A comparison of self-report and antiretroviral detection to inform estimates of antiretroviral therapy coverage, viral load suppression and HIV incidence in Kwazulu-Natal, South Africa

Abstract Background The recently increased access to antiretroviral therapy (ART) in South Africa has placed additional strain on human and infrastructure resources of the public health sector. Capacity from private-sector General Practitioners (GPs) could be leveraged to ease the current burden on the public health sector. Methods We conducted a retrospective record review of routine electronic medical record data on a systematic sample of HIV-infected adults (≥18 years old) initiated on ART at a tertiary hospital outpatient HIV clinic in Johannesburg, South Africa and down-referred to private-GPs for continued care after stabilization on ART. We compared these patients (“GP down-referred”) to a control-cohort who remained at the referring site (“Clinic A”) and patients from a regional hospital outpatient HIV clinic not offering down-referral to GPs (“Clinic B”). Study outcomes assessed are viral load suppression (VL < 50 copies/ml) and attrition from care (all-cause-mortality or > 90-days late for a last-scheduled visit) by 12 months of follow-up following down-referral or eligibility. Results A total of 3685 patients, comprising 373 (10.1%) GP down-referred, 2599 (70.5%) clinic A controls, and 713 (19.4%) clinic B controls were included in the analysis. Overall, 1535 patients (53.3%) had a suppressed viral load. A higher portion of GP down-referred patients had a suppressed viral load compared to clinic A and B patients (65.7% vs 49.1% vs 58.9%). After adjusting for demographic and baseline clinical covariates, we found no difference in viral load suppression between GP down-referred and control patients (adjusted relative risk [aRR] for clinic A vs GP down-referred 1.0; 95% CI: 0.9–1.1), (aRR for clinic B vs GP down-referred 1.0; 95% CI: 0.9–1.2). Clinic B controls experienced the highest attrition compared to GP down-referred and clinic A controls (33.2% vs 11.3% vs 5.9%) and had a higher risk of attrition compared to GP down-referred patients (adjusted hazard ratio [aHR] 4.2; 95% CI: 2.8–6.5), whereas clinic B controls had a lower risk of attrition (aHR 0.5; 95% CI: 0.3–0.7). Conclusions and recommendations Our results show that private-GPs can contribute to caring for stabilized public sector HIV patients on life-long ART. However, they require special efforts to improve retention in care.

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Large age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2013164118 ◽

2021 ◽

Vol 118 (28) ◽

pp. e2013164118

Author(s):

Adam Akullian ◽

Alain Vandormael ◽

Joel C. Miller ◽

Anna Bershteyn ◽

Edward Wenger ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Hiv Risk ◽

Large Scale ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Hiv Incidence ◽

Kwazulu Natal ◽

Sub Saharan ◽

Hiv 1

Recent declines in adult HIV-1 incidence have followed the large-scale expansion of antiretroviral therapy and primary HIV prevention across high-burden communities of sub-Saharan Africa. Mathematical modeling suggests that HIV risk will decline disproportionately in younger adult age-groups as interventions scale, concentrating new HIV infections in those >age 25 over time. Yet, no empirical data exist to support these projections. We conducted a population-based cohort study over a 16-y period (2004 to 2019), spanning the early scale-up of antiretroviral therapy and voluntary medical male circumcision, to estimate changes in the age distribution of HIV incidence in a hyperepidemic region of KwaZulu-Natal, South Africa, where adult HIV incidence has recently declined. Median age of HIV seroconversion increased by 5.5 y in men and 3.0 y in women, and the age of peak HIV incidence increased by 5.0 y in men and 2.0 y in women. Incidence declined disproportionately among young men (64% in men 15 to 19, 68% in men 20 to 24, and 46% in men 25 to 29) and young women (44% in women 15 to 19, 24% in women 20 to 24) comparing periods pre- versus post-universal test and treat. Incidence was stable (<20% change) in women aged 30 to 39 and men aged 30 to 34. Age shifts in incidence occurred after 2012 and were observed earlier in men than in women. These results provide direct epidemiological evidence of the changing demographics of HIV risk in sub-Saharan Africa in the era of large-scale treatment and prevention. More attention is needed to address lagging incidence decline among older individuals.

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Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v21i1.1085 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Nolundi Mshweshwe-Pakela ◽

Bhakti Hansoti ◽

Tonderai Mabuto ◽

Deanna Kerrigan ◽

Griffiths Kubeka ◽

...

Keyword(s):

South Africa ◽

Viral Load ◽

Antiretroviral Therapy ◽

Routine Care ◽

Viral Load Suppression ◽

Therapy Initiation

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The use of illustrated medication diaries to improve outcomes for children initiated on highly active antiretroviral therapy

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v19i1.804 ◽

2018 ◽

Vol 19 (1) ◽

Author(s):

Yashodhara Kannigan ◽

Kevin B. Spicer ◽

Fathima Naby

Keyword(s):

South Africa ◽

Viral Load ◽

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Intervention Group ◽

Control Group ◽

Viral Load Suppression ◽

Highly Active ◽

Z Scores ◽

Outcomes For Children

Background: Human immunodeficiency virus (HIV) represents a huge burden of disease in South Africa. Highly active antiretroviral therapy (HAART) is effective in reducing HIV-related morbidity and mortality. Simple, inexpensive methods like adherence diaries to optimise effects of HAART would be useful.Methods: This quasi-experimental study was performed at a paediatric antiretroviral clinic in KwaZulu-Natal, South Africa. Children, from birth to 15 years, initiated on HAART from 01 August 2015 to 31 July 2016 were given illustrated medication diaries to be completed by caregivers. Viral load suppression and improvement in growth parameters and CD4+ percentage were determined at six months and one year. These outcomes were compared to those of a group of children who had been initiated on HAART from 01 August 2014 to 31 July 2015 and who had not received diaries.Results: Ninety-nine children were included in the historical control group and 35 children in the intervention group. Viral load suppression (HIV-1 RNA of < 400 copies/mL) was 72% in the control group and 71% in the diary group at 6 months (p = 0.6). At 12 months, 73% of children in the control group and 57% of the diary group had suppressed viral loads (p = 0.18). At 6 months, 63% of children in the control group and 57% of the diary group had improved weight for height z-scores (p = 0.09). At 12 months, when compared with baseline weight for height z-scores, there was improvement in 34% and 41% of the control and diary groups, respectively (p = 0.6). CD4+ percentages improved in 51% of the control group and 50% of the diary group at 6 months (p = 0.70); improvement was noted in 44% and 49%, respectively, at 12 months (p = 0.33).Conclusion: The addition of an illustrated medication diary to routine adherence counselling did not improve outcomes for children initiated on HAART.

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Sustained cerebrospinal fluid viral load suppression and preserved cognitive outcome in HIV-infected people with Highly Active Antiretroviral Therapy containing abacavir and AZT – a longitudinal study over 24 months

Aktuelle Neurologie ◽

10.1055/s-0029-1238326 ◽

2009 ◽

Vol 36 (S 02) ◽

Author(s):

K Hahn ◽

S Neifer ◽

H Meisel ◽

E Schielke

Keyword(s):

Cerebrospinal Fluid ◽

Viral Load ◽

Longitudinal Study ◽

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Cognitive Outcome ◽

Viral Load Suppression ◽

Infected People ◽

Highly Active

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The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa

Scientific Reports ◽

10.1038/s41598-021-94057-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Aditi Kuber ◽

Anna Reuter ◽

Pascal Geldsetzer ◽

Natsayi Chimbindi ◽

Mosa Moshabela ◽

...

Keyword(s):

South Africa ◽

Blood Pressure ◽

Body Mass Index ◽

Antiretroviral Therapy ◽

Body Mass ◽

Treatment Guidelines ◽

Causal Effect ◽

Regression Discontinuity Design ◽

National Treatment ◽

Kwazulu Natal

AbstractWe use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.

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