Understanding patients reinitiating antiretroviral therapy in two South African districts

Rees, K. R.; Bisnauth, Melanie A.; O'Connor, Cara; Ramvhulela, Tshifhiwa; Vali, Nomzamo

doi:10.4102/sajhivmed.v23i1.1380

Cited by 3 publications

(3 citation statements)

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“…Even so, it appears likely that many patients opt to lie about prior exposure. Other research suggests that they have good reason for doing so, as clinics may refuse to reinitiate those who admit to prior default and/or may provide poorer service to them 28–30. Creating a clinic and community atmosphere that promotes honesty about prior exposure should also be a priority.…”

Section: Discussionmentioning

confidence: 99%

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or reinitiation in sub-Saharan Africa: a systematic review

Benade,

Maskew,

Juntunen

et al. 2023

BMJ Open

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ObjectivesAs countries have scaled up access to antiretroviral therapy (ART) for HIV, attrition rates of up to 30% annually have created a large pool of individuals who initiate treatment with prior ART experience. Little is known about the proportion of non-naïve reinitiators within the population presenting for treatment initiation.DesignSystematic review of published articles and abstracts reporting proportions of non-naïve adult patients initiating ART in sub-Saharan Africa.Data sourcesPubMed, Embase Elsevier, Web of Science Core Collection, International AIDS Society conferences, Conference on Retroviruses and Opportunistic Infections conferences.Eligibility criteriaClinical trials and observational studies; reporting on adults in sub-Saharan Africa who initiated lifelong ART; published in English between 1 January 2018 and 11 July 2023 and with data collected after January 2016. Initiator self-report, laboratory discernment of antiretroviral metabolites, and viral suppression at initiation or in the medical record were accepted as evidence of prior exposure.Data extraction and synthesisWe captured study and sample characteristics, proportions with previous ART exposure and the indicator of previous exposure reported. We report results of each eligible study, estimate the risk of bias and identify gaps in the literature.ResultsOf 2740 articles, 11 articles describing 12 cohorts contained sufficient information for the review. Proportions of initiators with evidence of prior ART use ranged from 5% (self-report only) to 53% (presence of ART metabolites in hair or blood sample). The vast majority of screened studies did not report naïve/non-naïve status. Metrics used to determine and report non-naïve proportions were inconsistent and difficult to interpret.ConclusionsThe proportion of patients initiating HIV treatment who are truly ART naïve is not well documented. It is likely that 20%–50% of ART patients who present for ART are reinitiators. Standard reporting metrics and diligence in reporting are needed, as is research to understand the reluctance of patients to report prior ART exposure.PROSPERO registration numberCRD42022324136.

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Section: Discussionmentioning

confidence: 99%

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or reinitiation in sub-Saharan Africa: a systematic review

Benade,

Maskew,

Juntunen

et al. 2023

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Even so, it appears likely that many patients opt to lie about prior exposure. Other research suggests that they have good reason for doing so, as clinics may refuse to re-initiate those who admit to prior default and/or may provide poorer service to them [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or re-initiation in sub- Saharan Africa: a systematic review

Benade

Maskew

Juntunen

et al. 2022

Preprint

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BackgroundAs countries in sub-Saharan Africa have scaled up access to antiretroviral therapy (ART) for HIV, patient attrition rates of up to 30% per year have created a large pool of individuals who initiate treatment with prior ART experience (non-naïve re-initiators). Little is known about the proportion of non-naïve re-initiators within the population presenting for treatment initiation.MethodsWe conducted a comprehensive, rapid review of recent peer-reviewed reports that presented data on proportions of adult patients initiating ART who were treatment naïve and non-naive in sub-Saharan Africa. Searching PubMed, EMBASE, Web of Science, and international conference abstracts, we sought studies published after 1 January 2018 with data collected after January 2016, when universal HIV treatment access became the norm. We included clinical trials and observational studies and accepted self-report, laboratory discernment of antiretroviral metabolites, or viral suppression at initiation or previously reported in the medical record as evidence of prior exposure. We report results of each eligible study and identify gaps in the literature.ResultsOf 1,782 articles returned in our initial search, we found nine, describing ten cohorts, that contained sufficient information for the review, of which half were from South Africa. The proportion of the study samples with evidence of prior ART use ranged from 5% (self-report only) to 53% (presence of ART metabolites in hair or blood sample among self-reported naïve patients). The vast majority of studies that were screened did not report proportions of initiators who were non-naïve, and among the few that did, the metrics used to determine and report non-naïve proportions were inconsistent and difficult to interpret.ConclusionThe proportion of patients initiating HIV treatment who are truly ART-naïve is not well documented in the literature. From the studies identified, it seems likely that 20% to 50%—and likely at least 30%—of ART patients who present for ART are re-initiators. Standard reporting metrics and diligence in reporting this characteristic of ART initiation cohorts are needed, as is research to understand the reluctance of patients to report prior ART exposure.

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“…One of their key findings suggests there is still progress to be made in normalizing return to care as a quarter of healthcare workers reported that patients are sent to the back of the queue and that transfer letters are required to receive care ( 19 ). Similarly, Rees et al ( 20 ) have called for being supportive of patients who are re-initiating ART after treatment interruptions, suggesting a need to remove judgment of patients who may be worried about re-initiation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of facility-level antiretroviral treatment patient status utilizing a national-level laboratory cohort: Toward an understanding of system-level tracking and clinic switching in South Africa

Murphy

Shumba²,

Jamieson³

et al. 2022

Front. Public Health

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BackgroundMost estimates of HIV retention are derived at the clinic level through antiretroviral (ART) patient management systems, which capture ART clinic visit data, yet these cannot account for silent transfers across HIV treatment sites. Patient laboratory monitoring visits may also be observed in routinely collected laboratory data, which include ART monitoring tests such as CD4 count and HIV viral load, key to our work here.MethodsIn this analysis, we utilized the NHLS National HIV Cohort (a system-wide viewpoint) to investigate the accuracy of facility-level estimates of retention in care for adult patients accessing care (defined using clinic visit data on patients under ART recorded in an electronic patient management system) at Themba Lethu Clinic (TLC). Furthermore, we describe patterns of facility switching among all patients and those patients classified as lost to follow-up (LTFU) at the facility level.ResultsOf the 43,538 unique patients in the TLC dataset, we included 20,093 of 25,514 possible patient records (78.8%) in our analysis that were linked with the NHLS National Cohort, and we restricted the analytic sample to patients initiating ART between 1 January 2007 and 31 December 2017. Most (60%) patients were female, and the median age (IQR) at ART initiation was 37 (31–45) years. We found the laboratory records augmented retention estimates by a median of 860 additional active records (about 8% of all median active records across all years) from the facility viewpoint; this augmentation was more noticeable from the system-wide viewpoint, which added evidence of activity of about one-third of total active records in 2017. In 2017, we found 7.0% misclassification at the facility-level viewpoint, a gap which is potentially solvable through data integration/triangulation. We observed 1,134/20,093 (5.6%) silent transfers; these were noticeably more female and younger than the entire dataset. We also report the most common locations for clinic switching at a provincial level.DiscussionIntegration of multiple data sources has the potential to reduce the misclassification of patients as being lost to care and help understand situations where clinic switching is common. This may help in prioritizing interventions that would assist patients moving between clinics and hopefully contribute to services that normalize formal transfers and fewer silent transfers.

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Understanding patients reinitiating antiretroviral therapy in two South African districts

Abstract: No abstract available.

Cited by 3 publications

References 0 publications

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or reinitiation in sub-Saharan Africa: a systematic review

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or reinitiation in sub-Saharan Africa: a systematic review

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or re-initiation in sub- Saharan Africa: a systematic review

Assessment of facility-level antiretroviral treatment patient status utilizing a national-level laboratory cohort: Toward an understanding of system-level tracking and clinic switching in South Africa

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