Linkage to HIV Care and Early Retention in Care Rates in the Universal Test-and-Treat Era: A Population-based Prospective Study in KwaZulu-Natal, South Africa

Nicol, Edward; Basera, Wisdom; Mukumbang, Ferdinand C.; Cheyip, Mireille; Mthethwa, Simangele; Lombard, Carl; Jama, Ngcwalisa Amanda; Pass, Desiree; Laubscher, Ria; Bradshaw, Debbie

doi:10.1007/s10461-022-03844-w

Cited by 6 publications

(13 citation statements)

References 36 publications

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“…South African studies have linked the NHLS data with other patient registries before the enactment of the POPIA (38-42). However, while some studies have attempted to link patient management systems in South Africa without patient identi ers (31,32), none have done so using large-scale data. We developed a simple linkage strategy using information on laboratory tests recorded in both NHLS and TIER.Net, without accessing primary patient identi ers such as names or national ID numbers.…”

Section: Discussionmentioning

confidence: 99%

Record linkage without patient identifiers: proof of concept using data from South Africa’s national HIV program

Shumba

Bor

Nattey

et al. 2023

Preprint

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Background:Linkage between health databases typically requires identifiers such as patient names and personal identification numbers. We developed and validated a record linkage strategy to combine administrative health databases without the use of patient identifiers, with application to South Africa’s public sector HIV treatment program. Methods: We linked CD4 counts and HIV viral loads from South Africa’s HIV clinical monitoring database (TIER.Net) and the National Health Laboratory Service (NHLS) for patients receiving care between 2015-2019 in Ekurhuleni District (Gauteng Province). We used a combination of variables related to lab results contained in both databases (result value; specimen collection date; facility of collection; patient year and month of birth; and sex). Exact matching linked on exact linking variable values while caliper matching applied exact matching with linkage on approximate test dates (± 5 days). We then developed a sequential linkage approach utilising specimen barcode matching, then exact matching, and lastly caliper matching. Performance measures were sensitivity and positive predictive value (PPV); share of patients linked across databases; and percent increase in data points for each linkage approach. Results: We attempted to link 2,017,290 lab results from TIER.Net (representing 523,558 unique patients) and 2,414,059 lab results from the NHLS database. Linkage performance was evaluated using specimen barcodes (available for a minority of records in TIER.net) as a “gold standard”. Exact matching achieved a sensitivity of 69.0% and PPV of 95.1%. Caliper-matching achieved a sensitivity of 75.7% and PPV of 94.5%. In sequential linkage, we matched 41.9% of TIER.Net labs by specimen barcodes, 51.3% by exact matching, and 6.8% by caliper matching, for a total of 71.9% of labs matched, with PPV=96.8% and Sensitivity= 85.9%. The sequential approach linked 86.0% of TIER.Net patients with at least one lab result to the NHLS database (N=1,450,087). Linkage to the NHLS Cohort increased the number of laboratory results associated with TIER.Net patients by 62.6%. Conclusions: Linkage of TIER.Net and NHLS without patient identifiers attained high accuracy and yield without compromising patient privacy. The integrated cohort provides a more complete view of patients’ lab history and could yield more accurate estimates of HIV program indicators.

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Section: Discussionmentioning

confidence: 99%

Record linkage without patient identifiers: proof of concept using data from South Africa’s national HIV program

Shumba

Bor

Nattey

et al. 2023

Preprint

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“…The majority of the 38 interviewed participants consisted of young people aged 23-36 years, who were at school, employed or looking for employment, and unmarried at the time of data collection. Males were underrepresented in this study, at 24% (9/38), because fewer men compared to women were recruited in the main study [23,24]. As reported in the main study, accessing men via the health facility continues to be a challenge, as men do not visit the health facilities as frequently compared to women [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

“…A qualitative study design was used to understand the perceptions and experiences of patients on enablers and barriers of linkage to HIV care. This study was embedded within the main study [23,24] and included in-depth interviews with newly diagnosed HIV-positive individuals. Linkage to care in this study refer to the proportion of adult population (18 years and above) per facility who successfully completed a rst medical clinic visit within three months of HIV positive diagnosis and have been initiated onto antiretroviral therapy (ART) as evidenced by a TIER.Net record.…”

Section: Methodsmentioning

confidence: 99%

“…Forty participants were randomly selected from a cohort of 1,194 HIV positive patients recruited in the main study [23,24].…”

Section: Samplingmentioning

confidence: 99%

“…However, individual, societal, and systematic factors continue to undermine efforts to link newly diagnosed HIV patients to care in most settings. This paper, which is a sequel to an earlier report on enhancing linkage to care in uThukela district [23,24], provides a qualitative analysis of a mixed method study, on barriers and enablers related to linkage to HIV care in a high single prevalence rural setting, in KwaZulu Natal, South Africa.…”

Section: Introductionmentioning

confidence: 99%

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Enhancing linkage to HIV care in the “Universal Test-and-Treat” era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa

Nicol

Jama

Mehlomakulu

et al. 2023

Preprint

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Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the ‘Universal Test-and-Treat’ (UTT) strategy – initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients’ perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors which facilitated or inhibited linkage-to-care were found at individual, family, community, as well as the health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experience with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training health care providers, community outreach and the provision of psychological, social, and financial support.

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Effect of UTT on viral suppression and ART adherence

Bachanas

Moore²

2022

The Lancet HIV

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Linkage to HIV Care and Early Retention in Care Rates in the Universal Test-and-Treat Era: A Population-based Prospective Study in KwaZulu-Natal, South Africa

Cited by 6 publications

References 36 publications

Record linkage without patient identifiers: proof of concept using data from South Africa’s national HIV program

Record linkage without patient identifiers: proof of concept using data from South Africa’s national HIV program

Enhancing linkage to HIV care in the “Universal Test-and-Treat” era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa

Effect of UTT on viral suppression and ART adherence

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