Retrospective Study on the Critical Factors for Retaining Patients on Antiretroviral Therapy in KwaZulu-Natal, South Africa

Vella, Venanzio; Govender, Thiloshini; Dlamini, Siphiwe N.; Taylor, Myra; Moodley, Indres; David, Verona; Jinabhai, C C

doi:10.1097/qai.0b013e3181e7744e

Cited by 23 publications

(18 citation statements)

References 31 publications

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“…Factors such as sex, age, and education level were frequently cited in these articles. For example, a number of articles noted that male sex was associated with an increased risk of attrition from care [28, 32–35, 37], as was younger age [27, 30, 34], and lower levels of education [28, 36, 39]. …”

Section: Resultsmentioning

confidence: 99%

“…This finding was replicated by Palombi et al [38], and likewise Koole et al [30] who found that retention rates decreased as the number of years the clinic had been in operation increased. Likewise, Vella et al [35] noted that clinics with part-time (compared to full-time) nursing and medical staff demonstrated poorer retention rates. Mutasa-Apollo et al [32] also note that those initiating medication at primary healthcare facilities (compared to district hospitals) were more likely to remain retained, and the authors suggest this is likely because rural patients would travel to urban hospitals to initiate treatment under medical specialists and then likely transfer back to rural facilities.…”

Section: Resultsmentioning

confidence: 99%

“…Other practical factors, including the ease with which patients can attend appointments [23], and clinic factors (e.g. the number of patients enrolled in a clinic and associated staff workloads; [35]); and the availability of medication adherence counselling prior to initiation [39] were also noted. These point to the subtle interplay between psychological and social factors impacting retention, and acknowledge the role of both in researching this area.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Adult Retention in HIV Care: A Systematic Review

2016

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A systematic literature review was conducted to identify predictors of poor adult retention in HIV medical care in developed and developing countries. An electronic search was conducted with MEDLINE (OVID), PubMED, EBSCO, SCOPUS, and Cochrane databases, as well as manual searches. Original, quantitative, adult studies in English, published between 1995 and 2015 were included. Only those with a focus on predictors of retention in care were reported on. Of the 345 articles identified, thirty were included following an independent assessment by two raters. In developed countries, the most frequently cited predictors of poor retention were active substance use and demographic factors. In developing countries, physical health factors were most frequently associated with poor retention in care. The results from this review suggests primary concerns for poor retention include substance use and physical health factors. Other psychosocial factors, such as psychiatric illness and social/welfare factors, were also found to be relevant.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of Adult Retention in HIV Care: A Systematic Review

2016

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“…Given that Namibia does not educate its own physicians and pharmacists and is experiencing rapid nurse turnover, the opportunity for long-term HCP relationships may be affected (UNGASS, 2010). The lack of a full-time senior professional nurse or doctor was a significant risk factor for retention on ARVs in South Africa (Vella, et al, 2010). These results emphasize the importance of both HCP availability and quality of the patient-provider relationship (Aragones, Sanchez, Campos, & Perez, 2011; Kagee, 2008).…”

Section: Discussionmentioning

confidence: 99%

Mediators of antiretroviral adherence: A multisite international study

et al. 2012

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“…In September 2016, South Africa implemented universal ART eligibility, extending ART eligibility to all 7.1 million HIV-positive South Africans. While the benefits of universal HIV treatment are evident, concerns that further expansion of ART programmes may compromise quality of care [3][4][5][6][7] make it essential to monitor trends in the mortality of patients on ART.…”

Section: Introductionmentioning

confidence: 99%

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Cornell

Johnson

Wood

et al. 2017

Journal of the International AIDS Society

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Introduction: South Africa has the largest number of individuals living with HIV and the largest antiretroviral therapy (ART) programme worldwide. In September 2016, ART eligibility was extended to all 7.1 million HIV-positive South Africans. To ensure that further expansion of services does not compromise quality of care, long-term outcomes must be monitored. Few studies have reported long-term mortality in resource-constrained settings, where mortality ascertainment is challenging. Combining site records with data linked to the national vital registration system, sites in the International Epidemiology Databases to Evaluate AIDS Southern Africa collaboration can identify >95% of deaths in patients with civil identification numbers (IDs). This study used linked data to explore long-term mortality and viral suppression among adults starting ART in South Africa. Methods: The study was a cohort analysis of routine data on adults with IDs starting ART 2004–2015 in five large ART cohorts. Mortality was estimated overall and by gender using the Kaplan-Meier estimator and Cox’s proportional hazards regression. Standardized mortality ratios (SMRs) were calculated by dividing observed numbers of deaths by numbers expected if patients had been HIV-negative. Viral suppression in patients with viral loads (VLs) in their last year of follow-up was the secondary outcome. Results: Among 72,812 adults followed for 350,376 person years (pyrs), the crude mortality rate was 3.08 (95% CI 3.02–3.14)/100 pyrs. Patients were predominantly female (67%) and the percentage of men initiating ART did not increase. Cumulative mortality 12 years after ART initiation was 23.9% (33.4% male and 19.4% female). Mortality peaked in patients enrolling in 2007–2009 and was higher in men than women at all durations. Observed mortality rates were higher than HIV-negative mortality, decreasing with duration. By 48 months, observed mortality was close to that in the HIV-negative population, and SMRs were similar for all baseline CD4 strata. Three-quarters of patients had VLs in their last year, and 86% of these were virally suppressed. Conclusions: The South African ART programme has shown a remarkable ability to initiate and manage patients successfully over 12 years, despite rapid expansion. With further scale-up, testing and initiating men on ART must be a national priority.

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Retrospective Study on the Critical Factors for Retaining Patients on Antiretroviral Therapy in KwaZulu-Natal, South Africa

Abstract: The analysis has identified the conditions influencing retention of ART patients in KZN. This has provided a method to estimate absorption capacity of the ART delivery sites, which is of added value for a sustainable expansion of the ART coverage.

Cited by 23 publications

References 31 publications

Predictors of Adult Retention in HIV Care: A Systematic Review

Predictors of Adult Retention in HIV Care: A Systematic Review

Mediators of antiretroviral adherence: A multisite international study

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

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