Mobility and structural barriers in rural South Africa contribute to loss to follow up from HIV care

AIDS Care ◽  
2020 ◽  
pp. 1-9
Author(s):  
Alisse Hannaford ◽  
Anthony P. Moll ◽  
Thuthukani Madondo ◽  
Bulelani Khoza ◽  
Sheela V. Shenoi
Keyword(s):  
South Africa ◽  
Hiv Care ◽  
Structural Barriers ◽  
Rural South ◽  
Loss To Follow Up ◽  
Rural South Africa

scholarly journals 1031. Mobility and Structural Barriers Contribute to Loss to Follow up from HIV Care in Rural South Africa

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S546-S546
Author(s):  
Alisse Hannaford ◽  
Anthony Moll ◽  
Thuthukani Madondo ◽  
Bulelani Khoza ◽  
Sheela Shenoi
Keyword(s):  
South Africa ◽  
Hiv Transmission ◽  
Hiv Care ◽  
Structural Barriers ◽  
Hiv Knowledge ◽  
Rural South ◽  
Increased Risk ◽  
Rural Settings ◽  
Rural South Africa

Abstract Background Retention in care is critical to achieving and sustaining viral load suppression, and reducing HIV transmission, yet lost to follow-up (LTFU) in South Africa remains substantial. We sought to understand reasons for disengagement and return to care in neglected rural settings. Methods Using convenience sampling, surveys were completed by 102 PLWH who disengaged from ART (minimum 90 days) and subsequently resumed care. A subset (n=60) completed individual in-depth interviews. Questions assessed HIV knowledge, stigma, barriers to health care, and reasons for both disengaging and returning to care. Results Among 102 participants (53% female), median duration of ART discontinuation was 9 months (IQR 4-22). Participants had HIV knowledge gaps regarding HIV transmission and increased risk of tuberculosis. Two thirds were unaware that ART prevents transmission to other sexual partners. The major contributors to LTFU were mobility and structural barriers. PLWH traveled for an urgent family need or employment and were not able to collect ART while away. Structural barriers included inability to access care, due to lack of financial resources to reach distant clinics, HIV stigma, dissatisfaction with being treated at an HIV specific clinic, pill fatigue and lack of social support. Illness was the major precipitant of returning to care. Conclusion Among those returning to HIV care, patient motivation to continue ART was high, but mobility and structural barriers impede longitudinal HIV care in rural South Africa, threatening the gains made from expanded ART access. To achieve 90-90-90, future interventions to improve retention must address barriers relevant to rural settings including emphasis on patient-centered care such as multi-month ART prescriptions, expanding medication distribution sites, including community-based dispensing sites, integrating ART into primary care, and facilitating linkage to remote facilities when away from their home clinic. Healthcare workers should be capacitated to identify patients’ barriers to chronic care and intervene on those at high risk of LTFU. Disclosures All Authors: No reported disclosures

Mortality and loss to follow-up among HAART initiators in rural South Africa

2009 ◽  
Vol 103 (6) ◽  
pp. 588-593 ◽  
Author(s):  
Peter MacPherson ◽  
Mosa Moshabela ◽  
Neil Martinson ◽  
Paul Pronyk
Keyword(s):  
South Africa ◽  
Rural South ◽  
Loss To Follow Up ◽  
Rural South Africa

scholarly journals The church and paediatric HIV care in rural South Africa: a qualitative study

AIDS Care ◽  
2015 ◽  
Vol 27 (11) ◽  
pp. 1404-1409 ◽  
Author(s):  
Wilma A.J. Norder ◽  
Remco P.H. Peters ◽  
Maarten O. Kok ◽  
Sabine L. van Elsland ◽  
Helen E. Struthers ◽  
...  
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Hiv Care ◽  
Rural South ◽  
Paediatric Hiv ◽  
The Church ◽  
Rural South Africa

scholarly journals Factors influencing HIV care outcomes among adolescents living with HIV in rural South Africa

2021 ◽  
Author(s):  
Lindsey Filiatreau ◽  
Audrey Pettifor ◽  
Jess Edwards ◽  
Nkosinathi Masilela ◽  
Rhian Twine ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Care ◽  
Rural South ◽  
Factors Influencing ◽  
Care Outcomes ◽  
Living With Hiv ◽  
Rural South Africa

scholarly journals The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roxanna Haghighat ◽  
Elona Toska ◽  
Nontuthuzelo Bungane ◽  
Lucie Cluver
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

scholarly journals Hypertension and diabetes control along the HIV care cascade in rural South Africa

2019 ◽  
Vol 22 (3) ◽  
pp. e25213 ◽  
Author(s):  
Jennifer Manne‐Goehler ◽  
Mark J Siedner ◽  
Livia Montana ◽  
Guy Harling ◽  
Pascal Geldsetzer ◽  
...  
Keyword(s):  
South Africa ◽  
Diabetes Control ◽  
Hiv Care ◽  
Rural South ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Rural South Africa

scholarly journals 844. Engagement in HIV Care as an Avenue to Primary Care in Rural South Africa: Results from the Vukuzazi Population Health Platform

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S13-S14 ◽  
Author(s):  
Itai M`yambo Magodoro ◽  
Stephen Oliver ◽  
Dickman Gareta ◽  
Tshwaraganang H Modise ◽  
Olivier Koole ◽  
...  
Keyword(s):  
South Africa ◽  
Regression Models ◽  
Noncommunicable Disease ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Rural South ◽  
Art Programs ◽  
The Past ◽  
Rural South Africa ◽  
Hiv Negative

Abstract Background The healthcare infrastructure developed in response to the HIV epidemic in sub-Saharan Africa has been proposed as a model to respond to the emerging noncommunicable disease (NCD) burden in the region. However, the evidence for the effectiveness of such a strategy is equivocal. Methods We conducted a population-wide health screening among adults ≥15 years within a demographic and health surveillance site (DHSS) in rural South Africa. We collected blood pressure (BP), glycated hemoglobin (HbA1c), HIV disease indicators, and healthcare utilization data. We defined hypertension (HTN) as BP ≥140/90mmHg or use of antihypertensive medication in the past 2 weeks, and diabetes (DM) as HbA1c ≥6.5% or use of hypoglycemic medication in the past two weeks. Cascade of care indicators included: (1) awareness of NCD diagnosis, (2) seeing a provider within the past 6 months; (3) reported use of medication; and (4) disease control, defined as BP <140/90 mmHg or HbA1c <6.5%. We fit regression models to NCD care indicators between people with HIV on ART (PWHA) and HIV negatives. To make population-level estimates, we used inverse probability sampling weights derived from sex- and age-adjusted regression models drawn from the entire DHSS population. Results Of 7,992 individuals, 5,911 (74.2%) were HIV-negative and 2,080 (25.8%) were PWHA (Table 1). PWHA had lower prevalence of both DM (6.8% vs. 10.4%) and HTN (18.0% vs. 24.8%). In multivariable models, linkage to HIV care was associated with improved HTN care cascade indicators, but not DM indicators (Figure 1). PWHA had lower systolic BP and HbA1c than HIV negatives (Figures 2 and 3). Conclusion Linkage to ART programs may be associated with better HTN but not DM care in rural South Africa. Future work should explore how to translate success in ART programs to other NCDs, and for HIV-negative individuals. Disclosures All Authors: No reported Disclosures.

scholarly journals Health Care Providers’ Challenges to High-Quality HIV Care and Antiretroviral Treatment Retention in Rural South Africa

2021 ◽  
Vol 31 (4) ◽  
pp. 722-735
Author(s):  
Aimée Julien ◽  
Sibyl Anthierens ◽  
Annelies Van Rie ◽  
Rebecca West ◽  
Meriam Maritze ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Care Providers ◽  
Antiretroviral Treatment ◽  
Hiv Care ◽  
Care Providers ◽  
Framework Analysis ◽  
High Quality ◽  
Rural South ◽  
Rural South Africa

Provision of high-quality HIV care is challenging, especially in rural primary care clinics in high HIV burden settings. We aimed to better understand the main challenges to quality HIV care provision and retention in antiretroviral treatment (ART) programs in rural South Africa from the health care providers’ perspective. We conducted semi-structured qualitative interviews with 23 providers from nine rural clinics. Using thematic and framework analysis, we found that providers and patients face a set of complex and intertwined barriers at the structural, programmatic, and individual levels. More specifically, analyses revealed that their challenges are primarily structural (i.e., health system- and microeconomic context-specific) and programmatic (i.e., clinic- and provider-specific) in nature. We highlight the linkages that providers draw between the challenges they face, the motivation to do their job, the quality of the care they provide, and patients’ dissatisfaction with the care they receive, all potentially resulting in poor retention in care.

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