ArticlePloS one2012
Determinants and consequences of failure of linkage to antiretroviral therapy at primary care level in Blantyre, Malawi: a prospective cohort study.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 4 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- The key design features and effectiveness of social network interventions for HIV testing and linkage services in low- and middle-income countries: a systematic review and meta-analysis.Journal of the International AIDS Society · 2025Pooled it
- The HIV care cascade in sub-Saharan Africa: systematic review of published criteria and definitions.Journal of the International AIDS Society · 2021Pooled it
- Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low- and middle-income countries.Social science & medicine (1982) · 2018Pooled it
- Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa: a systematic review and meta-analysis.Journal of the International AIDS Society · 2014Pooled it
- Trial
- Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi.BMC medicine · 2016Trial
- A novel community health worker tool outperforms WHO clinical staging for assessment of antiretroviral therapy eligibility in a resource-limited setting.Journal of acquired immune deficiency syndromes (1999) · 2014Trial
- Trial
- Article
- Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia.Cost effectiveness and resource allocation : C/E · 2020Article
- Article
- Cost-Effectiveness of Community-based Human Immunodeficiency Virus Self-Testing in Blantyre, Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- Design and protocol for a pragmatic randomised study to optimise screening, prevention and care for tuberculosis and HIV in Malawi (PROSPECT Study).Wellcome open research · 2018Article
- Article
- Determinants of time from HIV infection to linkage-to-care in rural KwaZulu-Natal, South Africa.AIDS (London, England) · 2017Article
- Test site predicts HIV care linkage and antiretroviral therapy initiation: a prospective 3.5 year cohort study of HIV-positive testers in northern Tanzania.BMC infectious diseases · 2016Article
- Article
- Article
- Uptake, Accuracy, Safety, and Linkage into Care over Two Years of Promoting Annual Self-Testing for HIV in Blantyre, Malawi: A Community-Based Prospective Study.PLoS medicine · 2015Article
- Screening for Tuberculosis Among Adults Newly Diagnosed With HIV in Sub-Saharan Africa: A Cost-Effectiveness Analysis.Journal of acquired immune deficiency syndromes (1999) · 2015Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundPoor rates of linkage from HIV diagnosis to ART initiation are a major barrier to universal coverage of ART in sub-Saharan Africa, with reasons for failure poorly understood. In the first study of this kind at primary care level, we investigated the pathway to care in the Malawian National Programme, one of the strongest in Africa. METHODS AND
findingsA prospective cohort study was undertaken at two primary care clinics in Blantyre, Malawi. Newly diagnosed HIV-positive adults (>15 years) were followed for 6-months to assess completion of eligibility assessments, initiation of ART and death. Two hundred and eighty participants were followed for 82.6 patient-years. ART eligibility assessments were problematic: only 134 (47.9%) received same day WHO staging and 121 (53.2%) completed assessments by 6-months. Completion of CD4 measurement (stage 1/2 only) was 81/153 (52.9%). By 6-months, 87/280 (31.1%) had initiated ART with higher uptake in participants who were ART eligible (68/91, 74.7%), and among participants who received same-day staging (52/134 [38.8%] vs. 35/146 [24.0%] p = 0.007). Non-completion of ART eligibility assessments (adjusted hazard ratio: 0.11, 95% CI: 0.06-0.21) was associated with failure to initiate ART. Retention in pre-ART care for non-ART initiators was low (55/193 [28.5%]). Of the 15 (5.4%) deaths, 11 (73.3%) occurred after ART initiation.
conclusionsAlthough uptake of ART was high and prompt for patients with known eligibility, there was frequent failure to complete eligibility assessment and poor retention in pre-ART care. HIV care programmes should urgently evaluate the way patients are linked to ART. In particular, there is a critical need for simplified, same-day ART eligibility assessments, reduced requirements for hospital visits, and active defaulter follow-up.
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