ArticleJournal of the International AIDS Society2021
Attrition in HIV care following HIV diagnosis: a comparison of the pre-UTT and UTT eras in South Africa.
Article in Journal of the International AIDS Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 5 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Systematic review and meta-analysis of retention and disengagement after initiation on antiretroviral therapy in low- and middle-income countries after the introduction of Universal Test and Treat policies.Journal of the International AIDS Society · 2025Pooled it
- Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV "Treat All" in Sub-Saharan Africa: a systematic review and meta-analysis.BMC infectious diseases · 2023Pooled it
- Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis.PloS one · 2023Pooled it
- Same-day ART initiation, loss to follow-up and viral load suppression among people living with HIV in low- and middle-income countries: systematic review and meta-analysis.The Pan African medical journal · 2023Pooled it
- Interventions to improve early retention of patients in antiretroviral therapy programmes in sub-Saharan Africa: A systematic review.PloS one · 2022Pooled it
- Impact of SMS and peer navigation on retention in HIV care among adults in South Africa: results of a three-arm cluster randomized controlled trial.Journal of the International AIDS Society · 2021Trial
- Postpartum continuity of care for women with HIV: Option B+ policy impact and limitations in South Africa.BMJ global health · 2026Article
- Gender, mental health symptoms, loss to clinic, and viral non-suppression 6 months after HIV care initiation among a cohort of people with HIV in Cameroon.BMC public health · 2025Article
- The Ripple Effect of COVID-19: How Lockdown Regulations Shaped Antiretroviral Therapy Initiation Among People Living With HIV in Johannesburg.Nursing & health sciences · 2025Article
- Universal "Test and Treat" for HIV Had Little Effect on Outcomes, but Missed Clinic Visits Threaten Success of Botswana's National Antiretroviral Treatment Program.AIDS patient care and STDs · 2025Article
- A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa.Addiction science & clinical practice · 2025Article
- Effect of rapid antiretroviral therapy initiation on loss to follow-up, mortality, and virologic failure among people with human immunodeficiency virus under the treat-all policy in China: analysis of routine data.Frontiers in cellular and infection microbiology · 2025Article
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- Does type of antiretroviral therapy pick-up point influence 12-month virologic suppression in South Africa?AIDS care · 2024Observational
- A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa.Research square · 2024Article
- Acceptability of a pilot motivational interviewing intervention at public health facilities to improve the HIV treatment cascade among people who inject drugs in Indonesia.Harm reduction journal · 2024Article
- Long-term HIV care outcomes under universal HIV treatment guidelines: A retrospective cohort study in 25 countries.PLoS medicine · 2024Article
- Long-term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania.Journal of the International AIDS Society · 2024Article
- Depression and HIV Care-seeking Behaviors in a Population-based Sample in North West Province, South Africa.AIDS and behavior · 2023Article
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Authors and funding
7 authors.
Funding
Abstract
introductionPolicies for Universal Test & Treat (UTT) and same-day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis.
methodsWe enrolled three cohorts of newly diagnosed HIV-infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre-UTT, N = 144), May-September 2017 (UTT, N = 178) and October-December 2017 (SDI, N = 88). A baseline survey was administered immediately after HIV diagnosis after which follow-up using clinical records (paper charts, electronic health records and laboratory data) ensued for 12 months. The primary outcome was patient loss to follow-up (being >90 days late for the last scheduled appointment) at 12 months post-HIV diagnosis. We modelled attrition across HIV policy periods with Cox proportional hazard regression.
resultsOverall, 410 of 580 screened HIV-positive patients were enrolled. Overall, attrition at 12 months was 30% lower in the UTT guideline period (38.2%) compared to pre-UTT (47.2%, aHR 0.7, 95% CI: 0.5 to 1.0). However, the total attrition was similar between the SDI (47.7%) and pre-UTT cohorts (aHR 1.0, 95% CI: 0.7 to 1.5). Older age at HIV diagnosis (aHR 0.5 for ≥40 vs. 25 to 29 years, 95% CI: 0.3 to 0.8) and being in a non-marital relationship (aHR 0.5 vs. being single, 95% CI: 0.3 to 0.8) protected against LTFU at 12 months, whereas LTFU rates increased with longer travel time to the diagnosing clinic (aHR 1.8 for ≥30 minutes vs. ≤15 minutes, 95% CI: 1.1 to 3.1). In analyses adjusted for the time-varying ART initiation status, compared to the pre-ART period of care, the hazard of on-ART LTFU was 90% higher among participants diagnosed under the SDI policy compared to pre-UTT (aHR 1.9, 95% CI: 1.1 to 2.9).
conclusionsOverall, nearly two-fifths of HIV positive patients are likely to disengage from care by 12 months after HIV diagnosis under the new SDI policy. Furthermore, the increase in on-ART patient attrition after the introduction of the SDI policy is cause for concern. Further research is needed to determine the best way for rapidly initiating patients on ART and also reducing long-term attrition from care.
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