Need for improvements in clinical practice to retain patients in pre-antiretroviral therapy care: Data from rural clinics in North West Province, South Africa

Abstract

We examined current challenges with patient engagement in HIV prevention and care in South Africa by assessing the procedures of eight public health clinics in the North West Province. Procedures consisted of (1) an inventory/audit of the HIV Counseling and Testing (HCT), pre-antiretroviral therapy (pre-ART) and antiretroviral therapy (ART) patient registers; (2) extraction of data from a convenience sample of 39 HIV-positive patient files; and (3) thirteen key informant interviews with clinic staff to characterize retention and re-engagement practices for patients. Incomplete registers revealed little evidence of follow-up services, particularly for pre-ART patients. The more detailed examination of patient files indicated substantial disparities in the proportion of pre-ART versus ART patients retained in care. Key informant interviews contextualized the data, with providers describing multiple procedures for tracking and ensuring service delivery for ART patients and fewer procedures to retain pre-ART patients. These findings suggest that enhanced strategies are needed for ensuring continued engagement in HIV care, with a particular emphasis on improving the retention of pre-ART patients. The preventive benefits of ART scale-up may not be achieved if improvements are not made in the proportion of earlier-stage HIV-positive patients who are successfully engaged in care.

“I Have to Push Him with a Wheelbarrow to the Clinic”: Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa

“…The need for improvements in clinical practice, particularly better patient-provider relations and systematized patient care engagement and follow-up, has emerged in other South African studies. 21,[56][57][58][59] Acknowledging the limitations of an overburdened healthcare system, staff training should be designed to encourage the provision of destigmatized, patient-centered care and to ensure adequate patient counseling at time of diagnosis. 50 There is also growing evidence supporting the need to improve access to HIV care by addressing a patient's socioeconomic circumstances.…”

Engaging HIV-positive clients in care: acceptability and mechanisms of action of a peer navigation program in South Africa

“…For example, South Africa expanded eligibility for its public ART program and decentralized medication delivery (Brennan et al, 2011; National Consolidated Guidelines for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) and the Management of HIV in Children, Adolescents and Adults, 2014). These changes have not eliminated care cascade challenges, however (Gilvydis et al, 2015). Additional efforts thus focus on enhancing interpersonal support for individual clients facing barriers to care and ART use, such as home-based care services (Fatti, Meintjes, Shea, Eley, & Grimwood, 2012;Torpey et al, 2008) and the identification of a "treatment supporter" within a client's social network (Kunutsor et al, 2012).…”

Where is the evidence? The use of routinely-collected patient data to retain adults on antiretroviral treatment in low and middle income countries–a state of the evidence review

“…As a result, 19 publications were analysed in total. Five of these publications are peerreviewed journal articles (Errol et al, 2012;Gilvydis et al, 2015;Nglazi, Kaplan, Wood, Bekker, & Lawn, 2010;Ramdas, Meyer, & Cameron, 2015;Tweya et al, 2010), six are abstracts and posters from an International AIDS Conference (Fox et al, 2017;Kitsao, Kimani, Muriuki, & Akolo, 2017;Mganga et al, 2014;Mugisa, Mugume, Odong, & Ndagire, 2014;Odhiambo et al, 2014;Wandina et al, 2011), four are reports (do Nascimento & Joao, 2013;do Nascimento et al, 2014;Vella, Govender, & Scelo, 2008;"South African National", 2010), two are theses (Naidoo, 2006;Ncholo, 2010), one (Chantal, 2011) is a document recording an online discussion, and one is a blog post (Tjaronda, Mwinga, Kagoya, & Mazibuko, 2017) (Table 1).…”