Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme

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dc.contributor.authorBoyles, Tom Hen_ZA
dc.contributor.authorWilkinson, Lynne Sen_ZA
dc.contributor.authorLeisegang, Roryen_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.date.accessioned2015-11-11T14:28:19Z
dc.date.available2015-11-11T14:28:19Z
dc.date.issued2011en_ZA
dc.description.abstractThe prognosis of patients with HIV in Africa has improved with the widespread use of antiretroviral therapy (ART) but these successes are threatened by low rates of long-term retention in care. There are limited data on predictors of retention in care, particularly from rural sites. METHODS: Prospective cohort analysis of outcome measures in adults from a rural HIV care programme in Madwaleni, Eastern Cape, South Africa. The ART programme operates from Madwaleni hospital and seven primary care feeder clinics with full integration between inpatient and outpatient services. Outreach workers conducted home visits for defaulters. RESULTS: 1803 adults initiated ART from June 2005 to May 2009. At the end of the study period 82.4% were in active care or had transferred elsewhere, 11.1% had died and 6.5% were lost to follow-up (LTFU). Independent predictors associated with an increased risk of LTFU were CD4 nadir >200, initiating ART as an inpatient or while pregnant, and younger age, while being in care for >6 months before initiating ART was associated with a reduced risk. Independent factors associated with an increased risk of mortality were baseline CD4 count <50 and initiating ART as an inpatient, while being in care for >6 months before initiating ART and initiating ART while pregnant were associated with a reduced risk. CONCLUSIONS: Serving a socioeconomically deprived rural population is not a barrier to successful ART delivery. Patients initiating ART while pregnant and inpatients may require additional counselling and support to reduce LTFU. Providing HIV care for patients not yet eligible for ART may be protective against being LTFU and dying after ART initiation.en_ZA
dc.identifier.apacitationBoyles, T. H., Wilkinson, L. S., Leisegang, R., & Maartens, G. (2011). Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme. <i>PLoS One</i>, http://hdl.handle.net/11427/14928en_ZA
dc.identifier.chicagocitationBoyles, Tom H, Lynne S Wilkinson, Rory Leisegang, and Gary Maartens "Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/14928en_ZA
dc.identifier.citationBoyles, T. H., Wilkinson, L. S., Leisegang, R., & Maartens, G. (2011). Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme. PLoS One, 6(5), e19201. doi:10.1371/journal.pone.0019201en_ZA
dc.identifier.ris TY - Journal Article AU - Boyles, Tom H AU - Wilkinson, Lynne S AU - Leisegang, Rory AU - Maartens, Gary AB - The prognosis of patients with HIV in Africa has improved with the widespread use of antiretroviral therapy (ART) but these successes are threatened by low rates of long-term retention in care. There are limited data on predictors of retention in care, particularly from rural sites. METHODS: Prospective cohort analysis of outcome measures in adults from a rural HIV care programme in Madwaleni, Eastern Cape, South Africa. The ART programme operates from Madwaleni hospital and seven primary care feeder clinics with full integration between inpatient and outpatient services. Outreach workers conducted home visits for defaulters. RESULTS: 1803 adults initiated ART from June 2005 to May 2009. At the end of the study period 82.4% were in active care or had transferred elsewhere, 11.1% had died and 6.5% were lost to follow-up (LTFU). Independent predictors associated with an increased risk of LTFU were CD4 nadir >200, initiating ART as an inpatient or while pregnant, and younger age, while being in care for >6 months before initiating ART was associated with a reduced risk. Independent factors associated with an increased risk of mortality were baseline CD4 count <50 and initiating ART as an inpatient, while being in care for >6 months before initiating ART and initiating ART while pregnant were associated with a reduced risk. CONCLUSIONS: Serving a socioeconomically deprived rural population is not a barrier to successful ART delivery. Patients initiating ART while pregnant and inpatients may require additional counselling and support to reduce LTFU. Providing HIV care for patients not yet eligible for ART may be protective against being LTFU and dying after ART initiation. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0019201 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme TI - Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme UR - http://hdl.handle.net/11427/14928 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14928
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0019201
dc.identifier.vancouvercitationBoyles TH, Wilkinson LS, Leisegang R, Maartens G. Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme. PLoS One. 2011; http://hdl.handle.net/11427/14928.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.en_ZA
dc.rights.holder© 2011 Boyles et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherDeath ratesen_ZA
dc.titleFactors influencing retention in care after starting antiretroviral therapy in a rural South African programmeen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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