The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa

Cloete, Christie; Regan, Susan; Giddy, Janet; Govender, Tessa; Erlwanger, Alison S.; Gaynes, Melanie R.; Freedberg, Kenneth A.; Katz, Jeffrey N.; Walensky, Rochelle P.; Losina, Elena; Bassett, Ingrid V.

doi:10.1093/ofid/ofu058

Cited by 24 publications

(36 citation statements)

References 25 publications

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“…Two studies evaluating transfer outcomes following clinic-initiated ‘official’ transfer have concluded that nearly all patients actively referred for transfer reach their destination clinic, however timing of transfer linkage was not assessed. (Cloete et al, 2014; O’Connor, Osih, & Jaffer, 2011) Only one prior study has reported on the timeliness of linkage to the new clinic following transfer, concluding that nearly all patients making official transfers out of a large hospital-based clinic in Malawi reached their destination facilities, with a mediation duration between departure and re-engagement of 1.3 months. (Yu et al, 2008) All three of these studies, however, have focused on official transfers from a central site to lower level health facilities.…”

Section: Discussionmentioning

confidence: 99%

Movement between facilities for HIV care among a mobile population in Kenya: transfer, loss to follow-up, and reengagement

Hickey

Omollo²,

Salmen

et al. 2016

AIDS Care

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HIV treatment is life-long, yet many patients travel or migrate for their livelihoods, risking treatment interruption. We examine timely reengagement in care among patients who transferred-out or were lost-to-follow-up (LTFU) from a rural HIV facility. We conducted a cohort study among 369 adult patients on antiretroviral therapy between November 2011 and November 2013 on Mfangano Island, Kenya. Patients who transferred or were LTFU (i.e. missed a scheduled appointment by ≥90 days) were traced to determine if they re-engaged or accessed care at another clinic. We report cumulative incidence and time to reengagement using Cox proportional hazards models adjusted for patient demographic and clinical characteristics. Among 369 patients at the clinic, 23(6%) requested an official transfer and 78(21%) were LTFU. Among official transfers, cumulative incidence of linkage to their destination facility was 91% at three months (95%CI 69–98%). Among LTFU, cumulative incidence of reengagement in care at the original or a new clinic was 14% at three months (95%CI 7–23%) and 60% at six months (95%CI 48–69%). In the adjusted Cox model, patients who left with an official transfer reengaged in care six times faster than those who did not (aHR 6.2, 95%CI 3.4–11.0). Patients who left an island-based HIV clinic in Kenya with an official transfer letter reengaged in care faster than those who were LTFU, although many in both groups had treatment gaps long enough to risk viral rebound. Better coordination of transfers between clinics, such as assisting patients with navigating the process or improving inter-clinic communication surrounding transfers, may reduce delays in treatment during transfer and improve overall clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Movement between facilities for HIV care among a mobile population in Kenya: transfer, loss to follow-up, and reengagement

Hickey

Omollo²,

Salmen

et al. 2016

AIDS Care

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“…37-39 The Sinikithemba cervical screening policy was based on international guidelines. Specifically, the hospital policy was to offer a Papanicolau test (Pap) within the first 3 months of initiating ART, a second smear within the first year, and annual smears thereafter.…”

Section: Methodsmentioning

confidence: 99%

Cervical Abnormalities in South African Women Living With HIV With High Screening and Referral Rates

Katz

Butler

Crankshaw

et al. 2016

JGO

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PurposeTo determine the prevalence of screening, cervical dysplasia, and malignancy on the basis of histologic diagnoses from colposcopy and large loop excision of the transformation zone among women living with HIV (WLWH) who attended an urban antiretroviral treatment (ART) clinic in KwaZulu-Natal, South Africa.Materials and MethodsWe performed a retrospective cohort study to examine a random sample of 462 WLWH during a 5-year period from 2004 to 2009. Women on ART for < 3 months were excluded. Data were abstracted from electronic records and paper charts to assess rates of cervical abnormalities detected on Pap smears as well as time to colposcopy.ResultsDuring the study period, 432 women (93.5%) had at least one evaluable Papanicolau test. At baseline, 237 women (54.9%) had an abnormal Papanicolau test, and of these patients, 181 (76.3%) had a Papanicolau test that qualified for further colposcopic evaluation. In addition, 115 women (63.5%) received colposcopy within a median of 39 days from referral. This yielded 74 evaluable histologic samples (64.3%), of which 21.6%, 27.0%, 27.0%, and 1.4% had cervical intraepithelial neoplasia (CIN) 1, CIN2, CIN3, and invasive cervical cancer, respectively.ConclusionIn a large sample of WLWH who received ART in KwaZulu-Natal, South Africa, where Papanicolau test coverage and rates of referral for colposcopy and large loop excision of the transformation zone were high, > 75% of women with evaluable histologic samples had evidence of cervical dysplasia or malignancy. These findings underscore the importance of routine cervical screening upon entry into HIV care to optimize survival.

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“…Sinikithemba was required to transfer all patients between March and the end of June 2012, during which patients visiting the clinic underwent a group counseling session explaining the clinic closure and transfer procedures (Cloete et al, 2014). Patients were transferred to primary healthcare clinics, community health centers, or were referred to hospital-based clinics based on their ART regimen or co-morbid conditions.…”

Section: Methodsmentioning

confidence: 99%

“…Our prior quantitative study estimated that nearly 20% of patients may not have linked to care and may have experienced a treatment interruption (Cloete et al, 2014). The qualitative study presented here was performed to assess potential reasons for these findings, including patient perceptions of the transfer process and factors impacting continued care engagement.…”

Section: Introductionmentioning

confidence: 99%

Understanding HIV-infected patients’ experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal, South Africa: a qualitative study

et al. 2015

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South Africa was the largest recipient of funding from the President's Emergency Plan for AIDS Relief (PEPFAR) for antiretroviral therapy (ART) programs from [2004][2005][2006][2007][2008][2009][2010][2011][2012] HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript have led to transfers from hospital and non-governmental organization-based care to governmentfunded, community-based clinics. We conducted semi-structured interviews with 36 participants to assess patient experiences related to transfer of care from a PEPFAR-funded, hospital-based clinic in Durban to either primary care clinics or hospital based clinics. Participant narratives revealed the importance of connectedness between patients and the PEPFAR-funded clinic program staff, who were described as respectful and conscientious. Participants reported that transfer clinics were largely focused on dispensing medication and on throughput, rather than holistic care. Although participants appreciated the free treatment at transfer sites, they expressed frustration with long waiting times and low perceived quality of patient-provider communication, and felt that they were treated disrespectfully. These factors eroded confidence in the quality of the care. The transfer was described by participants as hurried with an apparent lack of preparation at transfer clinics for new patient influx. Formal (e.g., counseling) and informal (e.g., family) social supports, both within and beyond the PEPFAR-funded clinic, provided a buffer to challenges faced during and after the transition in care. These data support the importance of social support, adequate preparation for transfer, and improving the quality of care in receiving clinics, in order to optimize retention in care and long-term adherence to treatment.

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The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa

Abstract: The rapid transfer of nearly 4000 HIV-infected patients from a hospital-based clinic to community-based clinics had an estimated success of 82%. Close collaboration between transferring and receiving clinics is necessary to ensure that the health gains from PEPFAR funding are maintained.

Cited by 24 publications

References 25 publications

Movement between facilities for HIV care among a mobile population in Kenya: transfer, loss to follow-up, and reengagement

Movement between facilities for HIV care among a mobile population in Kenya: transfer, loss to follow-up, and reengagement

Cervical Abnormalities in South African Women Living With HIV With High Screening and Referral Rates

Understanding HIV-infected patients’ experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal, South Africa: a qualitative study

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