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, partners, and collaborators are conducting epidemiologic analyses of several cohorts including the Themba Lethu Clinical HIV Treatment Cohort—one of the largest clinical HIV treatment databases in South Africa, which includes demographic, clinical, and laboratory data on over 23,000 patients initiated on ART collected as part of routine HIV care. The goal is to evaluate interventions aimed at improving retention in care and reducing late presentation for treatment and to generate program-relevant information to improve the ART treatment scale-up in South Africa. We have also conducted a series of highly influential systematic reviews of retention in HIV care and treatment programs throughout sub-Saharan Africa.
The results of our work on loss to follow-up have been influential in demonstrating both that the rates of retention in HIV care programs in sub-Saharan Africa are improving over time, but also that many patients are still being lost from treatment programs leading to increased mortality.
Publications
The following publications emanate from this project:
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Medication Side Effects and Retention in HIV Treatment: A Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia
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Does distance to clinic affect utilization of HIV care and treatment services
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Drug side effects and retention on HIV treatment: a prospective cohort study assessing the implementation of Tenofovir in South Africa and Zambia
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Estimating retention in HIV care accounting for patient transfers: A national laboratory cohort study in South Africa
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Routine data underestimates the incidence of first-line antiretroviral drug discontinuations due to adverse drug reactions: Observational study in two South African cohorts
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Patient related factors that contribute to poor adherence on second-line HIV treatment
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Acceptability and feasibility of a financial incentive intervention to improve retention in HIV care among pregnant women in Johannesburg, South Africa
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Citizenship status and engagement in HIV care: an observational cohort study to assess the association between reporting a national ID number and retention in public-sector HIV care in Johannesburg, South Africa
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Systematic review of retention of pediatric patients on HIV treatment in low and middle-income countries 2008–2013
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Non-ignorable loss to follow-up: correcting mortality estimates based on additional outcome ascertainment
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A Novel Approach to Accounting for Loss to Follow-Up when Estimating the Relationship between CD4 Count at ART Initiation and Mortality
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Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial
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Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough
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Loss to follow-up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa
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The Feasibility of Using Screening Criteria to Reduce Clinic Visits for Stable Patients on Antiretroviral Therapy in South Africa
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Patient Retention From HIV Diagnosis Through One Year on Antiretroviral Therapy at a Primary Health Care Clinic in Johannesburg, South Africa
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Initiating ART when presenting with higher CD4 counts results in reduced loss to follow-up in South Africa
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Defining retention and attrition in pre-antiretroviral HIV care: proposals based on experience in Africa
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Rapid point-of-care CD4 testing at mobile HIV testing sites to increase linkage to care: An evaluation of a pilot program in South Africa
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Treatment outcomes after 7 years of public-sector HIV treatment
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Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review
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Correcting Mortality for Loss to Follow-Up: A Nomogram Applied to Antiretroviral Treatment Programmes in Sub-Saharan Africa
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The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa
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Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa
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Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa
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Early loss to follow up after enrollment in pre-ART care at a large public clinic in Johannesburg, South Africa
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Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007‐2009; systematic review
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Using vital registration data to update mortality among patients lost to follow-up from ART programmes: evidence from the Themba Lethu Clinic, South Africa
HE2RO staff involved
Professor Sydney Rosen Dr. Matthew Fox Dr. Denise Evans Dr Mhairi Maskew Dr. William Macleod Dr. Kate ShearerStay up to date
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