Care trajectories among people living with HIV and followed within a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial)
type: Article
abstract: Background: Retention in care is essential to optimize antiretroviral treatment (ART) impact on viral suppression and ensure the success of the universal test and treat (UTT) strategy. We aimed to identify care trajectories and associated factors among ART-eligible patients within the UTT cluster-randomized TasP trial. Methods: Following home-based HIV testing, HIV-positive individuals were referred to TasP clinics and offered immediate ART (intervention arm) or according to national guidelines (control arm). This analysis included all patients ART-eligible at their first clinic visit ≥18 months before the trial end. Monthly clinical follow-up was offered in TasP clinics. A patient was considered exiting care if ≥3 months late for the last appointment, transferred-out or dead. Care trajectories, assessed over 18 months of follow-up, and their associated factors were identified using a group-based trajectory model (Nagin, 2005, Harvard University Press). Results: Among the 787 ART-eligible patients who attended TasP clinics, four trajectory groups were identified: 70.5% remained in care throughout the entire follow-up period (group 1), 13.6% exited care rapidly (median 4 [IQR 4-6] months after first visit) (group 2), 10.6% exited care latter (11 [9-13] months) (group 3) and 5.2% exited care then returned after 4 [3-9] months (group 4) (Figure 1). The risk of exiting care (groups 2&3) was higher in newly diagnosed patients and those <29 years. The “returning group” members (group 4) were more likely male, with CD4 >350 cells/mm3 at first visit, living in high HIV prevalence clusters (>34%) with the lower nurse-patient ratio, and less likely to have initiated ART. Conclusions: Although most patients remained in care over the 18-month period, a significant proportion exited care at different follow-up times. Particular attention should be paid to men, young and newly diagnosed patients, and those with CD4>350 in order to improve retention in care and maximize the effect…
presented at: 9th IAS Conference on HIV Science (IAS 2017)
citation key: gossetCareTrajectoriesPeople2017
creator: Person
author list: Person
is part of: Proceedings
  publisher: poster WEPED1454
    type: Organization
    locality name: Paris
  date: 2017-07-26

Person
given name: Andréa
surname: Gosset

Person
given name: Camelia
surname: Protopopescu

Person
given name: Nonhlanhla
surname: Okesola

Person
given name: Bruno
surname: Spire

Person
given name: Joseph
surname: Larmarange

Person
given name: Joanna
surname: Orne-Gliemann

Person
given name: Nuala
surname: McGrath

Person
given name: Deenan
surname: Pillay

Person
given name: François
surname: Dabis

Person
given name: Collins
surname: Iwuji

Person
given name: Sylvie
surname: Boyer