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Retention in care trajectories of HIV-positive individuals participating in a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial)

Gosset, A; Protopopescu, C; Larmarange, J; Orne-Gliemann, J; Mcgrath, N; Pillay, D; Dabis, F; ... Boyer, S; + view all (2019) 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 of Acquired Immune Deficiency Syndromes 10.1097/QAI.0000000000001938. (In press). Green open access

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Abstract

OBJECTIVE: 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/mm. 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.

Type: Article
Title: Retention in care trajectories of HIV-positive individuals participating in a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial)
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAI.0000000000001938
Publisher version: https://doi.org/10.1097/QAI.0000000000001938
Language: English
Additional information: Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: universal test and treat, HIV, South Africa, retention in care, trajectories
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
URI: https://discovery.ucl.ac.uk/id/eprint/10065153
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