Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa.
Differentiated models of HIV care (DMOC) aim to improve health care efficiency. We describe outcomes of five DMOC in KwaZulu-Natal, South Africa: facility adherence clubs (facility AC) and community adherence clubs (community AC), community antiretroviral treatment (ART) groups (CAG), spaced fast la...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0000336 |
| _version_ | 1827826631555678208 |
|---|---|
| author | Altynay Shigayeva Ntombi Gcwensa Celiwe Dlamini Ndlovu Nosicelo Ntumase Scelinhlanhla Sabela Liesbet Ohler Laura Trivino-Duran Ellie Ford Kamara Khanyo Hlophe Petros Isaakidis Gilles Van Cutsem |
| author_facet | Altynay Shigayeva Ntombi Gcwensa Celiwe Dlamini Ndlovu Nosicelo Ntumase Scelinhlanhla Sabela Liesbet Ohler Laura Trivino-Duran Ellie Ford Kamara Khanyo Hlophe Petros Isaakidis Gilles Van Cutsem |
| author_sort | Altynay Shigayeva |
| collection | DOAJ |
| description | Differentiated models of HIV care (DMOC) aim to improve health care efficiency. We describe outcomes of five DMOC in KwaZulu-Natal, South Africa: facility adherence clubs (facility AC) and community adherence clubs (community AC), community antiretroviral treatment (ART) groups (CAG), spaced fast lane appointments (SFLA), and community pick up points (PuP). This retrospective cohort study included 8241 eligible patients enrolled into DMOC between 1/1/2012 and 31/12/2018. We assessed retention in DMOC and on ART, and viral load suppression (<1000 copies/mL). Kaplan-Meier techniques were applied to describe crude retention. Mixed effects parametric survival models with Weibull distribution and clustering on health center and individual levels were used to assess predictors for ART and DMOC attrition, and VL rebound (≥1000 copies/mL). Overall DMOC retention was 85%, 80%, and 76% at 12, 24 and 36 months. ART retention at 12, 24 and 36 months was 96%, 93%, 90%. Overall incidence rate of VL rebound was 1.9 episodes per 100 person-years. VL rebound rate was 4.9 episodes per 100 person-years among those enrolled in 2012-2015, and 0.8 episodes per 100 person-years among those enrolled in 2016-2018 (RR 0.12; 95% CI, 0.09-0.15, p<0.001). Prevalence of confirmed virological failure was 0.6% (38/6113). Predictors of attrition from DMOC and from ART were male gender, younger age, shorter duration on ART before enrollment. Low level viremia (>200-399 copies/mL) was associated with higher hazards of VL rebound and attrition from ART. Concurrent implementation of several DMOC in a large ART program is feasible and can achieve sustained retention on ART and VL suppression. |
| first_indexed | 2024-03-12T03:14:21Z |
| format | Article |
| id | doaj.art-a43a88edaea44c7b8da5980126cb6f73 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T03:14:21Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-a43a88edaea44c7b8da5980126cb6f732023-09-03T14:12:44ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752022-01-01212e000033610.1371/journal.pgph.0000336Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa.Altynay ShigayevaNtombi GcwensaCeliwe Dlamini NdlovuNosicelo NtumaseScelinhlanhla SabelaLiesbet OhlerLaura Trivino-DuranEllie Ford KamaraKhanyo HlophePetros IsaakidisGilles Van CutsemDifferentiated models of HIV care (DMOC) aim to improve health care efficiency. We describe outcomes of five DMOC in KwaZulu-Natal, South Africa: facility adherence clubs (facility AC) and community adherence clubs (community AC), community antiretroviral treatment (ART) groups (CAG), spaced fast lane appointments (SFLA), and community pick up points (PuP). This retrospective cohort study included 8241 eligible patients enrolled into DMOC between 1/1/2012 and 31/12/2018. We assessed retention in DMOC and on ART, and viral load suppression (<1000 copies/mL). Kaplan-Meier techniques were applied to describe crude retention. Mixed effects parametric survival models with Weibull distribution and clustering on health center and individual levels were used to assess predictors for ART and DMOC attrition, and VL rebound (≥1000 copies/mL). Overall DMOC retention was 85%, 80%, and 76% at 12, 24 and 36 months. ART retention at 12, 24 and 36 months was 96%, 93%, 90%. Overall incidence rate of VL rebound was 1.9 episodes per 100 person-years. VL rebound rate was 4.9 episodes per 100 person-years among those enrolled in 2012-2015, and 0.8 episodes per 100 person-years among those enrolled in 2016-2018 (RR 0.12; 95% CI, 0.09-0.15, p<0.001). Prevalence of confirmed virological failure was 0.6% (38/6113). Predictors of attrition from DMOC and from ART were male gender, younger age, shorter duration on ART before enrollment. Low level viremia (>200-399 copies/mL) was associated with higher hazards of VL rebound and attrition from ART. Concurrent implementation of several DMOC in a large ART program is feasible and can achieve sustained retention on ART and VL suppression.https://doi.org/10.1371/journal.pgph.0000336 |
| spellingShingle | Altynay Shigayeva Ntombi Gcwensa Celiwe Dlamini Ndlovu Nosicelo Ntumase Scelinhlanhla Sabela Liesbet Ohler Laura Trivino-Duran Ellie Ford Kamara Khanyo Hlophe Petros Isaakidis Gilles Van Cutsem 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 |
| title | Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa. |
| title_full | Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa. |
| title_fullStr | Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa. |
| title_full_unstemmed | Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa. |
| title_short | Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa. |
| title_sort | retention on art and viral suppression among patients in alternative models of differentiated hiv service delivery in kwazulu natal south africa |
| url | https://doi.org/10.1371/journal.pgph.0000336 |
| work_keys_str_mv | AT altynayshigayeva retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT ntombigcwensa retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT celiwedlaminindlovu retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT nosicelontumase retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT scelinhlanhlasabela retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT liesbetohler retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT lauratrivinoduran retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT elliefordkamara retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT khanyohlophe retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT petrosisaakidis retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica AT gillesvancutsem retentiononartandviralsuppressionamongpatientsinalternativemodelsofdifferentiatedhivservicedeliveryinkwazulunatalsouthafrica |