Using national laboratory data to assess cumulative frequency of linkage after transfer to community‐based HIV clinics in South Africa

• Published in: Journal of the International AIDS Society Vol. 22; no. 6; pp. e25326 - n/a
• Main Authors: Bassett, Ingrid V, Huang, Mingshu, Cloete, Christie, Candy, Sue, Giddy, Janet, Frank, Simone C, Freedberg, Kenneth A, Losina, Elena, Walensky, Rochelle P, Parker, Robert A
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.06.2019; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS/HIV; Ambulatory Care Facilities - statistics & numerical data; Analysis; Antiretroviral agents; Care and treatment; CD4 and viral load data; CD4 Lymphocyte Count; Clinics; community‐based clinics; Data analysis; Data collection; Data warehouses; Diagnosis; Emergency preparedness; Female; Funding; Highly active antiretroviral therapy; HIV; HIV infection; HIV Infections - epidemiology; HIV Infections - immunology; HIV Infections - therapy; Hospitals; Human immunodeficiency virus; Humans; Laboratories; Male; Management; Medical care; Medical records; Medical research; Middle Aged; National Health Laboratory Service; Patient Transfer - statistics & numerical data; patient transfers; Patients; Population; Postpartum period; Public health; Public sector; Quality management; Retention; retention in care; South Africa; South Africa - epidemiology; Studies; transfer of HIV care; South Africa; Massachusetts; Sub-Saharan Africa; transfer of HIV care; patient transfers; South Africa; CD4 and viral load data; retention in care; National Health Laboratory Service; community-based clinics
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25326

Introduction Changes to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) funding have led to closures of non‐governmental HIV clinics with patient transfers to government‐funded clinics. We sought to determine the success of transfers in South Africa using a national data source. Methods All adults (≥18 years) on antiretroviral therapy (ART) who visited a single PEPFAR‐funded hospital‐based HIV clinic in Durban, South Africa from March to June 2012 were transferred to community‐based clinics. Previously, we matched patient records from the hospital‐based HIV clinic with National Health Laboratory Services (NHLS) Corporate Data Warehouse (CDW) data to estimate the proportion of patients with a CD4 count or viral load (VL) in the CDW during the year before transfer. As a proxy for retention in care, in this study we evaluated whether patients had a CD4 count or VL at another facility within approximately three years of transfer. Patients referred to a private doctor at transfer were excluded from the analysis. We assessed predictors (age, sex, CD4 count, VL status, ART duration and location of future care) of not having post‐transfer laboratory data using Cox proportional hazards models. Results Of the 3893 patients referred to a government facility at transfer, 41% were male and median age was 39 years (IQR 34 to 46). There was a post‐transfer CD4 count or VL from another facility for 23% of these individuals within six months, 44% within one year, 57% within two years and 61% within approximately three years. Male sex (aHR 1.20, 95% CI 1.10 to 1.31) and shorter duration on ART (<3 months, aHR 3.80, 95% CI 2.77 to 5.21; three months to one year, aHR 1.32, 95% CI 1.15 to 1.51, each compared with >1 year) were associated with not having a post‐transfer record. Conclusions Using data from the NHLS CDW, 61% of patients had evidence of a post‐transfer laboratory record at another facility within approximately three years after closure of a large South African HIV clinic. Males and those with shorter time on ART prior to transfer were at highest risk for lacking follow‐up laboratory data. As patients transfer care, national data sources can be used to evaluate long‐term patient care trajectories.