Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial).
<h4>Background</h4>Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, S...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0280479 |
| _version_ | 1828053945894830080 |
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| author | Mélanie Plazy Adama Diallo Thabile Hlabisa Nonhlanhla Okesola Collins Iwuji Kobus Herbst Sylvie Boyer France Lert Nuala McGrath Deenan Pillay François Dabis Joseph Larmarange Joanna Orne-Gliemann ANRS TasP Study Group |
| author_facet | Mélanie Plazy Adama Diallo Thabile Hlabisa Nonhlanhla Okesola Collins Iwuji Kobus Herbst Sylvie Boyer France Lert Nuala McGrath Deenan Pillay François Dabis Joseph Larmarange Joanna Orne-Gliemann ANRS TasP Study Group |
| author_sort | Mélanie Plazy |
| collection | DOAJ |
| description | <h4>Background</h4>Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa.<h4>Methods</h4>In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012-2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to "re-refer" people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up.<h4>Results</h4>Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47-2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07-7.48).<h4>Conclusions</h4>Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets. |
| first_indexed | 2024-04-10T20:15:10Z |
| format | Article |
| id | doaj.art-044cb6d6f06a4d27b737e2317c4e91f9 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-10T20:15:10Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-044cb6d6f06a4d27b737e2317c4e91f92023-01-26T05:32:11ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01181e028047910.1371/journal.pone.0280479Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial).Mélanie PlazyAdama DialloThabile HlabisaNonhlanhla OkesolaCollins IwujiKobus HerbstSylvie BoyerFrance LertNuala McGrathDeenan PillayFrançois DabisJoseph LarmarangeJoanna Orne-GliemannANRS TasP Study Group<h4>Background</h4>Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa.<h4>Methods</h4>In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012-2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to "re-refer" people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up.<h4>Results</h4>Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47-2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07-7.48).<h4>Conclusions</h4>Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets.https://doi.org/10.1371/journal.pone.0280479 |
| spellingShingle | Mélanie Plazy Adama Diallo Thabile Hlabisa Nonhlanhla Okesola Collins Iwuji Kobus Herbst Sylvie Boyer France Lert Nuala McGrath Deenan Pillay François Dabis Joseph Larmarange Joanna Orne-Gliemann ANRS TasP Study Group Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial). PLoS ONE |
| title | Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial). |
| title_full | Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial). |
| title_fullStr | Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial). |
| title_full_unstemmed | Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial). |
| title_short | Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial). |
| title_sort | implementation and effectiveness of a linkage to hiv care intervention in rural south africa anrs 12249 tasp trial |
| url | https://doi.org/10.1371/journal.pone.0280479 |
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