Lost to follow up rate in the first year of ART in adults initiated in a universal test and treat programme: a retrospective cohort study in Ekurhuleni District, South Africa

Abstract

Introduction South Africa adopted and implemented the Universal Test and Treat (UTT) strategy for HIV since 2016. However, the care outcomes for patients initiated antiretroviral therapy (ART) through the UTT strategy have not been established. We determined the rate of lost to follow up (LTFU) and associated factors in patients who were initiated on ART through the UTT and the pre-ART strategy at 12 months post ART initiation. Methods this retrospective study analyzed the records of a cohort of patients at 12 months post the initiation of ART. We extracted data from the TIER.Net electronic database of selected facilities in a sub-district in Gauteng Province, South Africa. Factors associated with LFTU at 12 months of ART were assessed and logistic regression performed to identify predictors of LFTU. Results records of 367 patients were evaluated, and 54% were initiated ART through the UTT strategy. The mean age was 36.3 years, mean CD4 cell count at ART initiation was 341 cells/mm 3 , and 25% were initiated at CD4 cell count above 500 cells/mm 3 . LTFU at 12 months was 28%, 50% were LFTU within six months, and 28% within three months of ART. LFTU in the UTT cohort was higher than in the pre-ART cohort, patients initiated through UTT were twice more likely to be LTFU (AOR = 1.84, CI: 1.13-3.00) than pre-ART patients. Conclusion the rate of LTFU at 12 months of ART was 28%, which indicate that the retention in care rate (60%) falls far short of the triple 90 targets required for viral suppression.

Retention in care and viral suppression after same‐day ART initiation: One‐year outcomes of the SLATE I and II individually randomized clinical trials in South Africa

“…We have no reason to suspect that this limitation would have affected our study arms differentially, however. While rates of loss to follow‐up in our study were high, they were not outside the bounds reported by other studies [ 19 , 20 ]. Loss to follow‐up and treatment interruptions during the first year after starting ART are common throughout the sub‐Saharan region and are a critically important challenge for the success of national ART programmes [ 21 ].…”

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

“…The impact of the implementation of the TA strategy on retention is debated. Some authors showed no influence on retention [6], while others reported a positive [20,35] or a negative impact [11,18,52,53]. Importantly, we demonstrated that the implementation of the TA strategy significantly modified the clinical characteristics of PLWH on ART toward a greater proportion of men, a higher CD4 cell count and a lower clinical WHO stage at treatment initiation.…”

“…Intensive supportive interventions need to address retention in care issues for patients initiating ART in the context of the TA strategy. In addition, different patient tracing strategies, such as SMS reminders, phone calls and home visits, would limit attrition [32,53].…”

Rates of viral suppression in a cohort of people with stable HIV from two community models of ART delivery versus facility-based HIV care in Lusaka, Zambia: a cluster-randomised, non-inferiority trial nested in the HPTN 071 (PopART) trial

“…Although few studies have evaluated the effect of universal treatment on long-term retention, studies published since 2019 have shown that 12 months retention following universal treatment is below that required for viral suppression, highlighting the need for targeted interventions to ensure long-term sustainability. 4,5 Many national programmes are scaling up alternative service delivery approaches, known as differentiated service delivery models, to cope with the growing number of people with HIV on treatment. 6 A range of differentiated service delivery models focusing on people with stable disease have been successfully implemented in sub-Saharan Africa allowing them to engage in care through on-going adherence support and dispensation of prepacked medications by community health workers.…”

“…Although few studies have evaluated the effect of universal treatment on long-term retention, studies published since 2019 have shown that 12 months retention following universal treatment is below that required for viral suppression, highlighting the need for targeted interventions to ensure long-term sustainability. 4 , 5 …”