ArticleBMC health services research2017
Imputing HIV treatment start dates from routine laboratory data in South Africa: a validation study.
Article in BMC health services research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 18 citations in OpenAlex.
- The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy.AIDS and behavior · 2021Trial
- Cohort profile: the South African National Health Laboratory Service (NHLS) National HIV Cohort.BMJ open · 2022Article
- Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines.AIDS and behavior · 2022Article
- Article
- Variation in HIV care and treatment outcomes by facility in South Africa, 2011-2015: A cohort study.PLoS medicine · 2021Article
- Impact of Viral Load Monitoring on Retention and Viral Suppression: A Regression Discontinuity Analysis of South Africa's National Laboratory Cohort.American journal of epidemiology · 2020Article
- The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV.BMC public health · 2020Article
- Delays in repeat HIV viral load testing for those with elevated viral loads: a national perspective from South Africa.Journal of the International AIDS Society · 2020Article
- Virological suppression and clinical management in response to viremia in South African HIV treatment program: A multicenter cohort study.PLoS medicine · 2020Article
- Trajectories of HIV-related internalized stigma and disclosure concerns among ART initiators and non-initiators in South Africa.Stigma and health · 2019Article
- Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa: a prospective cohort study.AIDS (London, England) · 2019Article
- Recreational ART use among individuals living with HIV/AIDS in South Africa: Examining longitudinal ART initiation and viral suppression.Drug and alcohol dependence · 2019Observational
- ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South Africa.Journal of the International AIDS Society · 2019Observational
- Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa: exploring avoidant coping as a longitudinal mediator.Journal of the International AIDS Society · 2018Article
- Estimating retention in HIV care accounting for patient transfers: A national laboratory cohort study in South Africa.PLoS medicine · 2018Article
- Understanding data sources to measure patient retention in HIV care in sub-Saharan Africa.International health · 2017Article
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Authors and funding
10 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundPoor clinical record keeping hinders health systems monitoring and patient care in many low resource settings. We develop and validate a novel method to impute dates of antiretroviral treatment (ART) initiation from routine laboratory data in South Africa's public sector HIV program. This method will enable monitoring of the national ART program using real-time laboratory data, avoiding the error potential of chart review.
methodsWe developed an algorithm to impute ART start dates based on the date of a patient's "ART workup", i.e. the laboratory tests used to determine treatment readiness in national guidelines, and the time from ART workup to initiation based on clinical protocols (21 days). To validate the algorithm, we analyzed data from two large clinical HIV cohorts: Hlabisa HIV Treatment and Care Programme in rural KwaZulu-Natal; and Right to Care Cohort in urban Gauteng. Both cohorts contain known ART initiation dates and laboratory results imported directly from the National Health Laboratory Service. We assessed median time from ART workup to ART initiation and calculated sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of our imputed start date vs. the true start date within a 6 month window. Heterogeneity was assessed across individual clinics and over time.
resultsWe analyzed data from over 80,000 HIV-positive adults. Among patients who had a workup and initiated ART, median time to initiation was 16 days (IQR 7,31) in Hlabisa and 21 (IQR 8,43) in RTC cohort. Among patients with known ART start dates, SE of the imputed start date was 83% in Hlabisa and 88% in RTC, indicating this method accurately predicts ART start dates for about 85% of all ART initiators. In Hlabisa, PPV was 95%, indicating that for patients with a lab workup, true start dates were predicted with high accuracy. SP (100%) and NPV (92%) were also very high.
conclusionsRoutine laboratory data can be used to infer ART initiation dates in South Africa's public sector. Where care is provided based on protocols, laboratory data can be used to monitor health systems performance and improve accuracy and completeness of clinical records.
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