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The cascade of care for HIV-exposed infants in rural South Africa

Chappell, Elizabeth Alice Christine; (2020) The cascade of care for HIV-exposed infants in rural South Africa. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Human Immunodeficiency Virus (HIV) in infants is not straightforward to diagnose, those born with HIV have high mortality, and those starting treatment at older ages have poorer outcomes, making the optimisation of care for HIV-exposed infants extremely important. The cascade of care is a tool used to describe the pathway from testing of HIV-exposed infants to successful treatment of those diagnosed with HIV, and, when used at a population-level, can identify gaps in healthcare systems and monitor improvements over time. This thesis used routinely collected data to assess the cascade for an estimated 17,570 HIV-exposed infants born between 2010 and 2016 in the Hlabisa health sub-district, KwaZulu-Natal, South Africa, a rural area where the antenatal HIV seroprevalence was 48% in 2016. The key cascade stages considered were the proportion of HIV-exposed infants who received an HIV polymerase chain reaction (PCR) test, the proportion of infants diagnosed with HIV who initiated antiretroviral therapy (ART), and the proportion of infants on ART who achieved viral suppression. A deterministic and probabilistic data linkage algorithm was developed to link, at an individual-level, data from demographic surveillance, PCR test data from the National Health Laboratory Service, and data from TIER.net, the national Department of Health ART surveillance system. Results suggest that by two years of age, 88% of HIV-exposed infants born in the sub-district had been tested, and of those diagnosed with HIV, 65% had initiated ART, of whom 53% were still on ART, of whom 68% were virally suppressed. Limitations to each of the sources of data used were described, which may have led to errors in the linkage and estimates of the cascade. Improvements to data collection systems are required, both for the quality and continuity of clinical care as well as for surveillance and research purposes.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The cascade of care for HIV-exposed infants in rural South Africa
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
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 Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10096148
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