Patient Retention from HIV Diagnosis through One Year on Antiretroviral Therapy at a Primary Healthcare Clinic in Johannesburg, South Africa

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Journal Article

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Author(s):
Clouse, Kate
Pettifor, Audrey E.
Maskew, Mhairi
Bassett, Jean
Van Rie, Annelies
Behets, Frieda M.-T. F.
Gay, Cynthia
Sanne, Ian
Fox, Matthew P.

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Forthcoming

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Journal of Acquired Immune Deficiency Syndromes

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DOI:
10.1097/QAI.0b013e318273ac48

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5492

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Abstract:

OBJECTIVE:: To compare patient retention at three stages of pre-antiretroviral (ART) care and two stages of post-ART care to identify when greatest attrition occurs. DESIGN:: An observational cohort study. METHODS:: We reviewed files of all adult, non-pregnant individuals testing HIV-positive January 1 - June 30, 2010, at a primary health clinic in Johannesburg, South Africa (N=842). We classified retention in pre-ART stage 1 (HIV diagnosis to CD4 results notification in </=3 months after first eligible CD4 result), as well as at 0-6 and 6-12 months post-ART. RESULTS:: Retention among all patients during pre-ART stage 1 was 69.8% (95%CI 66.7-72.9%). For patients initially ART-ineligible (n=221), 57.4% (95%CI 49.5-65.0%) returned for a repeat CD4 during pre-ART stage 2. Among those ART-eligible (n=589), 73.5% (95%CI 69.0-77.6%) were retained during pre-ART stage 3. Retention increased with time on ART, from 80.2% (95%CI 75.3-84.5%) at 6 months to 95.3% (95%CI 91.7-97.6%) between 6-12 months. Cumulative retention from diagnosis to 12 months on ART was 36.9% (95%CI 33.0-41.1%) for those ART-eligible and 43.0% (95%CI 36.4-49.8%) from diagnosis to repeat CD4 testing within one year among those ART-ineligible. CONCLUSIONS:: Patient attrition in the first year following HIV diagnosis was greatest prior to ART initiation: over 25% at each of three pre-ART stages. As countries expand HIV testing and ART programs, success will depend on linkage to care, especially prior to ART eligibility and initiation.

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http://dx.doi.org/10.1097/QAI.0b013e318273ac48

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Clouse, Kate; Pettifor, Audrey E.; Maskew, Mhairi; Bassett, Jean; Van Rie, Annelies; Behets, Frieda M.-T. F.; Gay, Cynthia; Sanne, Ian; & Fox, Matthew P. (Forthcoming). Patient Retention from HIV Diagnosis through One Year on Antiretroviral Therapy at a Primary Healthcare Clinic in Johannesburg, South Africa. Journal of Acquired Immune Deficiency Syndromes.