Assessment of facility-level antiretroviral treatment patient status utilizing a national-level laboratory cohort

Toward an understanding of system-level tracking and clinic switching in South Africa

Bibliographic Data

ID22069890
AuthorsJoshua P Murphy (0000-0001-5466-3131, University of the Witwatersrand, corresponding author), Khumbo Shumba (0000-0002-8293-8080, University of the Witwatersrand), Lise Jamieson (0000-0003-2354-4580, University of the Witwatersrand), Cornelius Nattey (0000-0002-8272-9529, University of the Witwatersrand), Sophie Pascoe (0000-0002-9199-8333, University of the Witwatersrand), Matthew P Fox (0000-0002-5132-7818, Boston University), Jacqui Miot (0000-0001-7070-3826, University of the Witwatersrand), Mhairi Maskew (0000-0003-4238-0200, University of the Witwatersrand)
Year2022
Volume10
Pages959481-959481
Publication date2022-12-15
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2022.959481
PMID36590005
OpenAlexW4311789711
LanguageEN
References cited25

Background: Most estimates of HIV retention are derived at the clinic level through antiretroviral (ART) patient management systems, which capture ART clinic visit data, yet these cannot account for silent transfers across HIV treatment sites. Patient laboratory monitoring visits may also be observed in routinely collected laboratory data, which include ART monitoring tests such as CD4 count and HIV viral load, key to our work here. Methods: In this analysis, we utilized the NHLS National HIV Cohort (a system-wide viewpoint) to investigate the accuracy of facility-level estimates of retention in care for adult patients accessing care (defined using clinic visit data on patients under ART recorded in an electronic patient management system) at Themba Lethu Clinic (TLC). Furthermore, we describe patterns of facility switching among all patients and those patients classified as lost to follow-up (LTFU) at the facility level. Results: Of the 43,538 unique patients in the TLC dataset, we included 20,093 of 25,514 possible patient records (78.8%) in our analysis that were linked with the NHLS National Cohort, and we restricted the analytic sample to patients initiating ART between 1 January 2007 and 31 December 2017. Most (60%) patients were female, and the median age (IQR) at ART initiation was 37 (31-45) years. We found the laboratory records augmented retention estimates by a median of 860 additional active records (about 8% of all median active records across all years) from the facility viewpoint; this augmentation was more noticeable from the system-wide viewpoint, which added evidence of activity of about one-third of total active records in 2017. In 2017, we found 7.0% misclassification at the facility-level viewpoint, a gap which is potentially solvable through data integration/triangulation. We observed 1,134/20,093 (5.6%) silent transfers; these were noticeably more female and younger than the entire dataset. We also report the most common locations for clinic switching at a provincial level. Discussion: Integration of multiple data sources has the potential to reduce the misclassification of patients as being lost to care and help understand situations where clinic switching is common. This may help in prioritizing interventions that would assist patients moving between clinics and hopefully contribute to services that normalize formal transfers and fewer silent transfers

Cohort · Cohort study · Environmental health · Family medicine · Medical emergency · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Medicine · Psychology · Emergency Medicine · Internal Medicine · Pediatrics

Tools

Open DOIOpen Access