Study Finds Retention Problems Among South African Patients Receiving HIV Treatment.
Fewer than half of patients who tested HIV-positive at a Johannesburg, South Africa clinic returned to complete eligibility testing for antiretroviral therapy (ART), suggesting that “strategies to reduce attrition from all stages of care are urgently needed,” a new study led by a BU researcher finds.
The study, published in the journal PLoS ONE, tracked 380 patients at a clinic in Johannesburg who had tested positive for HIV. Researchers found no evidence that 142 of them returned for a blood draw — a CD4 count measuring levels of infection-fighting white-blood cells — that would determine eligibility for ART treatment. Of the remaining 238, only about 39 percent completed eligibility testing for ART within three months.
Of those who had blood tests showing they were eligible for ART treatment, 88 percent initiated ART within six months. Among the 185 patients in that ART cohort, 22 transferred out and were excluded from further analysis. Of the remaining 163, 81 percent were retained in care through two years of treatment.
About 9 percent of the patients who either never had a blood draw or never returned to the clinic were known to have died.
“While momentum for increasing treatment thresholds is growing, if patients cannot be retained in HIV care from the time of testing positive through long-term adherence to antiretroviral therapy, such strategies may fall short of expected gains,” said the research team, led by Matthew Fox, associate professor of epidemiology at the BU School of Public Health and a researcher at the Center for Global Health & Development.
“These findings suggest that test-and-treat programs must focus on retention, particularly in the pre-ART period, in order to reduce morbidity, mortality and transmission.”
The study follows prior research by Fox and colleague Sydney Rosen, research associate professor of global health, that found a substantial loss of patients before and after starting ART, but that noted a lack of data following people from initial testing through long-term treatment.
The new study took place at a comprehensive clinic that conducts roughly 840 HIV tests per month. Patients who test positive are sent for a blood draw for CD4 staging and asked to return in one week for the results. Those not eligible for ART begin in “wellness care” and are asked to return every six months for repeat CD4 testing, or more frequently when closer to the treatment threshold. The study found that only about 50 percent of patients not eligible for ART at their first CD4 count repeated the counts at the clinic within one year of the first test.
Once a patient initiates ART, he or she is asked to return to the clinic every one to three months for the first 12 months, for either drug pickups or medical visits.
The study was funded by the National Institute of Allergy And Infectious Diseases and the United States Agency for International Development (USAID).
Besides Fox, the study team included researchers from University of the Witwatersrand, Johannesburg, South Africa; the Vanderbilt Institute for Global Health at Vanderbilt University; and the University of Washington.
Contributed by Lisa Chedekel