s evolution to a chronic disease, our findings show that the burden of AHD remains high among both ART-naive and ART-experienced patients in South Africa. This emphasizes the importance of regular measurement of CD4 cell count as an essential component of HIV care. In addition, providing innovative adherence support and interventions to retain ART patients in effective care is a crucial priority for those on ART.

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

Cited by 5 publications

References 49 publications

HIV care retention in three multi-month ART dispensing: a retrospective cohort study in Mozambique

HIV care retention in three multi-month ART dispensing: a retrospective cohort study in Mozambique

Understanding health outcome drivers among adherence club patients in clinics of Gauteng, South Africa: a structural equation modelling (SEM) approach

Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis

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