Factors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo Trial
<p><strong>Background:</strong> Poor linkage to HIV care is impeding achievement of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets. This study aims to identify risk factors for poor linkage-to-care after HIV counseling and testing, thereby informing st...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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Wolters Kluwer
2017
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| _version_ | 1797098682901856256 |
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| author | Dorward, J Mabuto, T Charalambous, S Fielding, K Hoffmann, C |
| author_facet | Dorward, J Mabuto, T Charalambous, S Fielding, K Hoffmann, C |
| author_sort | Dorward, J |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Poor linkage to HIV care is impeding achievement of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets. This study aims to identify risk factors for poor linkage-to-care after HIV counseling and testing, thereby informing strategies to achieve 90-90-90.</p> <p><strong>Setting:</strong> The Thol'impilo trial was a large randomized controlled trial performed between 2012 and 2015 in South Africa, comparing different strategies to improve linkage-to-care among adults aged ≥18 years who tested HIV-positive at mobile clinic HIV counseling and testing.</p> <p><strong>Methods:</strong> In this secondary analysis, sociodemographic factors associated with time to linkage-to-care were identified using Cox regression.</p> <p><strong>Results:</strong> Of 2398 participants, 61% were female, with median age 33 years (interquartile range: 27–41) and median CD4 count 427 cells/mm3 (interquartile range: 287–595). One thousand one hundred one participants (46%) had clinic verified linkage-to-care within 365 days of testing HIV-positive. In adjusted analysis, younger age [≤30 vs >40 years: adjusted hazard ratio (aHR): 0.58, 95% CI: 0.50 to 0.68; 31–40 vs >40 years: aHR: 0.81, 95% CI: 0.70 to 0.94, test for trend P ≺ 0.001], being male (aHR: 0.86, 95% CI: 0.76 to 0.98, P = 0.028), not being South African (aHR: 0.79, 95% CI: 0.66 to 0.96, P = 0.014), urban district (aHR: 0.82, 95% CI: 0.73 to 0.93, P = 0.002), being employed (aHR: 0.81, 95% CI: 0.72 to 0.92, P = 0.001), nondisclosure of HIV (aHR: 0.63, 95% CI: 0.56 to 0.72, P ≺ 0.001), and having higher CD4 counts (test for trend P ≺ 0.001) were all associated with decreased hazard of linkage-to-care.</p> <p><strong>Conclusion:</strong> Linkage-to-care was low in this relatively large cohort. Increasing linkage-to-care requires innovative, evidence-based interventions particularly targeting individuals who are younger, male, immigrant, urban, employed, and reluctant to disclose their HIV status.</p> |
| first_indexed | 2024-03-07T05:13:06Z |
| format | Journal article |
| id | oxford-uuid:dc3d5d1f-7bae-4fc3-b24d-138bf0a10c66 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:13:06Z |
| publishDate | 2017 |
| publisher | Wolters Kluwer |
| record_format | dspace |
| spelling | oxford-uuid:dc3d5d1f-7bae-4fc3-b24d-138bf0a10c662022-03-27T09:16:21ZFactors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo TrialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:dc3d5d1f-7bae-4fc3-b24d-138bf0a10c66EnglishSymplectic Elements at OxfordWolters Kluwer2017Dorward, JMabuto, TCharalambous, SFielding, KHoffmann, C<p><strong>Background:</strong> Poor linkage to HIV care is impeding achievement of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets. This study aims to identify risk factors for poor linkage-to-care after HIV counseling and testing, thereby informing strategies to achieve 90-90-90.</p> <p><strong>Setting:</strong> The Thol'impilo trial was a large randomized controlled trial performed between 2012 and 2015 in South Africa, comparing different strategies to improve linkage-to-care among adults aged ≥18 years who tested HIV-positive at mobile clinic HIV counseling and testing.</p> <p><strong>Methods:</strong> In this secondary analysis, sociodemographic factors associated with time to linkage-to-care were identified using Cox regression.</p> <p><strong>Results:</strong> Of 2398 participants, 61% were female, with median age 33 years (interquartile range: 27–41) and median CD4 count 427 cells/mm3 (interquartile range: 287–595). One thousand one hundred one participants (46%) had clinic verified linkage-to-care within 365 days of testing HIV-positive. In adjusted analysis, younger age [≤30 vs >40 years: adjusted hazard ratio (aHR): 0.58, 95% CI: 0.50 to 0.68; 31–40 vs >40 years: aHR: 0.81, 95% CI: 0.70 to 0.94, test for trend P ≺ 0.001], being male (aHR: 0.86, 95% CI: 0.76 to 0.98, P = 0.028), not being South African (aHR: 0.79, 95% CI: 0.66 to 0.96, P = 0.014), urban district (aHR: 0.82, 95% CI: 0.73 to 0.93, P = 0.002), being employed (aHR: 0.81, 95% CI: 0.72 to 0.92, P = 0.001), nondisclosure of HIV (aHR: 0.63, 95% CI: 0.56 to 0.72, P ≺ 0.001), and having higher CD4 counts (test for trend P ≺ 0.001) were all associated with decreased hazard of linkage-to-care.</p> <p><strong>Conclusion:</strong> Linkage-to-care was low in this relatively large cohort. Increasing linkage-to-care requires innovative, evidence-based interventions particularly targeting individuals who are younger, male, immigrant, urban, employed, and reluctant to disclose their HIV status.</p> |
| spellingShingle | Dorward, J Mabuto, T Charalambous, S Fielding, K Hoffmann, C Factors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo Trial |
| title | Factors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo Trial |
| title_full | Factors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo Trial |
| title_fullStr | Factors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo Trial |
| title_full_unstemmed | Factors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo Trial |
| title_short | Factors associated with poor linkage to HIV care in South Africa: Secondary analysis of data from the Thol'impilo Trial |
| title_sort | factors associated with poor linkage to hiv care in south africa secondary analysis of data from the thol impilo trial |
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