Patient Transfers and Their Impact on Gaps in Clinical Care: Differences by Gender in a Large Cohort of Adults Living with HIV on Antiretroviral Therapy in South Africa

Bengtson, Angela M.; Dice, Ana Lucia Espinosa; Kirwa, Kipruto; Cornell, Morna; Lurie, Mark N.

doi:10.1007/s10461-021-03191-2

Cited by 8 publications

(5 citation statements)

References 36 publications

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“…The majority of these children (n = 74, 55%) relocated or transferred to other non-study clinics for their chronic care; others (n = 41) were lost to follow-up, and some (n = 19) died. Patient transfers from one clinic to another is common and has been documented in other cohorts within the region [ 35 , 36 ]. In settings like Lesotho, where family migration is common [ 37 ], optimization of pediatric ART programs should include robust patient follow-up systems that ensure continuity of care whenever transfers occur.…”

Section: Discussionmentioning

confidence: 99%

Optimizing antiretroviral therapy for children living with HIV: Experience from an observational cohort in Lesotho

et al. 2023

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Introduction We describe transition of HIV-positive children from efavirenz- or nevirapine-based antiretroviral therapy (ART) to optimal dolutegravir (DTG) or lopinavir/ritonavir (LPV/r) (solid formulation)-based ART in Lesotho. Methods We followed a cohort of children less than 15 years of age who were initiated on ART on or after January 1, 2018 from 21 selected health facilities in Lesotho. From March 2020 to May 2022, we collected data retrospectively through chart abstraction and prospectively through caregiver interviews to cover a period of 24 months following treatment initiation. We used a structured questionnaire to collect data on demographics, ART regimen, drug formulations and switches, viral suppression, retention, and drug administration challenges. Data were summarized as frequencies and percentages, using SAS ver.9.4. Results Of 310 children enrolled in the study, 169 (54.5%) were female, and median age at ART initiation was 5.9 years (IQR 1.1–11.1). During follow-up, 19 (6.1%) children died, 41 (13.2%) were lost to follow-up and 74 (23.9%) transferred to non-study sites. At baseline, 144 (46.4%) children were receiving efavirenz-based ART regimen, 133 (42.9%) LPV/r, 27 (8.7%) DTG, 5 (1.6%) nevirapine; 1 child had incomplete records. By study end, 143 (46.1%) children were receiving LPV/r-based ART regimen, 109 (35.2%) DTG, and 58 (18.7%) were on efavirenz or nevirapine-based regimen. Of 116 children with viral load results after six months or more on a consistent regimen, viral suppression was seen in 35/53 (66.0%) children on LPV/r, 36/38 (94.7%) children on DTG and 19/24 (79.2%) children on efavirenz. Conclusion Following optimal ART introduction in Lesotho, most children in the cohort were transitioned and many attained or maintained viral suppression after transition; however, we recommend more robust viral load monitoring and patient tracking to reduce losses and improve outcomes after ART transition.

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Section: Discussionmentioning

confidence: 99%

Optimizing antiretroviral therapy for children living with HIV: Experience from an observational cohort in Lesotho

et al. 2023

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“…34,39 This suggests that in this analysis, the risk of viremia post-transfer in those who disengaged was increased even after treatment was restarted. Disengagement has previously been associated with transfer 29 and improving access to care and preventing disengagement in patients who transfer will thus be vital to improving treatment outcomes. In a qualitative study of 16 adults with HIV who silently transferred in South Africa, patients described the transfer process as confusing and difficult to navigate with numerous logistical barriers to transfer, including having to restart treatment at receiving facilities because of a lack of paperwork.…”

Section: Discussionmentioning

confidence: 99%

“…24 Up to 36% of PLH categorized as LTFU have been shown to have transferred silently between health facilities, and this misclassification has implications for programme evaluation and resource allocation. 15,25 There is evidence of suboptimal adherence to treatment and gaps in care at the time of transfer, 10,22,[26][27][28][29] but data on the association between transfer and viral load (VL) outcomes in PLH on ART are few.…”

Section: Introductionmentioning

confidence: 99%

Transfer of Patients on Antiretroviral Therapy Attending Primary Health Care Services in South Africa

Odayar

Benjamin

Phillips

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Patients stable on antiretroviral therapy (ART) may require transfer between health care facilities to maintain continuous care, yet data on the frequency, predictors, and virologic outcomes of transfers are limited.Methods: Data for all viral load (VL) testing at public sector health facilities in the Western Cape Province (2011-2018) were obtained. Participant inclusion criteria were a first VL between 2011 and 2013, age .15 years at ART initiation, and .1 VL within 5 years of ART initiation, of which $1 was at a primary health care facility. Two successive VLs taken at different facilities indicated a transfer. We assessed predictors of transfer using generalized estimating equations with Poisson regression and the association between transfer and subsequent VL. 1000 copies/mL using generalized mixed effects.Results: Overall 84,814 participants (median age at ART initiation 34 years and 68% female) were followed up for up to 4.5 years after their first VL: 34% (n = 29,056) transferred at least once, and among these, 26% transferred twice and 11% transferred thrice or more. Female sex, age ,30 years, and first VL . 1000 copies/mL were independently associated with an increased rate of transfer [adjusted

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“…Pregnant women were more likely to transfer care in our study as well, although none cited the end of ANC as the reason for a change in facility. This finding potentially reflects mobility among childbearing women and mothers of young children, including extended family visits [ 15 , 18 , 19 ]. The large majority of clinic changes in our data were driven by population mobility, most of which was within the province.…”

Section: Discussionmentioning

confidence: 99%

“…Recent detailed assessments of clinical records in government facilities in rural Mpumalanga Province have found that patient tracking overestimates loss to follow-up and underestimates clinic changes: nearly 1 in 3 patients recorded as lost to follow-up had initiated care elsewhere, with many transfers undocumented by the original facility [ 13 , 14 ]. Studies in urban centers have also identified moderate rates of clinic change and more common treatment gaps or cessation among those changing their source of care [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence, motivation, and outcomes of clinic transfer in a clinical cohort of people living with HIV in North West Province, South Africa

Leslie

Mooney

Gilmore

et al. 2022

BMC Health Serv Res

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Introduction Continuity of care is an attribute of high-quality health systems and a necessary component of chronic disease management. Assessment of health information systems for HIV care in South Africa has identified substantial rates of clinic transfer, much of it undocumented. Understanding the reasons for changing sources of care and the implications for patient outcomes is important in informing policy responses. Methods In this secondary analysis of the 2014 – 2016 I-Care trial, we examined self-reported changes in source of HIV care among a cohort of individuals living with HIV and in care in North West Province, South Africa. Individuals were enrolled in the study within 1 year of diagnosis; participants completed surveys at 6 and 12 months including items on sources of care. Clinical data were extracted from records at participants’ original clinic for 12 months following enrollment. We assessed frequency and reason for changing clinics and compared the demographics and care outcomes of those changing and not changing source of care. Results Six hundred seventy-five (89.8%) of 752 study participants completed follow-up surveys with information on sources of HIV care; 101 (15%) reported receiving care at a different facility by month 12 of follow-up. The primary reason for changing was mobility (N=78, 77%). Those who changed clinics were more likely to be young adults, non-citizens, and pregnant at time of diagnosis. Self-reported clinic attendance and ART adherence did not differ based on changing clinics. Those on ART not changing clinics reported 0.66 visits more on average than were documented in clinic records. Conclusion At least 1 in 6 participants in HIV care changed clinics within 2 years of diagnosis, mainly driven by mobility; while most appeared lost to follow-up based on records from the original clinic, self-reported visits and adherence were equivalent to those not changing clinics. Routine clinic visits could incorporate questions about care at other locations as well as potential relocation, particularly for younger, pregnant, and non-citizen patients, to support existing efforts to make HIV care records portable and facilitate continuity of care across clinics. Trial registration The original trial was registered with ClinicalTrials.gov, NCT02417233, on 12 December 2014.

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Patient Transfers and Their Impact on Gaps in Clinical Care: Differences by Gender in a Large Cohort of Adults Living with HIV on Antiretroviral Therapy in South Africa

Cited by 8 publications

References 36 publications

Optimizing antiretroviral therapy for children living with HIV: Experience from an observational cohort in Lesotho

Optimizing antiretroviral therapy for children living with HIV: Experience from an observational cohort in Lesotho

Transfer of Patients on Antiretroviral Therapy Attending Primary Health Care Services in South Africa

Prevalence, motivation, and outcomes of clinic transfer in a clinical cohort of people living with HIV in North West Province, South Africa

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