Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study
South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss fr...
Saved in:
Published in | PLoS medicine Vol. 14; no. 11; p. e1002434 |
---|---|
Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Public Library of Science
14.11.2017
Public Library of Science (PLoS) |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.
We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/μl (IQR 92-254 cells/μl). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/μl, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/μl. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/μl versus 214 cells/μl (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a "healthy cohort" effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome.
Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. |
---|---|
AbstractList | South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4.sup.+ threshold of [less than or equal to]200 cells/[mu]l to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4.sup.+ [less than or equal to] 350 cells/[mu]l. We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4.sup.+ count was 173 cells/[mu]l (IQR 92-254 cells/[mu]l). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4.sup.+ [less than or equal to] 200 cells/[mu]l, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4.sup.+ [less than or equal to] 350 cells/[mu]l. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4.sup.+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4.sup.+ 146 cells/[mu]l versus 214 cells/[mu]l (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4.sup.+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a "healthy cohort" effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome. Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4.sup.+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. Background South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/Ml to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/Ml. Methods and findings We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/Ml (IQR 92-254 cells/Ml). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/Ml, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/Ml. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/Ml versus 214 cells/Ml (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a “healthy cohort” effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome. Conclusions Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. Background South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4.sup.+ threshold of [less than or equal to]200 cells/[mu]l to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4.sup.+ [less than or equal to] 350 cells/[mu]l. Methods and findings We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4.sup.+ count was 173 cells/[mu]l (IQR 92-254 cells/[mu]l). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4.sup.+ [less than or equal to] 200 cells/[mu]l, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4.sup.+ [less than or equal to] 350 cells/[mu]l. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4.sup.+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4.sup.+ 146 cells/[mu]l versus 214 cells/[mu]l (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4.sup.+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a "healthy cohort" effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome. Conclusions Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4.sup.+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. BACKGROUNDSouth Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.METHODS AND FINDINGSWe performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/μl (IQR 92-254 cells/μl). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/μl, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/μl. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/μl versus 214 cells/μl (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a "healthy cohort" effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome.CONCLUSIONSOver one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. In a retrospective cohort study, Ingrid Katz and colleagues report on the continuity of care for people with HIV in Gugulethu Township, South Africa South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl. We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/μl (IQR 92-254 cells/μl). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/μl, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/μl. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/μl versus 214 cells/μl (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a "healthy cohort" effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome. Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/μl (IQR 92-254 cells/μl). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/μl, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/μl. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/μl versus 214 cells/μl (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a "healthy cohort" effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome.Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. Background South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/Ml to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/Ml. Methods and findings We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/Ml (IQR 92-254 cells/Ml). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/Ml, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/Ml. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/Ml versus 214 cells/Ml (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a “healthy cohort” effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome. Conclusions Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa. |
Audience | Academic |
Author | Kaplan, Richard Orrell, Catherine Fitzmaurice, Garrett Leone, Dominick Bangsberg, David R Bekker, Linda-Gail Katz, Ingrid T |
AuthorAffiliation | 5 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America 6 Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, United States of America 7 Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, United States of America 3 Harvard Medical School, Boston, Massachusetts, United States of America 4 Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa 1 Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America 8 Oregon Health & Science University–Portland State University School of Public Health, Portland, Oregon, United States of America San Francisco General Hospital, UNITED STATES 2 Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America |
AuthorAffiliation_xml | – name: 4 Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa – name: 7 Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, United States of America – name: San Francisco General Hospital, UNITED STATES – name: 2 Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America – name: 6 Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, United States of America – name: 5 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America – name: 1 Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America – name: 8 Oregon Health & Science University–Portland State University School of Public Health, Portland, Oregon, United States of America – name: 3 Harvard Medical School, Boston, Massachusetts, United States of America |
Author_xml | – sequence: 1 givenname: Ingrid T orcidid: 0000-0002-3014-238X surname: Katz fullname: Katz, Ingrid T organization: Harvard Medical School, Boston, Massachusetts, United States of America – sequence: 2 givenname: Richard surname: Kaplan fullname: Kaplan, Richard organization: Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa – sequence: 3 givenname: Garrett surname: Fitzmaurice fullname: Fitzmaurice, Garrett organization: Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, United States of America – sequence: 4 givenname: Dominick surname: Leone fullname: Leone, Dominick organization: Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, United States of America – sequence: 5 givenname: David R surname: Bangsberg fullname: Bangsberg, David R organization: Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, United States of America – sequence: 6 givenname: Linda-Gail surname: Bekker fullname: Bekker, Linda-Gail organization: Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa – sequence: 7 givenname: Catherine surname: Orrell fullname: Orrell, Catherine organization: Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29136014$$D View this record in MEDLINE/PubMed |
BookMark | eNqVk1trFDEUxwep2It-A9GAIArumswlk_FBWIrahWLBrn0N2eTMbEo2GZNM6z76zc3abdmVfVDyMOHM7_xzrsfZgXUWsuw5wWNS1OT9tRu8FWbcL0GNCcZ5WZSPsiNSlc2I0JoebN0Ps-MQrhPT4AY_yQ7zhhQUk_Io-zXzIOISbETdoBUYbSEgYRUC4c0KGRcCar1bIik8oNZ51IPrDSCjb7Tt0K2OC3Q2vULaolPRA5q5W_sOXboh2Set11J8QBPkIXoXepBR3wCSbuF8RCEOavU0e9wKE-DZ5nuSff_8aXZ6Njq_-DI9nZyPZE3LOCKYFKJmeUnmc9m2KiWiMMPFvKpxJYlqmagrCkWuaF4DowpXTdm0rGjygqpGFifZyzvdPuXEN9ULnDSswYTluEzE9I5QTlzz3uul8CvuhOZ_DM53XPiopQFOWsVyQRkpGlUqIQSbVyBSdFUuK9bSpPVx89owTw2SqcBemB3R3T9WL3jnbnhFWVXWeRJ4sxHw7scAIfKlDhKMERbcsI6blnVqKFnH_eovdH92G6oTKQFtW5felWtRPqnWQ0IbViRqtIfqwEIKMg1gq5N5hx_v4dNRsNRyr8PbHYfERPgZOzGEwKeX3_6D_frv7MXVLvt6i12AMHERnBmidjbsguUdKNPwBg_tQwMJ5ustvK80X28h32xhcnux3fwHp_u1K34DqyAs2A |
CitedBy_id | crossref_primary_10_1007_s10461_022_03623_7 crossref_primary_10_4102_sajhivmed_v20i1_963 crossref_primary_10_1093_cid_ciz214 crossref_primary_10_2147_IDR_S251619 crossref_primary_10_1080_09540121_2024_2346255 crossref_primary_10_2196_13741 crossref_primary_10_1097_QAI_0000000000002605 crossref_primary_10_1002_jia2_25458 crossref_primary_10_1371_journal_pmed_1002811 crossref_primary_10_1155_2020_1929436 crossref_primary_10_1371_journal_pmed_1003107 crossref_primary_10_1186_s13063_023_07322_z crossref_primary_10_1371_journal_pmed_1002574 |
Cites_doi | 10.1111/tmi.12346 10.1371/journal.pmed.1001056 10.1016/S1473-3099(13)70692-3 10.1097/QAD.0b013e328321823f 10.1016/S2214-109X(13)70092-5 10.1097/QAI.0000000000001026 10.1126/science.1230413 10.1007/s10461-014-0920-y 10.1371/journal.pone.0063596 10.1086/521173 10.1186/s12879-015-1207-2 10.1093/ofid/ofu058 10.1371/journal.pmed.1002268 10.1080/09540121.2015.1051502 10.1186/1758-2652-13-8 10.1097/QAI.0b013e318273ac48 10.1111/j.1365-3156.2012.03089.x 10.1371/journal.pone.0110252 10.1056/NEJMp1310982 10.3851/IMP2905 10.1056/NEJMoa1507198 10.1016/S2352-3018(16)30224-7 10.1111/tmi.12301 10.1097/QAI.0b013e3181ff0bdc 10.1056/NEJMoa1600693 10.1186/1758-2652-13-37 10.1097/QAD.0b013e32834b6464 |
ContentType | Journal Article |
Copyright | COPYRIGHT 2017 Public Library of Science 2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Katz IT, Kaplan R, Fitzmaurice G, Leone D, Bangsberg DR, Bekker L-G, et al. (2017) Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study. PLoS Med 14(11): e1002434. https://doi.org/10.1371/journal.pmed.1002434 2017 Katz et al 2017 Katz et al 2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Katz IT, Kaplan R, Fitzmaurice G, Leone D, Bangsberg DR, Bekker L-G, et al. (2017) Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study. PLoS Med 14(11): e1002434. https://doi.org/10.1371/journal.pmed.1002434 |
Copyright_xml | – notice: COPYRIGHT 2017 Public Library of Science – notice: 2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Katz IT, Kaplan R, Fitzmaurice G, Leone D, Bangsberg DR, Bekker L-G, et al. (2017) Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study. PLoS Med 14(11): e1002434. https://doi.org/10.1371/journal.pmed.1002434 – notice: 2017 Katz et al 2017 Katz et al – notice: 2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Katz IT, Kaplan R, Fitzmaurice G, Leone D, Bangsberg DR, Bekker L-G, et al. (2017) Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study. PLoS Med 14(11): e1002434. https://doi.org/10.1371/journal.pmed.1002434 |
DBID | NPM AAYXX CITATION IOV ISN ISR 3V. 7TK 7X7 7XB 88E 8FI 8FJ 8FK ABUWG AFKRA AZQEC BENPR CCPQU DWQXO FYUFA GHDGH K9. M0S M1P PIMPY PQEST PQQKQ PQUKI PRINS 7X8 5PM DOA CZK |
DOI | 10.1371/journal.pmed.1002434 |
DatabaseName | PubMed CrossRef Opposing Viewpoints In Context Gale In Context: Canada Gale In Context: Science ProQuest Central (Corporate) Neurosciences Abstracts ProQuest Health & Medical Collection ProQuest Central (purchase pre-March 2016) Medical Database (Alumni Edition) Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest Central UK/Ireland ProQuest Central Essentials AUTh Library subscriptions: ProQuest Central ProQuest One Community College ProQuest Central Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Health & Medical Complete (Alumni) Health & Medical Collection (Alumni Edition) Medical Database Publicly Available Content Database ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic ProQuest One Academic UKI Edition ProQuest Central China MEDLINE - Academic PubMed Central (Full Participant titles) Directory of Open Access Journals PLoS Medicine |
DatabaseTitle | PubMed CrossRef Publicly Available Content Database ProQuest Central Essentials ProQuest One Academic Eastern Edition ProQuest Health & Medical Complete (Alumni) ProQuest Central (Alumni Edition) ProQuest One Community College ProQuest Hospital Collection Health Research Premium Collection (Alumni) Neurosciences Abstracts ProQuest Central China ProQuest Hospital Collection (Alumni) ProQuest Central ProQuest Health & Medical Complete Health Research Premium Collection ProQuest Medical Library ProQuest One Academic UKI Edition Health and Medicine Complete (Alumni Edition) ProQuest Central Korea ProQuest One Academic ProQuest Medical Library (Alumni) ProQuest Central (Alumni) MEDLINE - Academic |
DatabaseTitleList | MEDLINE - Academic PubMed Publicly Available Content Database |
Database_xml | – sequence: 1 dbid: DOA name: DOAJ Directory of Open Access Journals url: https://www.doaj.org/ sourceTypes: Open Website – sequence: 2 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 3 dbid: 7X7 name: ProQuest Health & Medical Collection url: https://search.proquest.com/healthcomplete sourceTypes: Aggregation Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine Public Health |
DocumentTitleAlternate | Early loss from care in South Africa |
EISSN | 1549-1676 |
Editor | Deeks, Steven G |
Editor_xml | – sequence: 1 givenname: Steven G surname: Deeks fullname: Deeks, Steven G |
EndPage | e1002434 |
ExternalDocumentID | 1989018204 oai_doaj_org_article_1fd82a68139d4daaa8b5ea82452c58f6 A516766983 10_1371_journal_pmed_1002434 29136014 |
Genre | Journal Article |
GeographicLocations | South Africa Cape Town South Africa |
GeographicLocations_xml | – name: South Africa – name: Cape Town South Africa |
GrantInformation_xml | – fundername: ; grantid: K23 MH097667 |
GroupedDBID | --- 123 29O 2WC 3V. 53G 5VS 7X7 88E 8FI 8FJ AAFWJ AAWTL ABDBF ABUWG ACGFO ACIHN ACPRK ADBBV ADRAZ AEAQA AENEX AFKRA AFPKN AFRAH AFXKF AHMBA AKRSQ ALIPV ALMA_UNASSIGNED_HOLDINGS AOIJS B0M BAWUL BCGST BCNDV BENPR BPHCQ BVXVI BWKFM CCPQU CS3 DIK DU5 E3Z EAP EAS EBD EBS EJD EMK EMOBN ESX F5P FPL FYUFA GROUPED_DOAJ GX1 H13 HMCUK HYE IAO ICW IHR IHW INH INR IOF IOV IPNFZ IPO ISN ISR ITC KQ8 M1P M48 MK0 M~E NPM O5R O5S OK1 P2P PIMPY PQQKQ PROAC PSQYO PV9 RIG RNS RPM RZL SV3 TR2 TUS UKHRP WOQ WOW XSB YZZ ~8M AAYXX CITATION 7TK 7XB 8FK AZQEC DWQXO K9. PQEST PQUKI PRINS 7X8 5PM AAPBV ABPTK CZK |
ID | FETCH-LOGICAL-c764t-1013a78241bbcffd090d0803b5705c1df8a756e32d627e86d05949f839236d9c3 |
IEDL.DBID | RPM |
ISSN | 1549-1676 1549-1277 |
IngestDate | Sun Oct 01 00:20:29 EDT 2023 Thu Jul 04 21:10:32 EDT 2024 Tue Sep 17 21:28:27 EDT 2024 Fri Jun 28 07:30:46 EDT 2024 Thu Oct 10 17:24:42 EDT 2024 Thu Feb 22 23:28:15 EST 2024 Fri Feb 02 05:15:24 EST 2024 Fri Feb 02 04:14:02 EST 2024 Thu Aug 01 20:05:01 EDT 2024 Thu Aug 01 19:14:32 EDT 2024 Thu Aug 01 19:20:43 EDT 2024 Tue Aug 20 22:12:13 EDT 2024 Fri Aug 23 00:37:45 EDT 2024 Sat Sep 28 08:50:13 EDT 2024 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 11 |
Language | English |
License | This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Creative Commons Attribution License |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c764t-1013a78241bbcffd090d0803b5705c1df8a756e32d627e86d05949f839236d9c3 |
Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 LGB served as a guest editor on PLOS Medicine's HIV Special Issue. |
ORCID | 0000-0002-3014-238X |
OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685472/ |
PMID | 29136014 |
PQID | 1989018204 |
PQPubID | 1436338 |
ParticipantIDs | plos_journals_1989018204 doaj_primary_oai_doaj_org_article_1fd82a68139d4daaa8b5ea82452c58f6 pubmedcentral_primary_oai_pubmedcentral_nih_gov_5685472 proquest_miscellaneous_1964702914 proquest_journals_1989018204 gale_infotracmisc_A516766983 gale_infotracgeneralonefile_A516766983 gale_infotracacademiconefile_A516766983 gale_incontextgauss_ISR_A516766983 gale_incontextgauss_ISN_A516766983 gale_incontextgauss_IOV_A516766983 gale_healthsolutions_A516766983 crossref_primary_10_1371_journal_pmed_1002434 pubmed_primary_29136014 |
PublicationCentury | 2000 |
PublicationDate | 20171114 |
PublicationDateYYYYMMDD | 2017-11-14 |
PublicationDate_xml | – month: 11 year: 2017 text: 20171114 day: 14 |
PublicationDecade | 2010 |
PublicationPlace | United States |
PublicationPlace_xml | – name: United States – name: San Francisco – name: San Francisco, CA USA |
PublicationTitle | PLoS medicine |
PublicationTitleAlternate | PLoS Med |
PublicationYear | 2017 |
Publisher | Public Library of Science Public Library of Science (PLoS) |
Publisher_xml | – name: Public Library of Science – name: Public Library of Science (PLoS) |
References | J Bor (ref25) 2013; 339 IT Katz (ref21) 2011; 25 IT Katz (ref30) 2015; 19 P Duff (ref32) 2010; 13 MS Cohen (ref23) 2016; 375 ref33 ref10 ref2 C Collins (ref8) 2013; 1 ref1 C Njuguna (ref15) 2013; 8 S Rosen (ref19) 2011; 8 B Grinsztejn (ref26) 2014; 14 SD Lawn (ref14) 2009; 23 IT Katz (ref29) 2015; 27 MP Fox (ref31) 2010; 13 (ref17) 2007 (ref6) 2010 MP Fox (ref11) 2017; 14 N Haber (ref28) 2017; 4 SD Lawn (ref16) 2007; 45 SA Lippman (ref35) 2016; 73 K Clouse (ref20) 2013; 62 LG Bekker (ref7) 2014; 19 IT Katz (ref3) 2013; 369 MP Fox (ref36) 2014; 9 C Danel (ref24) 2015; 373 ref9 ref4 M Plazy (ref27) 2015; 15 C Mugglin (ref34) 2012; 17 C Cloete (ref12) 2014; 1 A Grimsrud (ref13) 2014; 19 MD Nglazi (ref5) 2011; 56 M Plazy (ref18) 2014; 19 (ref22) 2015 |
References_xml | – volume: 19 start-page: 1029 issue: 9 year: 2014 ident: ref13 article-title: Outcomes of a nurse-managed service for stable HIV-positive patients in a large South African public sector antiretroviral therapy programme publication-title: Trop Med Int Health doi: 10.1111/tmi.12346 contributor: fullname: A Grimsrud – volume: 8 start-page: e1001056 issue: 7 year: 2011 ident: ref19 article-title: Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review publication-title: PLoS Med doi: 10.1371/journal.pmed.1001056 contributor: fullname: S Rosen – ident: ref1 – volume: 14 start-page: 281 issue: 4 year: 2014 ident: ref26 article-title: Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial publication-title: Lancet Infect Dis doi: 10.1016/S1473-3099(13)70692-3 contributor: fullname: B Grinsztejn – volume: 23 start-page: 335 issue: 3 year: 2009 ident: ref14 article-title: Changing mortality risk associated with CD4 cell response to antiretroviral therapy in South Africa publication-title: AIDS doi: 10.1097/QAD.0b013e328321823f contributor: fullname: SD Lawn – volume: 1 start-page: e319 issue: 6 year: 2013 ident: ref8 article-title: Country ownership and the turning point for HIV/AIDS publication-title: Lancet Glob Health doi: 10.1016/S2214-109X(13)70092-5 contributor: fullname: C Collins – volume: 73 start-page: 91 issue: 1 year: 2016 ident: ref35 article-title: Attrition and opportunities along the HIV care continuum: findings from a population-based sample, North West Province, South Africa publication-title: J Acquir Immune Defic Syndr doi: 10.1097/QAI.0000000000001026 contributor: fullname: SA Lippman – volume: 339 start-page: 961 issue: 6122 year: 2013 ident: ref25 article-title: Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment publication-title: Science doi: 10.1126/science.1230413 contributor: fullname: J Bor – year: 2010 ident: ref6 article-title: The South African antiretroviral treatment guidelines—2010 – volume: 19 start-page: 704 issue: 4 year: 2015 ident: ref30 article-title: Understanding treatment refusal among adults presenting for HIV-testing in Soweto, South Africa: a qualitative study publication-title: AIDS Behav doi: 10.1007/s10461-014-0920-y contributor: fullname: IT Katz – volume: 8 start-page: e63596 issue: 5 year: 2013 ident: ref15 article-title: Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir publication-title: PLoS ONE doi: 10.1371/journal.pone.0063596 contributor: fullname: C Njuguna – volume: 45 start-page: 803 issue: 6 year: 2007 ident: ref16 article-title: Promoting retention in care: an effective model in an antiretroviral treatment service in South Africa publication-title: Clin Infect Dis doi: 10.1086/521173 contributor: fullname: SD Lawn – ident: ref9 – year: 2015 ident: ref22 article-title: Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV – volume: 15 start-page: 452 year: 2015 ident: ref27 article-title: Change of treatment guidelines and evolution of ART initiation in rural South Africa: data of a large HIV care and treatment programme publication-title: BMC Infect Dis doi: 10.1186/s12879-015-1207-2 contributor: fullname: M Plazy – volume: 1 start-page: ofu058 issue: 2 year: 2014 ident: ref12 article-title: The linkage outcomes of a large-scale, rapid transfer of HIV-infected patients from hospital-based to community-based clinics in South Africa publication-title: Open Forum Infect Dis doi: 10.1093/ofid/ofu058 contributor: fullname: C Cloete – volume: 14 start-page: e1002268 issue: 4 year: 2017 ident: ref11 article-title: A new cascade of HIV care for the era of “treat all” publication-title: PLoS Med doi: 10.1371/journal.pmed.1002268 contributor: fullname: MP Fox – volume: 27 start-page: 1298 issue: 10 year: 2015 ident: ref29 article-title: Understanding HIV-infected patients’ experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal, South Africa: a qualitative study publication-title: AIDS Care doi: 10.1080/09540121.2015.1051502 contributor: fullname: IT Katz – ident: ref4 – volume: 13 start-page: 8 year: 2010 ident: ref31 article-title: Barriers to initiation of antiretroviral treatment in rural and urban areas of Zambia: a cross-sectional study of cost, stigma, and perceptions about ART publication-title: J Int AIDS Soc doi: 10.1186/1758-2652-13-8 contributor: fullname: MP Fox – ident: ref2 – volume: 62 start-page: e39 issue: 2 year: 2013 ident: ref20 article-title: Patient retention from HIV diagnosis through one year on antiretroviral therapy at a primary health care clinic in Johannesburg, South Africa publication-title: J Acquir Immune Defic Syndr doi: 10.1097/QAI.0b013e318273ac48 contributor: fullname: K Clouse – volume: 17 start-page: 1509 year: 2012 ident: ref34 article-title: Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis publication-title: Trop Med Int Health doi: 10.1111/j.1365-3156.2012.03089.x contributor: fullname: C Mugglin – volume: 9 start-page: e110252 issue: 10 year: 2014 ident: ref36 article-title: Attrition through multiple stages of pre-treatment and ART HIV care in South Africa publication-title: PLoS ONE doi: 10.1371/journal.pone.0110252 contributor: fullname: MP Fox – volume: 369 start-page: 1385 issue: 15 year: 2013 ident: ref3 article-title: PEPFAR in transition—implications for HIV care in South Africa publication-title: N Engl J Med doi: 10.1056/NEJMp1310982 contributor: fullname: IT Katz – year: 2007 ident: ref17 article-title: WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children – volume: 19 start-page: 105 issue: Suppl 3 year: 2014 ident: ref7 article-title: Provision of antiretroviral therapy in South Africa: the nuts and bolts publication-title: Antivir Ther doi: 10.3851/IMP2905 contributor: fullname: LG Bekker – volume: 373 start-page: 808 issue: 9 year: 2015 ident: ref24 article-title: A trial of early antiretrovirals and isoniazid preventive therapy in Africa publication-title: N Engl J Med doi: 10.1056/NEJMoa1507198 contributor: fullname: C Danel – volume: 4 start-page: e223 issue: 5 year: 2017 ident: ref28 article-title: From HIV infection to therapeutic response: a population-based longitudinal HIV cascade-of-care study in KwaZulu-Natal, South Africa publication-title: Lancet HIV doi: 10.1016/S2352-3018(16)30224-7 contributor: fullname: N Haber – volume: 19 start-page: 680 issue: 6 year: 2014 ident: ref18 article-title: Continuum in HIV care from entry to ART initiation in rural KwaZulu-Natal, South Africa publication-title: Trop Med Int Health doi: 10.1111/tmi.12301 contributor: fullname: M Plazy – volume: 56 start-page: e1 issue: 1 year: 2011 ident: ref5 article-title: Changes in programmatic outcomes during 7 years of scale-up at a community-based antiretroviral treatment service in South Africa publication-title: J Acquir Immune Defic Syndr doi: 10.1097/QAI.0b013e3181ff0bdc contributor: fullname: MD Nglazi – volume: 375 start-page: 830 issue: 9 year: 2016 ident: ref23 article-title: Antiretroviral therapy for the prevention of HIV-1 transmission publication-title: N Engl J Med doi: 10.1056/NEJMoa1600693 contributor: fullname: MS Cohen – volume: 13 start-page: 37 year: 2010 ident: ref32 article-title: Barriers to accessing highly active antiretroviral therapy by HIV-positive women attending an antenatal clinic in a regional hospital in western Uganda publication-title: J Int AIDS Soc doi: 10.1186/1758-2652-13-37 contributor: fullname: P Duff – ident: ref10 – volume: 25 start-page: 2177 issue: 17 year: 2011 ident: ref21 article-title: Antiretroviral therapy refusal among newly diagnosed HIV-infected adults publication-title: AIDS doi: 10.1097/QAD.0b013e32834b6464 contributor: fullname: IT Katz – ident: ref33 |
SSID | ssj0029090 |
Score | 2.382992 |
Snippet | South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for... Background South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4.sup.+ threshold of [less than or... South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4.sup.+ threshold of [less than or equal to]200... Background South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/Ml to... BACKGROUNDSouth Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to... In a retrospective cohort study, Ingrid Katz and colleagues report on the continuity of care for people with HIV in Gugulethu Township, South Africa Background South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/Ml to... |
SourceID | plos doaj pubmedcentral proquest gale crossref pubmed |
SourceType | Open Website Open Access Repository Aggregation Database Index Database |
StartPage | e1002434 |
SubjectTerms | Acquired immune deficiency syndrome AIDS Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Care and treatment CD4 antigen Chi-square test Cohort analysis Demographics Drug therapy Evaluation Guidelines HIV HIV infections Hospitals Human immunodeficiency virus Medical schools Medicine and Health Sciences Mortality Overcrowding People and places Physical Sciences Practice guidelines (Medicine) Pregnancy Public health Regression analysis Research and Analysis Methods Studies Systematic review Tuberculosis |
SummonAdditionalLinks | – databaseName: Directory of Open Access Journals dbid: DOA link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1Lj9MwELZQD4gL4r2FAgNCcCFsE78SbmXFqou0iwS7q71Fju2USqu06uMH8M-ZsZNqgyqxB67xp1SdGTvf2ONvGHunbWqtwrTEC2ESIfMqyR13CVJzV_BaOBt6EZyeqemF-HYlr260-qKasCgPHA13mNYuz4zKkak44YwxeSW9yenA0Mq8jmLbqeySqTbVKsZhd4X0x5I007q9NMd1etj66NMSvzZBgFRw0fsoBe3-3Qo9WF4v1vvo599VlDc-S8cP2P2WT8Ik_o-H7I5vHrG7p-2J-WP2-7yrJIfZliStqMwdTOPAk7Qx4M-uge6YANWAAVJYiEXlcD2nvQagjVqYnlzCvIEjs_RA-9EfIbTeg9hl6DNMYOU3q0V3bROo7e5qA0G79gm7OP56fjRN2rYLidVKbHBhTrlB4iDSqrJ17dCUDnklr6QeS5u6OjdaKs8zpzLtc-VI8qWoiWlxdLDlT9mgWTT-gEGNuTe-C11Ye1wsuDGZNdYjydCFlsYNWdLZvVxGdY0yHLFpzEqiAUvyU9n6aci-kHN2WNLGDg8wYso2Ysp_RcyQvSbXlvGi6W6GlxOZKq1UkfMhexsQpI_RUAHOzGzX6_Lk--UtQD_PbgP60QN9aEH1AiMJLRRvRqANSZyrh3zfQ86iNPk-4KgHxDXD9oYPKKw7G69Lqpwbk5Y_mnjUhfr-4Te7YXopleg1frEljBIaZ16KmGdxZuz8hE85Zv44ontzpufI_kgz_xXEzqXKpdDZ8__h-RfsXkasjKo4xYgNNqutf4mcclO9CsvHH83Ncuc priority: 102 providerName: Directory of Open Access Journals – databaseName: AUTh Library subscriptions: ProQuest Central dbid: BENPR link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV3fb9MwELagkxASQjB-rDDgQAheCGtix055Qd20qUNaQWOb9hY5tlMqTUlp2j-A_5y7xAkETWiv8dc08vnO5_Pdd4y9VSY0RuKxxAmhAxEnWZBYbgN0ze2Y58KauhfByUxOz8WXy_jSB9wqn1bZ2sTaUNvSUIx8j3J7RsQ2Lj4vfwbUNYpuV30LjdtsKwoFXdNu7R_Ovp12R67xqI6yEA9ZEEZK-eI5rsI9L6uPS9x1aiJSwUVvc6o5_DtLPVheldV1bui_2ZR_bU9HD9h971fCpFkID9ktV2yzOyf-5nyb3Wvic9CUHT1iv87aDHOYb4jqitLfQRcWHFEeA35GBVR7ApQbBujaQpNsDlcLikEABXBhenwBiwIO9NIBxak_QN2SD5ruQ59gAiu3XpVtOSdQO97VGmpO28fs_Ojw7GAa-HYMgVFSrNFgh1yjQyHCLDN5bnFqLfqbPIvVKDahzROtYul4ZGWkXCItUcGMc_LAOAre8CdsUJSF22GQ45kc35XbJHdoRLjWkdHGofOhxirWdsiCVg7psmHdSOurN4WnlWZCU5Jb6uU2ZPskrA5LnNn1g3I1T70KpiH-XaRlgj6vFVZrnWSx0wldPZs4yeWQvSJRp00Baqf56SQOpZJynPAhe1MjiDejoMScud5UVXr89eIGoO-zm4BOe6D3HpSXuLJwhpqKCZxDIu3qId_1kPOGsvw64G4PiLbE9IZ3aJm3c1ylf7QOf9ku_euHX3fD9FJK3StcuSGMFAo1MUTM00ZTOjnhUy5HNKJ6OtQTZH-kWPyoSdBjmcRCRc_-_1nP2d2I_DDK2xS7bLBebdwL9CLX2UtvKn4Dz1hwPg priority: 102 providerName: ProQuest – databaseName: Scholars Portal Open Access Journals dbid: M48 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1bi9NAFB7WCuKLeN9q1VFEX8zSZG6pIFIXl67QFXR32bcwmZl0CyWpSQv66D_3nMkFIxX6VMh8TeCcOTPfzJz5DiGvlQmNkbAscZzrgIs4DWLLbADU3E5Yxq3xtQjmZ3J2wb9ciasD0tZsbQxY7VzaYT2pi3J19PPHr48Q8B981QYVtn86WsP84SVFOeM3yE38wT4_5925QjQZ-10X1CULwkip5jLd_97Sm6y8pn83cg_Wq6LaRUv_za78a7o6uUvuNDyTTuuOcY8cuPw-uTVvTtIfkN_nbYY5XWxR6grT36nOLXUoeUzhsxXFuycUc8MoUFtaJ5vT1RL3IChu4NLZ6SVd5vRYrx3Ffep31Jfko3X1ofd0Sku3KYv2OifFcrzlhnpN24fk4uTz-fEsaMoxBEZJvoEBO2QaCAUP09RkmQVTWuCbLBVqLExos1grIR2LrIyUi6VFKZhJhgyMgeMNe0QGeZG7Q0IzWJPDuzIbZw4GEaZ1ZLRxQD7URAlthyRo7Z6sa9WNxB-9KVit1AZM0E9J46ch-YTO6bCome0fFOUiaUIwCeFzkZYxcF7LrdY6ToXTMR49GxFnckheoGuT-gJqF_nJVIRSSTmJ2ZC88gjUzcgxMWeht1WVnH693AP0_Wwf0Lce6G0DygroSWCh-sYE2BBFu3rINz3kopYs3wUc9YAwlphe8yF269bGVYIZdWPU-AcTj9quvrv5ZdeML8XUvdwVW8RIriDyQsA8riOj8xM8ZXKMLaoXMz1H9lvy5bUXQRcyFlxFT_ZxyVNyO0I2htmbfEQGm3LrngGX3KTP_fDwB2zNcb4 priority: 102 providerName: Scholars Portal |
Title | Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study |
URI | https://www.ncbi.nlm.nih.gov/pubmed/29136014 https://www.proquest.com/docview/1989018204 https://search.proquest.com/docview/1964702914 https://pubmed.ncbi.nlm.nih.gov/PMC5685472 https://doaj.org/article/1fd82a68139d4daaa8b5ea82452c58f6 http://dx.doi.org/10.1371/journal.pmed.1002434 |
Volume | 14 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3db9MwELe2IiFeJr5XKMUgBC-kbWLHTnjrpk0dqGWMbepb5NhOqdQlVT_-AP5z7pykIqgPEy9-qK9JdOc739l3vyPkg9S-1gLCEsu58ngYpV5kmPHANTcxy7jRrhfBeCJGN_zrNJwekLCuhXFJ-zqd9_LFXS-f_3K5lcs73a_zxPqX49NQRCGXQf-QHErG6hC9irLigTtYQegxzw-krOrlmPT7lXh6S9hoHPYoZ9iXJ4h9BnEJb2xNDsF_Z6dby0Wx3ueE_ptL-dfmdP6YHFVeJR2WX_-EHNj8KXk4ru7Nn5Hf13U-OZ1tEdgKk92pyg21CHBM4bVripUmFDPBKDiytEwtp4s5njhQPK6lo4tbOs_pqVpaiqfSn6lrwEfLXkNf6JCu7GZV1MWbFJvvrjbUIdg-JzfnZ9enI69qvuBpKfgGzLPPFLgP3E9TnWUGuGrAu2RpKAeh9k0WKRkKywIjAmkjYRD4Jc7Q32IgZs1ekFZe5PaY0AwicHhWZqLMgslgSgVaaQuuhoxlqEybeDXfk2WJsZG4izYJsUnJwARFllQia5MTFM6OFhGy3Q_FapZU6yTx4XWBEhF4uIYbpVSUhlZFeNGswygTbfIWRZuU5aY7PU-GoS-kEHHE2uS9o0CUjBzTcGZqu14nF99v70H0c3IfoqsG0aeKKCtgJQGHyvoI4CFCdDUoPzYoZyVA-T7CToMQLIduTB_jsq55vE4wf26AiP7A4k691PdPv9tN40MxUS-3xRZpBJeghD7QvCw1YyenWs_aRDZ0piHI5gxYAAd5Xmn8q__-52vyKECHDBM4eYe0NqutfQPu5CbtghGZyi55cHI2ubzqukMZGL_9iGAccxzBvPwBJd54Jw |
link.rule.ids | 230,315,733,786,790,870,891,2115,2236,12083,21416,24346,27955,27956,31752,31753,33777,33778,43343,43838,53825,53827,74100,74657 |
linkProvider | National Library of Medicine |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV3fb9MwELagSICEEIwfKwxmEIKXhTWxY6e8oDIxtbAWCbqpb5ZjO6XSlJSm_QP4z7lzko6gCu01_ppGPt_5fL77jpA30oTGCDiWOM51wOMkDRLLbACuue2zjFvjexGMJ2J4zr_M4lkdcCvrtMrGJnpDbQuDMfJjzO3pIds4_7j8FWDXKLxdrVto3CS3OGMc17mcXR24-j0fY0EWsiCMpKxL55gMj2tJvV_CnuNpSDnjra3JM_hv7XRneVmUu5zQf3Mp_9qcTh-Q-7VXSQfVMnhIbrh8j9we1_fme-ReFZ2jVdHRI_J72uSX0_kGia4w-Z3q3FKHhMcUPqOkWHlCMTOMgmNLq1RzernACATF8C0dji7oIqcneukoRqmPqG_IR6veQx_ogK7celU0xZwUm_Gu1tQz2j4m56efpyfDoG7GEBgp-BrMdcg0uBM8TFOTZRam1oK3ydJY9mIT2izRMhaORVZE0iXCIhFMP0P_i4HYDXtCOnmRu31CMziRw7sym2QOTAjTOjLaOHA9ZF_G2nZJ0MhBLSvODeUv3iScVaoJVSg3VcutSz6hsLZYZMz2D4rVXNUKqEL4u0iLBDxey63WOkljpxO8eDZxkokuOURRq6r8dKv3ahCHQgrRT1iXvPYIZM3IMS1nrjdlqUbfLq4B-jG5Duh7C_SuBmUFrCyYoapeAuYQKbtayLct5LwiLN8FPGgBwZKY1vA-LvNmjkt1pXPwy2bp7x5-tR3Gl2LiXu6KDWIEl6CJIWCeVpqylRM8ZaKHI7KlQy1BtkfyxU9PgR6LJOYyevb_zzokd4bT8Zk6G02-Pid3I_TIMIOTH5DOerVxL8CfXKcvvdH4AxySccU |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV3fb9MwELagSBMSQjB-rDCYQQheCG1ix055QWVQtcAKgm3qW-TYTqk0JaVp_wD-c-4cpyOoQnuNv6aR73w-n---I-SF1KHWAo4llnMV8DjJgsQwE4BrbgYs50a7XgQnUzE-459m8cznP1U-rbKxic5Qm1JjjLyHuT19ZBvnvdynRXz7MHq3_BVgBym8afXtNK6TG7BL9rGNg5xdHr4GfRdvQUayIIyk9GV0TIY9L7U3S9h_HCUpZ7y1TTk2_63N7iwvymqXQ_pvXuVfG9XoDrntPUw6rFXiLrlmi32yd-Lv0PfJrTpSR-sCpHvk92mTa07nGyS9wkR4qgpDLZIfU_iMimIVCsUsMQpOLq3TzunFAqMRFEO5dDw5p4uCHqulpRixfk1dcz5a9yF6S4d0ZdersinspNiYd7Wmjt32PjkbfTw9Hge-MUOgpeBrMN0hU-Ba8DDLdJ4bmFoDnifLYtmPdWjyRMlYWBYZEUmbCIOkMIMcfTEGKqDZA9IpysIeEJrD6RzelZskt2BOmFKRVtqCGyIHMlamS4JGDumy5t9I3SWchHNLPaEpyi31cuuS9yisLRbZs92DcjVP_WJMQ_i7SIkEvF_DjVIqyWKrEryE1nGSiy45QlGndSnq1gakwzgUUohBwrrkuUMgg0aBujhXm6pKJ1_PrwD6Mb0K6HsL9MqD8hI0C2aorp2AOUT6rhbyZQs5r8nLdwEPW0CwKro1fIBq3sxxlV6uP_hlo_q7h59th_GlmMRX2HKDGMElrMQQMA_rlbKVEzxloo8jsrWGWoJsjxSLn44OPRZJzGX06P-fdUT2wF6kXybTz4_JzQidM0zm5Ieks15t7BNwLdfZU2cz_gCwtnXx |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Treatment+guidelines+and+early+loss+from+care+for+people+living+with+HIV+in+Cape+Town%2C+South+Africa%3A+A+retrospective+cohort+study&rft.jtitle=PLoS+medicine&rft.au=Katz%2C+Ingrid+T&rft.au=Kaplan%2C+Richard&rft.au=Fitzmaurice%2C+Garrett&rft.au=Leone%2C+Dominick&rft.date=2017-11-14&rft.pub=Public+Library+of+Science&rft.issn=1549-1277&rft.eissn=1549-1676&rft.volume=14&rft.issue=11&rft_id=info:doi/10.1371%2Fjournal.pmed.1002434&rft.externalDBID=IOV&rft.externalDocID=A516766983 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1549-1676&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1549-1676&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1549-1676&client=summon |