Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention

Simple item page
dc.contributor.advisorMyer, Landonen_ZA
dc.contributor.authorGrimsrud, Anna Thoraen_ZA
dc.date.accessioned2015-10-30T11:20:39Z
dc.date.available2015-10-30T11:20:39Z
dc.date.issued2015en_ZA
dc.descriptionIncludes bibliographical referencesen_ZA
dc.description.abstractOver the past decade, antiretroviral therapy (ART) programmes have rapidly expanded in resource-limited settings. Access to ART has been accelerated through a public health approach to reduce morbidity and mortality, thereby transforming HIV from a humanitarian crisis to a chronic disease. However, the benefits of ART to patients and communities are dependent on patients being retained in care. This thesis investigates loss to follow-up (LTFU) after ART initiation, in the context of scale-up and limited resources and evaluates models of ART delivery to improve retention. After a brief introduction that offers orientation to the key issues and concepts in the field, Chapter 2 provides a comprehensive literature review discussing the public health concerns related to LTFU in ART programmes, as well as the methodological concerns encountered in studying LTFU. Six results chapters (Chapters 3-8) are presented using complementary cohort data from two collaborative datasets (one from programmes in resource-limited settings and one including only South African cohorts) and from a single ART programme at a community health centre. How to define LTFU is the focus of Chapter 3, demonstrating that definitions can have an appreciable impact on estimates of LTFU. In Chapter 4, temporal factors related to the expansion of ART programmes are investigated, with evidence that the risk of patient LTFU increases with each successive calendar year of ART initiation, and that the rate of programme expansion has a stronger association with the risk of LTFU than absolute programme size. Analyses in Chapter 5 suggest that patients initiating ART at higher CD4 cell counts, above 300 cells/μl, may have an increased risk of LTFU compared to patients initiating ART with lower CD4 cell counts. Taken together, these findings underscore the notion that LTFU is a burgeoning threat to the long-term successes of ART programmes in South Africa and other resource-limited settings. Chapters 6-8 report on the implementation and outcomes from innovative models of ART delivery for stable ART patients. Patient outcomes from (i) a nurse-managed ART service and then (ii) community-based 'Adherence Clubs' highlight that comparable and, in some cases, favourable patient outcomes may be achieved when ART delivery is decentralised. This thesis concludes that LTFU is a significant challenge faced by ART programmes. In the context of ambitious targets and evidence of the potential benefits of ART for individuals and communities, concurrent changes to the health system are necessary to support retention in care. The successes of ART programmes in treating a chronic condition in resource-limited settings can be built upon by expanding community-based ART provision and potentially integrating management of other adulthood illnesses.en_ZA
dc.identifier.apacitationGrimsrud, A. T. (2015). <i>Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/14578en_ZA
dc.identifier.chicagocitationGrimsrud, Anna Thora. <i>"Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2015. http://hdl.handle.net/11427/14578en_ZA
dc.identifier.citationGrimsrud, A. 2015. Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Grimsrud, Anna Thora AB - Over the past decade, antiretroviral therapy (ART) programmes have rapidly expanded in resource-limited settings. Access to ART has been accelerated through a public health approach to reduce morbidity and mortality, thereby transforming HIV from a humanitarian crisis to a chronic disease. However, the benefits of ART to patients and communities are dependent on patients being retained in care. This thesis investigates loss to follow-up (LTFU) after ART initiation, in the context of scale-up and limited resources and evaluates models of ART delivery to improve retention. After a brief introduction that offers orientation to the key issues and concepts in the field, Chapter 2 provides a comprehensive literature review discussing the public health concerns related to LTFU in ART programmes, as well as the methodological concerns encountered in studying LTFU. Six results chapters (Chapters 3-8) are presented using complementary cohort data from two collaborative datasets (one from programmes in resource-limited settings and one including only South African cohorts) and from a single ART programme at a community health centre. How to define LTFU is the focus of Chapter 3, demonstrating that definitions can have an appreciable impact on estimates of LTFU. In Chapter 4, temporal factors related to the expansion of ART programmes are investigated, with evidence that the risk of patient LTFU increases with each successive calendar year of ART initiation, and that the rate of programme expansion has a stronger association with the risk of LTFU than absolute programme size. Analyses in Chapter 5 suggest that patients initiating ART at higher CD4 cell counts, above 300 cells/μl, may have an increased risk of LTFU compared to patients initiating ART with lower CD4 cell counts. Taken together, these findings underscore the notion that LTFU is a burgeoning threat to the long-term successes of ART programmes in South Africa and other resource-limited settings. Chapters 6-8 report on the implementation and outcomes from innovative models of ART delivery for stable ART patients. Patient outcomes from (i) a nurse-managed ART service and then (ii) community-based 'Adherence Clubs' highlight that comparable and, in some cases, favourable patient outcomes may be achieved when ART delivery is decentralised. This thesis concludes that LTFU is a significant challenge faced by ART programmes. In the context of ambitious targets and evidence of the potential benefits of ART for individuals and communities, concurrent changes to the health system are necessary to support retention in care. The successes of ART programmes in treating a chronic condition in resource-limited settings can be built upon by expanding community-based ART provision and potentially integrating management of other adulthood illnesses. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention TI - Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention UR - http://hdl.handle.net/11427/14578 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14578
dc.identifier.vancouvercitationGrimsrud AT. Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/14578en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherAntiretroviral therapy programmesen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherHIVen_ZA
dc.titleLoss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retentionen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnamePhDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
thesis_hsf_2015_grimsrud_anna_thora (1).pdf
Size:
3.55 MB
Format:
Adobe Portable Document Format
Description:
Download
Collections
PhD / Doctoral