ArticleTropical medicine & international health : TM & IH2020
Estimating retention in HIV care accounting for clinic transfers using electronic medical records: evidence from a large antiretroviral treatment programme in the Western Cape, South Africa.
Article in Tropical medicine & international health : TM & IH, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Initiation of dolutegravir vs. efavirenz on 12- and 24-month retention and viral suppression: a target trial emulation.Infectious diseases (London, England) · 2026Article
- Population mobility and disease progression in people living with HIV: a machine learning analysis of a 10-year dynamic cohort.Frontiers in public health · 2026Article
- Guidelines for the transfer of people living with HIV attending primary healthcare facilities in South Africa: a scoping review.International health · 2025Article
- Article
- Improving HIV testing and retention among adolescents and youths: Lessons from a quasi-experimental study of the Red-Carpet Program in Malawi.PLOS global public health · 2024Article
- Evaluation of the impact of PEPFAR transition on retention in care in South Africa's Western Cape Province.South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde · 2023Article
- A Community-Based, Mobile Electronic Medical Record System App for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi: Design Process and Pilot Implementation.JMIR formative research · 2023Article
- Evaluation of the impact of PEPFAR transition on retention in care in South Africa's Western Cape.medRxiv : the preprint server for health sciences · 2023Article
- Trajectories of re-engagement: factors and mechanisms enabling patient return to HIV care in Zambia.Journal of the International AIDS Society · 2023Article
- Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa.PLOS global public health · 2022Article
- Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis.BMJ open · 2021Article
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Authors and funding
5 authors.
Funding
Abstract
backgroundEstimates of retention in antiretroviral treatment (ART) programmes may be biased if patients who transfer to healthcare clinics are misclassified as lost to follow-up (LTFU) at their original clinic. In a large cohort, we estimated retention in care accounting for patient transfers using medical records.
methodsUsing linked electronic medical records, we followed adults living with HIV (PLWH) in Cape Town, South Africa from ART initiation (2012-2016) through database closure at 36 months or 30 June 2016, whichever came first. Retention was defined as alive and with a healthcare visit in the 180 days between database closure and administrative censoring on 31 December 2016. Participants who died or did not have a healthcare visit in > 180 days were censored at their last healthcare visit. We estimated the cumulative incidence of retention using Kaplan-Meier methods considering (i) only records from a participant's ART initiation clinic (not accounting for transfers) and (ii) all records (accounting for transfers), over time and by gender. We estimated risk differences and bootstrapped 95% confidence intervals to quantify misclassification in retention estimates due to patient transfers.
resultsWe included 3406 PLWH initiating ART. Retention through 36 months on ART rose from 45.4% (95% CI 43.6%, 47.2%) to 54.3% (95% CI 52.4%, 56.1%) after accounting for patient transfers. Overall, 8.9% (95% CI 8.1%, 9.7%) of participants were misclassified as LTFU due to patient transfers.
conclusionsPatient transfers can appreciably bias estimates of retention in HIV care. Electronic medical records can help quantify patient transfers and improve retention estimates.
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