Exploring healthcare workers’ experiences of managing patients returning to HIV care in Johannesburg, South Africa

Bisnauth, Melanie A.; Davies, Nick; Monareng, Sibongile; Struthers, Helen; McIntyre, James; Rees, K. R.

doi:10.1080/16549716.2021.2012019

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…It is evident that the Welcome Service intervention strategy and its execution did not fully address the challenge of disengagement in those returning to care, however, this evaluation demonstrates that some changes can be made at facility-level. It also highlights the complexity of patient-HCW relations, root challenges in the health system and broader social influences on engagement 2 , 3 , 15 , 59 . Further research is needed to identify the form that interventions to support re-engagement should take in different contexts, while adhering to the core function and principles around which the Welcome Service was designed.…”

Section: Discussionmentioning

confidence: 99%

Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF’s Welcome Service

Arendse,

Walker,

Pfaff

et al. 2024

Sci Rep

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Psychosocial challenges impact patients’ ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement: 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs’ understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.

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Section: Discussionmentioning

confidence: 99%

Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF’s Welcome Service

Arendse,

Walker,

Pfaff

et al. 2024

Sci Rep

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“…Even so, it appears likely that many patients opt to lie about prior exposure. Other research suggests that they have good reason for doing so, as clinics may refuse to reinitiate those who admit to prior default and/or may provide poorer service to them 28–30. Creating a clinic and community atmosphere that promotes honesty about prior exposure should also be a priority.…”

Section: Discussionmentioning

confidence: 99%

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or reinitiation in sub-Saharan Africa: a systematic review

Benade,

Maskew,

Juntunen

et al. 2023

BMJ Open

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ObjectivesAs countries have scaled up access to antiretroviral therapy (ART) for HIV, attrition rates of up to 30% annually have created a large pool of individuals who initiate treatment with prior ART experience. Little is known about the proportion of non-naïve reinitiators within the population presenting for treatment initiation.DesignSystematic review of published articles and abstracts reporting proportions of non-naïve adult patients initiating ART in sub-Saharan Africa.Data sourcesPubMed, Embase Elsevier, Web of Science Core Collection, International AIDS Society conferences, Conference on Retroviruses and Opportunistic Infections conferences.Eligibility criteriaClinical trials and observational studies; reporting on adults in sub-Saharan Africa who initiated lifelong ART; published in English between 1 January 2018 and 11 July 2023 and with data collected after January 2016. Initiator self-report, laboratory discernment of antiretroviral metabolites, and viral suppression at initiation or in the medical record were accepted as evidence of prior exposure.Data extraction and synthesisWe captured study and sample characteristics, proportions with previous ART exposure and the indicator of previous exposure reported. We report results of each eligible study, estimate the risk of bias and identify gaps in the literature.ResultsOf 2740 articles, 11 articles describing 12 cohorts contained sufficient information for the review. Proportions of initiators with evidence of prior ART use ranged from 5% (self-report only) to 53% (presence of ART metabolites in hair or blood sample). The vast majority of screened studies did not report naïve/non-naïve status. Metrics used to determine and report non-naïve proportions were inconsistent and difficult to interpret.ConclusionsThe proportion of patients initiating HIV treatment who are truly ART naïve is not well documented. It is likely that 20%–50% of ART patients who present for ART are reinitiators. Standard reporting metrics and diligence in reporting are needed, as is research to understand the reluctance of patients to report prior ART exposure.PROSPERO registration numberCRD42022324136.

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“…Even so, it appears likely that many patients opt to lie about prior exposure. Other research suggests that they have good reason for doing so, as clinics may refuse to re-initiate those who admit to prior default and/or may provide poorer service to them[21–23]. Creating a clinic and community atmosphere that promotes honesty about prior exposure should also be a priority.…”

Section: Discussionmentioning

confidence: 99%

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or re-initiation in sub- Saharan Africa: a systematic review

Benade

Maskew

Juntunen

et al. 2022

Preprint

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BackgroundAs countries in sub-Saharan Africa have scaled up access to antiretroviral therapy (ART) for HIV, patient attrition rates of up to 30% per year have created a large pool of individuals who initiate treatment with prior ART experience (non-naïve re-initiators). Little is known about the proportion of non-naïve re-initiators within the population presenting for treatment initiation.MethodsWe conducted a comprehensive, rapid review of recent peer-reviewed reports that presented data on proportions of adult patients initiating ART who were treatment naïve and non-naive in sub-Saharan Africa. Searching PubMed, EMBASE, Web of Science, and international conference abstracts, we sought studies published after 1 January 2018 with data collected after January 2016, when universal HIV treatment access became the norm. We included clinical trials and observational studies and accepted self-report, laboratory discernment of antiretroviral metabolites, or viral suppression at initiation or previously reported in the medical record as evidence of prior exposure. We report results of each eligible study and identify gaps in the literature.ResultsOf 1,782 articles returned in our initial search, we found nine, describing ten cohorts, that contained sufficient information for the review, of which half were from South Africa. The proportion of the study samples with evidence of prior ART use ranged from 5% (self-report only) to 53% (presence of ART metabolites in hair or blood sample among self-reported naïve patients). The vast majority of studies that were screened did not report proportions of initiators who were non-naïve, and among the few that did, the metrics used to determine and report non-naïve proportions were inconsistent and difficult to interpret.ConclusionThe proportion of patients initiating HIV treatment who are truly ART-naïve is not well documented in the literature. From the studies identified, it seems likely that 20% to 50%—and likely at least 30%—of ART patients who present for ART are re-initiators. Standard reporting metrics and diligence in reporting this characteristic of ART initiation cohorts are needed, as is research to understand the reluctance of patients to report prior ART exposure.

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Exploring healthcare workers’ experiences of managing patients returning to HIV care in Johannesburg, South Africa

Cited by 11 publications

References 15 publications

Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF’s Welcome Service

Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF’s Welcome Service

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or reinitiation in sub-Saharan Africa: a systematic review

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or re-initiation in sub- Saharan Africa: a systematic review

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