ArticleHIV medicine2020
Clinical outcomes after first-line HIV treatment failure in South Africa: the next cascade of care.
Article in HIV medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The viral load monitoring cascade in HIV treatment programmes in sub-Saharan Africa: a systematic review.BMC public health · 2024Pooled it
- Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead - a systematic review.BMC public health · 2022Pooled it
- Resistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa : An Unblinded Randomized Controlled Trial.Annals of internal medicine · 2021Trial
- Optimised electronic patient records to improve clinical monitoring of people living with HIV (MONART trial) intervention: a qualitative process evaluation.BMC health services research · 2026Article
- Identifying care gaps along the HIV treatment failure cascade: A multistate analysis of viral load monitoring, re-suppression, and regimen switches in Zambia.PLoS medicine · 2025Article
- Viral suppression among patients in HIV/AIDS care at healthcare facilities in Ethiopia: Same-day antiretroviral initiation.PloS one · 2025Article
- The Impact of Drought on HIV Care in Rural South Africa: An Interrupted Time Series Analysis.EcoHealth · 2023Article
- Determinants of therapy failure among adults on first-line antiretroviral therapy in Asmara, Eritrea: a multicenter retrospective matched case-control study.BMC infectious diseases · 2022Article
- Comparing effectiveness of first-line antiretroviral therapy between peri-urban and rural clinics in KwaZulu-Natal, South Africa.HIV medicine · 2022Article
- Article
- Magnitude of Viral Load Suppression and Associated Factors among Clients on Antiretroviral Therapy in Public Hospitals of Hawassa City Administration, Ethiopia.HIV/AIDS (Auckland, N.Z.) · 2022Article
- Optimised electronic patient records to improve clinical monitoring of HIV-positive patients in rural South Africa (MONART trial): study protocol for a cluster-randomised trial.BMC infectious diseases · 2021Article
- Differentiated service delivery for people using second-line antiretroviral therapy: clinical outcomes from a retrospective cohort study in KwaZulu-Natal, South Africa.Journal of the International AIDS Society · 2021Article
- A nurse-led intervention to improve management of virological failure in public sector HIV clinics in Durban, South Africa: A pre- and post-implementation evaluation.South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde · 2021Article
- Cohort Profile Update: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey.International journal of epidemiology · 2021Article
- Urgent need to improve programmatic management of patients with HIV failing first-line antiretroviral therapy.Public health action · 2020Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
introductionThere is limited literature on the appropriateness of viral load (VL) monitoring and management of detectable VL in public health settings in rural South Africa.
methodsWe analysed data captured in the electronic patient register from HIV-positive patients ≥ 15 years old initiating antiretroviral therapy (ART) in 17 public sector clinics in rural KwaZulu-Natal, during 2010-2016. We estimated the completion rate for VL monitoring at 6, 12, and 24 months. We described the cascade of care for those with any VL measurement ≥ 1000 HIV-1 RNA copies/mL after ≥ 20 weeks on ART, including the following proportions: (1) repeat VL within 6 months; (2) re-suppressed; (3) switched to second-line regimen.
resultsThere were 29 384 individuals who initiated ART during the period [69% female, median age 31 years (interquartile range 25-39)]. Of those in care at 6, 12, and 24 months, 40.7% (9861/24 199), 34% (7765/22 807), and 25.5% (4334/16 965) had a VL test at each recommended time-point, respectively. The VL results were documented at all recommended time-points for 12% (2730/22 807) and 6.2% (1054/16 965) of ART-treated patients for 12 and 24 months, respectively. Only 391 (18.3%) of 2135 individuals with VL ≥ 1000 copies/mL on first-line ART had a repeat VL documenting re-suppression or were appropriately changed to second-line with persistent failure. Completion of the treatment failure cascade occurred a median of 338 days after failure was detected.
conclusionWe found suboptimal VL monitoring and poor responses to virologic failure in public-sector ART clinics in rural South Arica. Implications include increased likelihood of morbidity and transmission of drug-resistant HIV.
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