Evidence map›Paper›PMID 34746712›Full record

ArticleEClinicalMedicine2021

The geography of emergency department-based HIV testing in South Africa: Can patients link to care?

Bhakti Hansoti, Anant Mishra, Aditi Rao, Lucy Chimoyi, Andrew D Redd, Steven J Reynolds, David F Stead, John Black, Roshen Maharaj, Elizabeth Hahn and 7 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.3field-weighted citation impact, top 42% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 6 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 6 institutions in 2 countries.

Bhakti HansotiThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Anant MishraThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Aditi RaoThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Lucy ChimoyiImplementation Research Division, The Aurum Institute, 29 Queens Rd, Parktown, Johannesburg, 2194, South Africa.
Andrew D ReddThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Steven J ReynoldsThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
David F SteadDepartment of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa.
John BlackDepartment of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa.
Roshen MaharajDepartment of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa.
Elizabeth HahnThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Pamela MdaNelson Mandela Hospital Clinical Research Unit, Sisson St, Fort Gale, Mthatha 5100, South Africa.
Nomzamo MvandabaDepartment of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa.
Yandisa NyanisaDepartment of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa.
Victoria ChenThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Katie ClarkThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Sofia RyanThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Thomas C QuinnThe Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs.
Johns Hopkins University · USLivingstone Hospital · ZAWalter Sisulu University · ZAAurum Institute · ZACecilia Makiwane Hospital · ZANelson Mandela Academic Hospital · ZA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEmergency Departments (EDs) can serve as clinical sites for identification of new HIV infections and their entry into care. We examined if HIV-positive patients who present to EDs in South Africa are able to successfully link to care.

methodsWe conducted a one-year longitudinal prospective cohort study in four hospitals across the Eastern Cape, South Africa, with participants followed between July 2016 and July 2018. All adult, non-critical patients presenting to the ED were systematically approached, asked about their HIV status, and, if unknown, offered a point-of-care (POC) HIV test. All HIV-positive patients were further consented to participate in a follow-up study to assess subsequent linkage to care and distance from "home" to ED. Linkage to care was defined as self-reported linkage (telephonic) or evidence of repeated CD4/viral load testing in the National Health Laboratory System (NHLS) at either the 6- or 12-months post index ED visit.

findingsA total of 983 HIV-positive patients consented to participate in the study. In the 12 months following their ED visit, 34·1% of patients demonstrated linkage to care (335/983), 23·8% did not link to care (234/983), and 42·1% (414/983) were lost to follow-up. Though not statistically significant, a high percentage of young men (27/50, 54%) and those presenting with a trauma-related complaints (100/205, 48.8%) did not link to care. A considerable proportion of patients (105/454, 23·2%,) resided 50 or more kilometers from their index ED sites, though there was not a significant difference in linkage to care rate between those who lived closer or further from the ED.

interpretationWe have shown that strategies to improve linkage to care from the ED should consider the high rates of poor linkage among young men and those presenting to the ED with trauma. Furthermore, innovative linkage to care solutions will need to account for the unique geographical consideration of this population, given that many ED patients will need to continue care at a site distant from the diagnosis site.

fundingThis research was supported by the South African Medical Research Council, the Division of Intramural Research, the National Institute of Allergy and Infectious Diseases, National Institutes of Health, and the Johns Hopkins Center for Global Health.

Indexed as

Emergency departmentsHIVHIV testingLinkage to CareSouth Africa

Identifiers

PMID34746712
PMCPMC8548925
OpenAlexW3194361874

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.