Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression

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dc.contributor.authorNglazi, Mweete Den_ZA
dc.contributor.authorKaplan, Richarden_ZA
dc.contributor.authorOrrell, Catherineen_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorLawn, Stephen Den_ZA
dc.date.accessioned2016-01-11T06:56:16Z
dc.date.available2016-01-11T06:56:16Z
dc.date.issued2013en_ZA
dc.description.abstractObjectives: To determine the proportion, characteristics and outcomes of patients who transfer-out from an antiretroviral therapy (ART) service in a South African township. METHODS: This retrospective cohort study included all patients aged ≥15 years who enrolled between September 2002 and December 2009. Follow-up data were censored in December 2010. Kaplan-Meier survival analysis was used to describe time to transfer-out and cox proportional hazard analysis was used to determine associated risk factors. RESULTS: 4511 patients (4003 ART-naïve and 508 non-naïve at baseline) received ART during the study period. Overall, 597 (13.2%) transferred out. The probability of transferring out by one year of ART steadily increased from 1.4% in 2002/2004 cohort to 8.9% for the 2009 cohort. Independent risk factors for transfer-out were more recent calendar year of enrolment, younger age (≤25 years) and being ART non-naïve at baseline (i.e., having previously transferred into this clinic from another facility). The proportions of patients transferred out who had a CD4 cell count <200 cells/µL and/or a viral load ≥1000 copies/mL were 19% and 20%, respectively. CONCLUSIONS: With scale-up of ART over time, an increasing proportion of patients are transferring between ART services and information systems are needed to track patients. Approximately one-fifth of these have viral loads >1000 copies/mL around the time of transfer, suggesting the need for careful adherence counseling and assessment of medication supplies among those planning transfer.en_ZA
dc.identifier.apacitationNglazi, M. D., Kaplan, R., Orrell, C., Myer, L., Wood, R., Bekker, L., & Lawn, S. D. (2013). Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression. <i>PLoS One</i>, http://hdl.handle.net/11427/16313en_ZA
dc.identifier.chicagocitationNglazi, Mweete D, Richard Kaplan, Catherine Orrell, Landon Myer, Robin Wood, Linda-Gail Bekker, and Stephen D Lawn "Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/16313en_ZA
dc.identifier.citationNglazi, M. D., Kaplan, R., Orrell, C., Myer, L., Wood, R., Bekker, L. G., & Lawn, S. D. (2013). Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression. PLoS One, 8(3), e57907. doi:10.1371/journal.pone.0057907en_ZA
dc.identifier.ris TY - Journal Article AU - Nglazi, Mweete D AU - Kaplan, Richard AU - Orrell, Catherine AU - Myer, Landon AU - Wood, Robin AU - Bekker, Linda-Gail AU - Lawn, Stephen D AB - Objectives: To determine the proportion, characteristics and outcomes of patients who transfer-out from an antiretroviral therapy (ART) service in a South African township. METHODS: This retrospective cohort study included all patients aged ≥15 years who enrolled between September 2002 and December 2009. Follow-up data were censored in December 2010. Kaplan-Meier survival analysis was used to describe time to transfer-out and cox proportional hazard analysis was used to determine associated risk factors. RESULTS: 4511 patients (4003 ART-naïve and 508 non-naïve at baseline) received ART during the study period. Overall, 597 (13.2%) transferred out. The probability of transferring out by one year of ART steadily increased from 1.4% in 2002/2004 cohort to 8.9% for the 2009 cohort. Independent risk factors for transfer-out were more recent calendar year of enrolment, younger age (≤25 years) and being ART non-naïve at baseline (i.e., having previously transferred into this clinic from another facility). The proportions of patients transferred out who had a CD4 cell count <200 cells/µL and/or a viral load ≥1000 copies/mL were 19% and 20%, respectively. CONCLUSIONS: With scale-up of ART over time, an increasing proportion of patients are transferring between ART services and information systems are needed to track patients. Approximately one-fifth of these have viral loads >1000 copies/mL around the time of transfer, suggesting the need for careful adherence counseling and assessment of medication supplies among those planning transfer. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0057907 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression TI - Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression UR - http://hdl.handle.net/11427/16313 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16313
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0057907
dc.identifier.vancouvercitationNglazi MD, Kaplan R, Orrell C, Myer L, Wood R, Bekker L, et al. Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression. PLoS One. 2013; http://hdl.handle.net/11427/16313.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of 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© 2013 Nglazi 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.otherViral loaden_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherCohort studiesen_ZA
dc.subject.otherConfidence intervalsen_ZA
dc.subject.otherHealth care facilitiesen_ZA
dc.subject.otherPublic and occupational healthen_ZA
dc.titleIncreasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppressionen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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