Quantifying the HIV treatment cascade in a South African health sub‐district by gender: retrospective cohort study

Abstract

objectives To quantify the HIV care cascade in a Cape Town sub-district to understand rates of linkage to and engagement in HIV care.methods We used routinely collected data to reconstruct the treatment cascade for 8382 infected individuals who tested HIV + in 2012/2013. We obtained data on patient gender, year of initial HIVpositive test, age at testing and initial CD4 cell count and defined five stages of the HIV care cascade. We quantified attrition across cascade stages.results Two-thirds of the sample (5646) were women. Men were older at time of first testing (36.5 vs. 31.3 years) and had more advanced HIV disease at diagnosis (298 vs. 404 CD4 cells/µL for women). The median duration of follow-up was 818 days. Among women, 90.5% attended an initial HIV care visit, 54.6% became eligible for antiretroviral therapy under local guidelines during followup, 49.3% initiated ART and 45.6% achieved a therapeutic response. Among men, 88.0% attended an initial HIV care visit, 67.4% became ART eligible during follow-up, 48.0% initiated ART and 42.4% achieved a therapeutic response. Approximately 3% of women and 5% of men died during follow-up.conclusions We were able to reconstruct the HIV treatment cascade using routinely collected data. In this setting, rates of engagement in care differ by gender in key stages of the cascade, with men faring worse than women at each cascade point. This highlights the need for interventions aimed at encouraging earlier testing, linkage, ART initiation and retention among men.keywords HIV treatment cascade, linkage to care, gender differences, South Africa Sustainable Development Goals (SDGs): SDG 3 (good health and well-being), SDG 5 (gender equity), SDG 10 (reduced inequalities), SDG 17 (partnerships for the goals)

Estimating retention in HIV care accounting for clinic transfers using electronic medical records: evidence from a large antiretroviral treatment programme in the Western Cape, South Africa

“…Follow‐up data for participants were available through the end of 2016. The primary purpose of this original cohort was to examine associations between gender, HIV testing, and subsequent HIV service uptake and outcomes [17]. South Africa has a national death registry; however, data for cohort members were not authorised for linkage to the national death registry.…”

Leaving no one behind? An equity analysis of the HIV care cascade among a cohort of people living with HIV in Manitoba, Canada

“…Notable heterogeneity also exists along the cascade based on participants' reported HIV exposure categories, with MSM progressing relatively well participants reporting IDU having relatively poor odds of reaching virologic suppression. These trends are not unprecedented; similar inequalities across the cascade have been noted in a variety of contexts [28][29][30][31][32]. While our multivariable logistic regression analyses highlight specific inequalities of statistical significance across the cascade, the use of equiplots to analyze disaggregated cascade data is an innovative and important method for identifying inequalities that, although not statistically significant, are highly relevant and should be considered during programmatic planning and design to address population-level inequities in HIV-related health outcomes.…”

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

“…Twenty-eight studies reported on this step [20,23,24,[26][27][28]31,[33][34][35][37][38][39]41,44,45,[47][48][49][50][51][52][53][54][55][56][57][58]: 15 cohort studies, 10 crosssectional and three of mixed design. Twenty-four studies (86%) provided a clear definition of the step (Table 2).…”