Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient’s perspective in Johannesburg, South Africa

Bisnauth, Melanie A.; Davies, Nick; Monareng, Sibongile; Buthelezi, Fezile; Struthers, Helen; McIntyre, James; Rees, K. R.

doi:10.1371/journal.pone.0256540

Cited by 19 publications

(21 citation statements)

References 32 publications

(82 reference 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 re-initiate those who admit to prior default and/or may provide poorer service to them[21–23]. 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 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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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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“… 18 The clinical flow with counselors must allocate time for patients, especially with the implementation of SDI. 21 , 32 Many women are initiated onto ART but there still remains a lack of understanding the importance of adherence after the birth of the baby, especially during the course of breastfeeding. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Providing HIV Prevention of Mother to Child Transmission (PMTCT) Services to Migrants During the COVID-19 Pandemic in South Africa: Insights of Healthcare Providers

Bisnauth

Coovadia

Kawonga

et al. 2022

Health�Serv�Insights

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Background: In March 2020, COVID-19 entered South Africa, resulting in 2.9 million cases, the country took preventative and precautionary measures to control the spread of COVID-19 infection. These measures limited population mobility especially for migrant women living with HIV (WLWH) and the provision of PMTCT services. The purpose of this research was to explore the challenges of the COVID-19 pandemic on PMTCT provision by healthcare providers and understand what strategies could be implemented with lifelong antiretroviral therapy (ART) for migrants to better manage the program. Methods: Twelve in-depth interviews were conducted with healthcare providers across city and provincial levels on how the changes to the healthcare system with COVID-19 affected highly mobile patients’ adherence and utilization of PMTCT services. A thematic content analysis was used for emerging themes and guided by The Utilization of PMTCT Services conceptual framework. Results: Five main themes emerged: (1) Facilitators and barriers to adherence, which included the need for multi-month dispensing for the long term supply of antiretrovirals (ARVs) and the fear of contracting COVID-19 at the hospital that disrupted patients’ continuum of care; (2) Healthcare providers work environment, where participants felt overwhelmed with the high patient demand and the lack of infrastructural resources to follow social distancing protocols; (3) Financial challenges and opportunity costs, PMTCT proved difficult for migrants due to border closures and documentation required to receive care, this resulted in treatment interruption and left many unable to receive support at the facility due to capacity restrictions; (4) Interpersonal interactions, mistreatment, and xenophobic attitudes existed toward the migrant HIV population; and (5) “Program sustainability” revealed three key areas for strengthening: longer duration of time allocated with counseling for same-day initiation, the increased use of technology, and translation services for migrants. Conclusions: It is important to take what was learned during the pandemic and integrate it into routine service delivery, which includes long-term medication supply to reduce risk with multiple visits to collect medication, and the use of technology to alleviate the high-burden of patient demand. Healthcare policies that work toward inclusion and sustainability for migrants are needed to improve the integration of safer and practical methods of PMTCT provision into health systems.

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“…9 Bisnauth et al found that mobility, such as moving house or relocation, ART side effects or pill burden and time constraints were some of the most common reasons reported for disengagement from care or loss to follow-up by PLHIV. 10 Retention in HIV care for ART services for vulnerable populations, such as adolescents, is particularly challenging and has been noted as a global priority for action. [11][12][13] Previous studies also confirmed that retention in care, treatment adherence and treatment outcomes for adolescents in southern Africa are worse, compared with other age groups.…”

Section: Open Accessmentioning

confidence: 99%

“…For example, in South Africa, only 70% of those who knew their HIV status were on ART in 2017 9. Bisnauth et al found that mobility, such as moving house or relocation, ART side effects or pill burden and time constraints were some of the most common reasons reported for disengagement from care or loss to follow-up by PLHIV 10. Retention in HIV care for ART services for vulnerable populations, such as adolescents, is particularly challenging and has been noted as a global priority for action 11–13.…”

Section: Introductionmentioning

confidence: 99%

Service delivery models for enhancing linkage to and retention in HIV care services for adolescent girls and young women and adolescent boys and young men: a protocol for an overview of systematic reviews

Jonas

Zani²,

Ramraj³

et al. 2022

BMJ Open

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IntroductionRecent advances in the HIV care continuum have shown that an individual diagnosed with HIV should be initiated on antiretroviral therapy as soon as possible regardless of the CD4 count levels and retained in HIV care services. Studies have reported large losses in the HIV continuum of care, before and after the era of universal test and treat. Several systematic reviews have reported on the strategies for improving linkage to and retention in HIV treatment and care. The purpose of this overview of systematic reviews is to identify HIV care interventions or service delivery models (SDMs) and synthesise evidence on the effects of these to link adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) to care and retain them in care. We also aim to highlight gaps in the evidence on interventions and SDMs to improve linkage and retention in HIV care of AGYW and ABYM.Methods and analysisAn electronic search of four online databases: PubMed, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science will be performed to identify systematic reviews on the effects of linkage to and retention in HIV care interventions or SDMs for AGYW aged 15–24 years and ABYM aged 15–35 years. Our findings on the effects of interventions and SDMs will be interpreted considering the intervention and or SDMs’ effectiveness by the time period, setting and population of interest. Two or more authors will independently screen articles for inclusion using a priori criteria.Ethics and disseminationEthics approval is not required for this study as only published secondary data will be used. Our findings will be disseminated through peer-reviewed publication, conference abstracts and through presentations to stakeholders and other community fora. The findings from this overview of systematic reviews will inform mixed-methods operations research on HIV intervention programming and delivery of HIV care services for AGYW and ABYM in South Africa.PROSPERO registration numberCRD42020177933.

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Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient’s perspective in Johannesburg, South Africa

Cited by 19 publications

References 32 publications

Prior exposure to antiretroviral therapy among adult patients presenting for HIV treatment initiation or re-initiation 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

Providing HIV Prevention of Mother to Child Transmission (PMTCT) Services to Migrants During the COVID-19 Pandemic in South Africa: Insights of Healthcare Providers

Service delivery models for enhancing linkage to and retention in HIV care services for adolescent girls and young women and adolescent boys and young men: a protocol for an overview of systematic reviews

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