Linkage to Care Following an HIV Diagnosis in Three Public Sector Clinics in eThekwini (Durban), South Africa: Findings from a Prospective Cohort Study

Hoffman, Susie; Leu, Cheng-Shiun; Ramjee, Gita; Blanchard, Kelly; Gandhi, Anisha D.; O’Sullivan, Lucia F.; Kelvin, Elizabeth A.; Exner, Theresa M.; Mantell, Joanne E.; Lince-Deroche, Naomi

doi:10.1007/s10461-019-02688-1

Cited by 3 publications

(12 citation statements)

References 45 publications

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“…Two studies applied observational cluster randomized [65] and nonrandomized trials [66], and the remaining three employed a case-control design [67][68][69]. Twenty-one studies reported on linkage to HIV care [7,8,11,15,17,19,27,44,45,47,48,50,[57][58][59][60][61][67][68][69][70] (Table 1), seventeen on ART initiation [9, 10, 13, 14, 39-43, 51-53, 55, 62-65] and the rest eight reported both outcomes [12,20,23,46,49,54,56, 66] (Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Maheu-Giroux et al [27] identi ed a median time to care linkage after HIV infection of 4.9 years. Among studies that investigated the rate of linkage to care since diagnosis, the rate was within three months of diagnosis [12,49,50,56,58,66,70]. The rate ranges from 24% in Tanzania [12] to 93% in South Africa [50].…”

Section: Measurementsmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%

“…Fifteen studies reported associations between behavioural or psychosocial factors and late linkage to care [11,17,19,23,27,44,45,49,50,56,60,[67][68][69][70]. Testing because of illness [19,44,45,68,69], having a previous history of HIV diagnosis [11,27,49], readiness for treatment [56], holding a positive-outcome belief in care and using positive reframing as a coping strategy [70] increased the likelihood of linkage to care. Non-disclosure of HIV status [17,45,56,60,67,70], a desire for repeated testing [23,60], an experience or fear of stigma [56, 67, 69], having low household social support [67] and having severe depression and anxiety [50] increased delays in care linkage.…”

Section: Measurementsmentioning

confidence: 99%

“…Testing because of illness [19,44,45,68,69], having a previous history of HIV diagnosis [11,27,49], readiness for treatment [56], holding a positive-outcome belief in care and using positive reframing as a coping strategy [70] increased the likelihood of linkage to care. Non-disclosure of HIV status [17,45,56,60,67,70], a desire for repeated testing [23,60], an experience or fear of stigma [56, 67, 69], having low household social support [67] and having severe depression and anxiety [50] increased delays in care linkage. Six studies reported perceptions related to clinical conditions as barriers to linkage to care [11,15,20,49,57,58].…”

Section: Measurementsmentioning

confidence: 99%

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Risk Factors for Late Linkage to Care and Delayed Antiretroviral Therapy Initiation Amongst HIV Infected Adults in Sub-saharan Africa: a Systematic Review and Meta-analyses

Fuge

Tsourtos

Miller

2022

Preprint

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Background: Late linkage to care and delay in antiretroviral therapy (ART) initiation threaten the clinical and public health benefits of ART such as: preventing acquired immunodeficiency syndrome (AIDS) and non-AIDS related morbidities and mortality, as well as reducing new infections. The prevalence of both of these poor care outcomes remains high in sub-Saharan African (SSA) countries. Quantitative synthesises of the existing data are lacking, which would help ascertain the best evidence-based interventions. This review aimed to systematically synthesise the available literature on factors affecting linkage to care and ART initiation amongst HIV infected adults in SSA. Methods: Systematic searches were undertaken of the following databases: Emcare, Medline, PubMed and Web of Science. In our review, we included observational studies that analysed factors affecting linkage to HIV care and ART initiation amongst adults (age ≥19 years) in SSA, and were published between January 1, 2015 and June 1, 2021. All included studies were assessed for risk of bias using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. RevMan-5 software was used to conduct meta-analyses and Mantel-Haenszel statistics to pool outcomes with 95% confidence interval and <0.05 level of significance. The review protocol has been published at the International Prospective Register of Systematic Reviews (PROSPERO; Number: CRD42021264398).Results: Forty-six studies were included in the systematic review, of which 18 fulfilled requirements for meta-analysis. Health care delivery, psychosocial, behavioural and sociodemographic factors were identified as determinants of late linkage to care and delay in ART initiation. The meta-analyses showed that people of a younger age group (<35 years) were 29% (OR: 0.71; 95%CI: 0.55-0.91, I2 = 74%) and 45% (OR: 0.55; 95%CI: 0.49-0.63, I2 = 0%) less likely to be linked to care and initiate ART respectively compared to people of an older age group (≥35 years). Employed people and people who travelled for more than an hour to reach a clinic were more than 1.3 (OR: 1.32; 95%CI: 1.14-1.52, I2 = 14%) and 1.2 (OR: 1.27; 95%CI: 1.15-1.39, I2 = 57%) times more likely to be presented late for care, respectively. The likelihood of linkage to care decreased by 26% (OR: 0.74; 95%CI: 0.62-0.87, I2 = 25%) for people who were unable to disclose their HIV status and 50% (OR: 0.50; 95%CI: 0.42-0.60, I2 = 0%) for those who had a baseline CD4 count >350cells/mm3 compared to CD4 count ≤350cells/mm3, but increased by 65% (OR: 1.65; 95%CI: 1.16-2.34, I2 = 0%) for those who were diagnosed through health facility-based testing approaches compared to community-based approaches. Conclusion: This systematic review and meta-analyses identified a range of risk factors for late linkage to care and delayed ART initiation amongst HIV infected adults in SSA including: health service delivery, psychosocial, behavioural and sociodemographic circumstances. We recommend implementation of patient-centred intervention approaches to alleviate these barriers.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%

See 3 more Smart Citations

Risk Factors for Late Linkage to Care and Delayed Antiretroviral Therapy Initiation Amongst HIV Infected Adults in Sub-saharan Africa: a Systematic Review and Meta-analyses

Fuge

Tsourtos

Miller

2022

Preprint

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Risk factors for late linkage to care and delayed antiretroviral therapy initiation among adults with HIV in sub-Saharan Africa: a systematic review and meta-analyses

Fuge¹,

Tsourtos²,

Miller³

2022

International Journal of Infectious Diseases

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Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study

Tariq

Ramjee

et al. 2021

PLoS ONE

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Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010–2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19–0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01–1.07) and higher CD4+ cell count (≥300μL vs. <150μL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19–0.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding.

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Linkage to Care Following an HIV Diagnosis in Three Public Sector Clinics in eThekwini (Durban), South Africa: Findings from a Prospective Cohort Study

Cited by 3 publications

References 45 publications

Risk Factors for Late Linkage to Care and Delayed Antiretroviral Therapy Initiation Amongst HIV Infected Adults in Sub-saharan Africa: a Systematic Review and Meta-analyses

Risk Factors for Late Linkage to Care and Delayed Antiretroviral Therapy Initiation Amongst HIV Infected Adults in Sub-saharan Africa: a Systematic Review and Meta-analyses

Risk factors for late linkage to care and delayed antiretroviral therapy initiation among adults with HIV in sub-Saharan Africa: a systematic review and meta-analyses

Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study

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