Linkage, Retention and Adherence for HIV Treatment in South Africa

Linkage, Retention and Adherence for HIV Treatment in South Africa

The successful expansion of access to HIV testing in sub-Saharan Africa has led to hundreds of thousands of people learning that they are HIV-positive. Only a small fraction of these individuals, however, are enrolling in HIV/AIDS care and treatment programs at the time of diagnosis or at any time before they become seriously ill. As a result, most patients seek HIV/AIDS treatment long after they were eligible and with severe illness. At the same time, scale-up of services has put pressure on the ability of treatment programs to maintain care for existing patients on treatment while continuing to expand access to new patients. With increased demand and limited capacity, many patients who start care discontinue treatment. HE2RO and collaborators study retention in care by conducting epidemiologic analyses of several cohorts including the Themba Lethu Clinical HIV Treatment Cohort of over 30,000 patients—one of the largest clinical HIV treatment databases in South Africa. We also actively work on interventions to improve linkage and retention at all stages of HIV care to generate program-relevant information to improve the ART treatment scale-up in South Africa.


  • Retention and Attrition from HIV Care

    With the rapid expansion of access to antiretroviral therapy (ART) in sub-Saharan Africa, the number of HIV-positive people on treatment has increased dramatically. In South Africa, scale-up of services has put pressure on the ability of treatment programs to maintain care for existing patients while continuing to expand access to new patients. With increased demand and limited capacity, many HIV-positive patients never access care, and many who do discontinue treatment. HE2RO staff, 
  • RapIT: Rapid Initiation of Antiretroviral Therapy to Promote Early HIV/AIDS Treatment in South Africa

    The RapIT study was a randomized strategy evaluation of the feasibility, effectiveness, and cost-effectiveness of rapid ART initiation using accelerated clinic procedures and point-of-care laboratory tests. Outpatient, non-pregnant, HIV-positive adults who came to two South African clinics for an HIV test or CD4 count, consented to study participation, and were eligible for ART under 2010 guidelines were randomized 1:1 to rapid ART initiation or to standard care. Those who were assigned to 
  • Rapid Initiation of Antiretroviral Treatment (RapIT) for Pregnant Women

    Alongside the primary RapIT study, we are enrolling pregnant women at a public clinic in Johannesburg in a prospective study of the impact of the guidelines on retention on ART for the duration of pregnancy. We are comparing our main outcome, adherence to ART until delivery, for these women to a retrospective comparison group who received PMTCT under earlier 
  • Investigating the Feasibility of Implementation of Multi-Disciplinary Point-of-Care Testing in an HIV Treatment Clinic Using a Randomised Controlled Trial

    A major challenge to successful implementation of both antiretroviral and anti-tuberculosis therapy in low-resource settings remains the ability to diagnose and monitor the progress of both infections, a process that is hampered by lack of laboratory infrastructure, technical skill and poor integration of HIV and TB services. Recent technological innovations in the Point of Care (POC) testing arena promises to alleviate the problem by providing access to on-site laboratory tests with the future 
  • Remote Electronic Treatment Adherence Monitoring of Patients on Antiretroviral Therapy in South Africa: A Pilot Study

    Electronic patient adherence monitoring is a novel method for improving adherence to HIV treatment. This pilot study aimed to generate preliminary data for a larger trial. We determine the effectiveness and cost-effectiveness of using electronic patient adherence monitoring in patients at high risk of failing second-line antiretroviral therapy (ART) at Themba Lethu HIV clinic in Johannesburg, South Africa compared to the standard of care, which involves optimized adherence counseling. 
  • Impact of Nutritional Supplementation on Physical Development, Retention in Care and Adherence to ART in HIV-Positive Infants and Children

    The study aims to determine whether a nutritional supplement, FutureLife HIGH-ENERGY Smart food, given to caregivers/guardians to give to their HIV-positive infants and children for 6 months concurrently with antiretroviral therapy (ART) compared to standard of care results in improved growth and physical development as measured by an increase in height-for-age Z score (HAZ), weight-for-age Z score (WAZ) and mid-upper arm circumference (MUAC) at 6, 12 and 24 months. Secondary outcomes 
  • An Evaluation of the Acceptability and Feasibility of Booked Appointments in a Large HIV Clinic in Johannesburg, South Africa

    In many resource-limited settings, health care delivery systems face constraints due to increasing need for health expenditure and the large proportion of the population reliant on the public sector. In South Africa, the existing service delivery structure faces additional challenges related to the growing number of HIV-infected South Africans initiating antiretroviral therapy. Long queues, long wait times, and overcrowding are often characteristic of South Africa’s public health care 
  • Attrition from HIV Care and Treatment Before and After an Increase in the CD4 Count Eligibility Threshold

    South Africa has recently announced that as of January 2015, it will be increasing its HIV treatment CD4 eligibility threshold from 350 cells/μl to 500 cells/μl1 making more patients eligible for treatment than ever before. However efforts to increase HIV treatment coverage may be minimized if losses to follow up, which have been shown to be high along the continuum of HIV care, offset gains from getting more people onto treatment. HE2RO will conduct a prospective cohort study of adult 
  • Evaluation of the National Department of Health’s National Adherence Guidelines for Chronic Diseases in South Africa (ENHANCE)

    The South African Department of Health (NDoH) has developed the “National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)” and is in the process of implementing these nationally. The guidelines outline the provision of a minimum package of interventions which are designed to increase linkage to and retention in care and adherence to treatment. In order inform the national roll-out, HE2RO and Boston University, in collaboration with the National Department of Health and The 
  • SLATE: Simplified Algorithm for Treatment Eligibility

    In its 2015 revision of the global guidelines for HIV care and treatment, the World Health Organization called for initiating lifelong antiretroviral treatment (ART) for all patients testing positive for HIV, regardless of CD4 cell count. As countries adopt the new recommendation, known as “treat all,” millions of additional patients are becoming eligible for ART worldwide. In sub-Saharan Africa, where most of these patients are located, studies continue to document high losses of 
  • Building the Capacity of Lay Health Counsellors to Improve ART Uptake among High CD4 Patients under the “Treat All’ Policy in South Africa

    In September 2016, South Africa began implementing test-and-treat, in which everyone who tests HIV positive is offered antiretroviral therapy (ART), in hopes of attaining the UNAIDS 90-90-90 targets. However the success of the test-and-treat approach depends on early HIV testing and lifelong HIV treatment. In South Africa, lay HIV counselors are the first to introduce ART to newly diagnosed patients. However, most are under-trained with little professional supervision and emotional support and 
  • Understanding the Predictors of Early ANC Initiation and Patterns of Postpartum Maternal Mobility in Relation to Paediatric HIV Diagnosis and Linkage to HIV Care

    The elimination of vertical transmission of HIV is within reach in South Africa, given the high coverage of the Prevention of Mother to Child Transmission (PMTCT) program. However to achieve the 90-90-90 targets for children, we need to improve early infant diagnosis (EID) efforts by strengthening postpartum retention and participation of women the PMTCT program, including mothers who initially test HIV negative in antenatal care (ANC). This study aims to firstly map out patterns of maternal 

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