Attrition in HIV care following HIV diagnosis: a comparison of the pre‐UTT and UTT eras in South Africa

The study determined the nutritional status of adult antiretroviral therapy (ART) recipients, and investigated the association between the duration on ART and the nutritional status. This study was based in primary health facilities in Gauteng, South Africa. The data collected included sociodemographic variables; the duration of the treatment; and the body mass index (BMI), classified as undernutrition (<18.5 kg/m2), normal (18.5–24.9 kg/m2), or overweight/obesity (≥25 kg/m2). ART recipients (n = 480) had a mean age of 35 (± 8.4SD) years. All had taken ART for six months or more (range 6–48 months). The data were analyzed using STATA 13.0. The overall prevalence of overweight/obesity was 39%, it was higher in females (46%) than in males (30%), 26% were overweight, and 13% were obese. Underweight was 13%, and was higher in males (18%) than females (9%). Being overweight was more likely in those aged ≥35 years and those in smaller households. Being obese was less likely in males, in the employed, and in those with a higher income, but was more likely in those with a longer duration on ART. Abdominal obesity was high, but less likely in males. Interventions to prevent overweight/obesity should be integrated into routine HIV care, while at the same time addressing the burden of undernutrition among ART recipients.

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Faculty Opinions recommendation of Key informant perspectives on policy- and service-level challenges and opportunities for delivering integrated sexual and reproductive health and HIV care in South Africa.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.716197979.791552890 ◽

2012 ◽

Author(s):

Kelly Blanchard ◽

Ruth Manski ◽

Amanda Dennis

Keyword(s):

South Africa ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Service Level ◽

Hiv Care ◽

Key Informant ◽

Challenges And Opportunities

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Faculty Opinions recommendation of Missed opportunities for early infant HIV diagnosis: results of a national study in South Africa.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725260533.793502072 ◽

2014 ◽

Author(s):

Lynne Mofenson

Keyword(s):

South Africa ◽

National Study ◽

Hiv Diagnosis ◽

Missed Opportunities ◽

Early Infant

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Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017

Journal of the International AIDS Society ◽

10.1002/jia2.25740 ◽

2021 ◽

Vol 24 (5) ◽

Author(s):

Nathaniel T Yohannes ◽

Cathy A Jenkins ◽

Kate Clouse ◽

Claudia P Cortés ◽

Fernando Mejía Cordero ◽

...

Keyword(s):

Latin American ◽

Hiv Care ◽

Hiv Care Continuum ◽

Hiv Diagnosis ◽

Care Continuum ◽

American Women ◽

Pregnancy And Postpartum

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Understanding the Reasons for Deferring ART Among Patients Diagnosed Under the Same-Day-ART Policy in Johannesburg, South Africa

AIDS and Behavior ◽

10.1007/s10461-021-03171-6 ◽

2021 ◽

Author(s):

Dorina Onoya ◽

Tembeka Sineke ◽

Idah Mokhele ◽

Jacob Bor ◽

Matthew P. Fox ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Self Report ◽

Hiv Diagnosis ◽

Adjusted Risk ◽

Art Initiation ◽

Art Policy ◽

Universal Test And Treat ◽

Post Test ◽

Treat All

AbstractWe aimed to examine the correlates of antiretroviral therapy (ART) deferral to inform ART demand creation and retention interventions for patients diagnosed with HIV during the Universal Test and Treat (UTT) policy in South Africa. We conducted a cohort study enrolling newly diagnosed HIV-positive adults (≥ 18 years), at four primary healthcare clinics in Johannesburg between October 2017 and August 2018. Patients were interviewed immediately after HIV diagnosis, and ART initiation was determined through medical record review up to six-months post-test. ART deferral was defined as not starting ART six months after HIV diagnosis. Participants who were not on ART six-months post-test were traced and interviewed telephonically to determine reasons for ART deferral. Modified Poisson regression was used to evaluate correlates of six-months ART deferral. We adjusted for baseline demographic and clinical factors. We present crude and adjusted risk ratios (aRR) associated with ART deferral. Overall, 99/652 (15.2%) had deferred ART by six months, 20.5% men and 12.2% women. Baseline predictors of ART deferral were older age at diagnosis (adjusted risk ratio (aRR) 1.5 for 30–39.9 vs 18–29.9 years, 95% confidence intervals (CI): 1.0–2.2), disclosure of intentions to test for HIV (aRR 2.2 non-disclosure vs disclosure to a partner/spouse, 95% CI: 1.4–3.6) and HIV testing history (aRR 1.7 for > 12 months vs < 12 months/no prior test, 95% CI: 1.0–2.8). Additionally, having a primary house in another country (aRR 2.1 vs current house, 95% CI: 1.4–3.1) and testing alone (RR 4.6 vs partner/spouse support, 95% CI: 1.2–18.3) predicted ART deferral among men. Among the 43/99 six-months interviews, women (71.4%) were more likely to self-report ART initiation than men (RR 0.4, 95% CI: 0.2–0.8) and participants who relocated within SA (RR 2.1 vs not relocated, 95% CI: 1.2–3.5) were more likely to still not be on ART. Under the treat-all ART policy, nearly 15.2% of study participants deferred ART initiation up to six months after the HIV diagnosis. Our analysis highlighted the need to pay particular attention to patients who show little social preparation for HIV testing and mobile populations.

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Who Is Not Linking to HIV Care in Tennessee — the Benefits of an Intersectional Approach

Journal of Racial and Ethnic Health Disparities ◽

10.1007/s40615-021-01023-6 ◽

2021 ◽

Author(s):

Leslie J. Pierce ◽

Peter Rebeiro ◽

Meredith Brantley ◽

Errol L. Fields ◽

Cathy A. Jenkins ◽

...

Keyword(s):

Black Males ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hiv Care ◽

Older Individuals ◽

Hiv Diagnosis ◽

Race And Gender ◽

Targeted Interventions ◽

And Gender ◽

Linkage To Hiv Care

Abstract Introduction Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee. Methods Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care. Results Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care. Conclusions Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care.

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The “ART” of Linkage: Pre-Treatment Loss to Care after HIV Diagnosis at Two PEPFAR Sites in Durban, South Africa

PLoS ONE ◽

10.1371/journal.pone.0009538 ◽

2010 ◽

Vol 5 (3) ◽

pp. e9538 ◽

Cited By ~ 142

Author(s):

Elena Losina ◽

Ingrid V. Bassett ◽

Janet Giddy ◽

Senica Chetty ◽

Susan Regan ◽

...

Keyword(s):

South Africa ◽

Hiv Diagnosis ◽

Pre Treatment

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Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

BioMed Research International ◽

10.1155/2016/2648923 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Shu Su ◽

Shifu Li ◽

Shunxiang Li ◽

Liangmin Gao ◽

Ying Cai ◽

...

Keyword(s):

Treatment Adherence ◽

Waiting Time ◽

Cox Regression ◽

Treatment Guidelines ◽

Current Treatment ◽

Hiv Treatment ◽

Hiv Care ◽

Hiv Diagnosis ◽

Treatment Data ◽

Poor Treatment

Background.Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment.Methods.A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015.Results.Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less,P<0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression.Conclusion.Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.

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Engaging the ‘Missing Men’ in the HIV Treatment Cascade: Creating a Tailored Intervention to Improve Men’s Uptake of HIV Care Services in Rural South Africa: A Study Protocol

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073709 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3709

Author(s):

Oluwafemi Adeagbo ◽

Kammila Naidoo

Keyword(s):

South Africa ◽

Health Outcomes ◽

Hiv Treatment ◽

Hiv Care ◽

Treatment Cascade ◽

Hiv Care Cascade ◽

Care Services ◽

The Social ◽

Hiv Treatment Cascade ◽

Male Specific

Men, especially young men, have been consistently missing from the HIV care cascade, leading to poor health outcomes in men and ongoing transmission of HIV in young women in South Africa. Although these men may not be missing for the same reasons across the cascade and may need different interventions, early work has shown similar trends in men’s low uptake of HIV care services and suggested that the social costs of testing and accessing care are extremely high for men, particularly in South Africa. Interventions and data collection have hitherto, by and large, focused on men in relation to HIV prevention in women and have not approached the problem through the male lens. Using the participatory method, the overall aim of this study is to improve health outcomes in men and women through formative work to co-create male-specific interventions in an HIV-hyper endemic setting in rural KwaZulu-Natal, South Africa.

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