Retention in care trajectories of HIV-positive individuals participating in a universal test and treat programme in rural South Africa %28ANRS 12249 TasP trial%29.pdf (647.92 kB)
Retention in care trajectories of HIV-positive individuals participating in a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial)
journal contribution
posted on 2023-06-20, 14:17 authored by Andréa Gosset, Camelia Protopopescu, Joseph Larmarange, Joanna Orne-Gliemann, Nuala McGrath, Deenan Pillay, François Dabis, Collins IwujiCollins Iwuji, Sylvie BoyerObjective: To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral treatment (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012-2016). Design: A cluster-randomized trial whereby individuals identified HIV-positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control). Methods: Exiting care was defined as =3 months late for a clinic appointment, transferring elsewhere, or death. Group-Based Trajectory Modelling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients. Results: Four RIC trajectory groups were identified: i) group 1 “remained” in care (reference, n=554, 71.3%), ii) group 2 exited care then “returned” after (median [interquartile range]) 4 [3-9] months (n=40, 5.2%), iii) group 3 “exited care rapidly” (after 4 [4-6] months, n=98, 12.6%), iv) group 4 “exited care later” (after 11 [9-13] months, n=85, 10.9%). Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young (<29 years), without a regular partner and to have a CD4 count >350 cells/mm3. Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged =39 years. Conclusions: High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed HIV-patients are needed to maximize RIC.
History
Publication status
- Published
File Version
- Accepted version
Journal
Journal of Acquired Immune Deficiency SyndromesISSN
1525-4135Publisher
Lippincott, Williams & WilkinsExternal DOI
Issue
4Volume
80Page range
375-385Department affiliated with
- BSMS Publications
Full text available
- Yes
Peer reviewed?
- Yes
Legacy Posted Date
2018-12-04First Open Access (FOA) Date
2019-12-18First Compliant Deposit (FCD) Date
2018-12-04Usage metrics
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