Cohort Profile: Hlabisa HIV Treatment and Care Programme

Houlihan, Catherine; Bland, Ruth; Mutevedzi, Portia; Lessells, Richard J; Ndirangu, James; Thulare, Hilary; Newell, Marie‐Louise

doi:10.1093/ije/dyp402

Cited by 136 publications

(220 citation statements)

References 23 publications

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“…Few people refused the offer of HIV testing once they had received counselling on the importance of knowing their HIV status for optimal general medical care and TB treatment. The HIV testing rate had risen to 94% [13] from the previously reported 88%, [6,11] with an age-sex profile comparable to previous studies in the area. [2,6] There was no significant difference in terms of socio-demographic characteristics between patients not offered an HIV test and those offered one, indicating that health workers were following the TB guidelines on HIV screening satisfactorily and have adopted a successful PITC approach.…”

Section: Discussionsupporting

confidence: 81%

“…The programme is integrated with the Hlabisa HIV Treatment and Care Programme (ART programme), which receives additional staff support and database management from the Africa Centre for Health and Population Studies (www.africacentre.com). [6,11] The ART programme utilises a decentralised approach with integration of TB and HIV services to primary healthcare, linking treatment, care and prevention services. [11] TB nurses at each PHC identify TB suspects and collect sputum, which is sent to the National Health Laboratory Service (NHLS) for acid-fast bacilli smear testing.…”

Section: Methodology Settingmentioning

confidence: 99%

“…[6,11] The ART programme utilises a decentralised approach with integration of TB and HIV services to primary healthcare, linking treatment, care and prevention services. [11] TB nurses at each PHC identify TB suspects and collect sputum, which is sent to the National Health Laboratory Service (NHLS) for acid-fast bacilli smear testing. All smear-positive patients are initiated onto the first-line standard TB regimen, and patients with negative smears (most of whom are HIV-infected) who remain symptomatic are referred to the DH for further clinical assessment and X-rays.…”

Section: Methodology Settingmentioning

confidence: 99%

“…[11,12] A rapid HIV test is performed in patients who agree to be tested, and blood samples from HIV-positive patients are sent to the NHLS for CD4 cell counts. Results are available within 2 days and patients are requested to return to the clinic for their CD4 count results within a week of sample collection.…”

Section: Methodology Settingmentioning

confidence: 99%

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An integrated approach to improving the availability and utilisation of tuberculosis healthcare in rural South Africa

Bärnighausen²,

Newell

2013

S Afr Med J

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Background. Patients with tuberculosis (TB) face several challenges in accessing care, and an integrated service that includes HIV testing could be preferable for them and ensure timely HIV treatment initiation and optimal TB care. Objectives. To investigate factors, including uptake of HIV testing, associated with availability and utilisation of healthcare by TB patients in a rural programme devolved to primary care in Hlabisa sub-district, KwaZulu-Natal. Methods. Three hundred TB patients were randomly selected in a two-stage-sampling scheme with five primary healthcare clinic (PHC) sampling units selected with probability proportional to size. Data were collected using a structured questionnaire. We describe key availability and utilisation factors and analyse factors associated with being offered an HIV test in multiple regressions controlling for sex, age, education, employment and marital status. Results. Most patients (75.2%) received care for a first episode of TB, mainly pulmonary. Nearly all (94.3%) were offered an HIV test during their current TB treatment episode, patients using their closest clinic being substantially more likely to have been offered HIV testing than those not using their closest clinic (adjusted odds ratio 12.79, p=0.05). About one-fifth (20.3%) of patients did not take medication under observation, and 3.4% reported missing taking their tablets at some stage. Average travelling time to the clinic and back was 2 hours, most patients (56.8%) using minibus taxis. Conclusion. We demonstrate high HIV testing rates among TB patients in a rural public programme, suggesting appropriate management of HIV-TB co-infected patients. We describe healthcare availability and utilisation factors that can inform the proposed district management teams for PHC re-engineering on areas needing improvement.

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Section: Discussionsupporting

confidence: 81%

Section: Methodology Settingmentioning

confidence: 99%

Section: Methodology Settingmentioning

confidence: 99%

Section: Methodology Settingmentioning

confidence: 99%

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An integrated approach to improving the availability and utilisation of tuberculosis healthcare in rural South Africa

Bärnighausen²,

Newell

2013

S Afr Med J

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“…Both NHLS and the ACCDB database contain data from Hlabisa primary care clinics since 2004 21. Linkage between trial, NHLS and ACCDB database used a probabilistic score based on first name, last name, date of birth, South African ID number and cell phone number.…”

Section: Methodsmentioning

confidence: 99%

The impact of population dynamics on the population HIV care cascade: results from the ANRS 12249 Treatment as Prevention trial in rural KwaZulu‐Natal (South Africa)

et al. 2018

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IntroductionThe universal test and treat strategy (UTT) was developed to maximize the proportion of all HIV‐positive individuals on antiretroviral treatment (ART) and virally suppressed, assuming that it will lead to a reduction in HIV incidence at the population level. The evolution over time of the cross‐sectional HIV care cascade is determined by individual longitudinal trajectories through the HIV care continuum and underlying population dynamics. The purpose of this paper is to quantify the contribution of each component of population change (in‐ and out‐migration, HIV seroconversion, ageing into the cohort and definitive exit such as death) on the HIV care cascade in the context of the ANRS 12249 Treatment as Prevention (TasP) cluster‐randomized trial, investigating UTT in rural KwaZulu‐Natal, South Africa, between 2012 and 2016.Methods HIV test results and information on clinic visits, ART prescriptions, viral load and CD4 count, migration and deaths were used to calculate residency status, HIV status and HIV care status for each individual on a daily basis. Position within the HIV care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). We compared the cascade score of each individual joining or leaving the population of resident adults living with HIV with the average score of their cluster at the time of entry or exit. Then, we computed the contribution of each entry or exit on the average cascade score and their annualized total contribution, by component of change.ResultsWhile the average cascade score increased over time in all clusters, that increase was constrained by population dynamics. Permanent exits and ageing into the people living with HIV cohort had a marginal effect. Both in‐migrants and out‐migrants were less likely to be retained at each step of the HIV care continuum. However, their overall impact on the cross‐sectional cascade was limited as the effect of in‐ and out‐migration balanced each other. The contribution of HIV seroconversions was negative in all clusters.ConclusionsIn a context of high HIV incidence, the continuous flow of newly infected individuals slows down the efforts to increase ART coverage and population viral suppression, ultimately attenuating any population‐level impact on HIV incidence.Clinical Trial Number NCT01509508 (clinicalTrials.gov)/DOH‐27‐0512‐3974 (South African National Clinical Trials Register).

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Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa

et al. 2019

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Introduction The universal test‐and‐treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods The TasP cluster‐randomized trial (2012 to 2016) implemented six‐monthly repeat home‐based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 × 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART‐initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90‐90‐90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context‐specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH‐27‐0512‐3974 (South African National Clinical Trials Register).

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Cohort Profile: Hlabisa HIV Treatment and Care Programme

Cited by 136 publications

References 23 publications

An integrated approach to improving the availability and utilisation of tuberculosis healthcare in rural South Africa

An integrated approach to improving the availability and utilisation of tuberculosis healthcare in rural South Africa

The impact of population dynamics on the population HIV care cascade: results from the ANRS 12249 Treatment as Prevention trial in rural KwaZulu‐Natal (South Africa)

Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa

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