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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The "ART" of linkage: Pre-treatment loss to care after HIV diagnosis at two PEPFAR sites in Durban, South Africa
PLoS ONE, Volume 5, No. 3, Article e9538, Year 2010
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Description
Background: Although loss to follow-up after antiretroviral therapy (ART) initiation is increasingly recognized, little is known about pre-treatment losses to care (PTLC) after an initial positive HIV test. Our objective was to determine PTLC in newly identified HIV-infected individuals in South Africa. Methodology/Principal Findings: We assembled the South African Test, Identify and Link (STIAL) Cohort of persons presenting for HIV testing at two sites offering HIV and CD4 count testing and HIV care in Durban, South Africa. We defined PTLC as failure to have a CD4 count within 8 weeks of HIV diagnosis. We performed multivariate analysis to identify factors associated with PTLC. From November 2006 to May 2007, of 712 persons who underwent HIV testing and received their test result, 454 (64%) were HIV-positive. Of those, 206 (45%) had PTLC. Infected patients were significantly more likely to have PTLC if they lived ≥10 kilometers from the testing center (RR = 1.37; 95% CI: 1.11-1.71), had a history of tuberculosis treatment (RR = 1.26; 95% CI: 1.00-1.58), or were referred for testing by a health care provider rather than self-referred (RR = 1.61; 95% CI: 1.22-2.13). Patients with one, two or three of these risks for PTLC were 1.88, 2.50 and 3.84 times more likely to have PTLC compared to those with no risk factors. Conclusions/Significance: Nearly half of HIV-infected persons at two high prevalence sites in Durban, South Africa, failed to have CD4 counts following HIV diagnosis. These high rates of pre-treatment loss to care highlight the urgent need to improve rates of linkage to HIV care after an initial positive HIV test. © 2010 Losina et al.
Authors & Co-Authors
Losina, Elena
United States, Boston
Massachusetts General Hospital
United States, Boston
Brigham and Women's Hospital
United States, Boston
School of Public Health
United States, Boston
Harvard Medical School
Bassett, Ingrid V.
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard Medical School
Giddy, Janet
South Africa, Durban
Mccord Hospital
Chetty, S.
South Africa, Durban
Mccord Hospital
Regan, Susan
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard Medical School
Walensky, Rochelle P.
United States, Boston
Massachusetts General Hospital
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
United States, Boston
Harvard T.h. Chan School of Public Health
Ross, Douglas S.
South Africa, Durban
St. Mary's Hospital
Scott, Callie A.
United States, Boston
Massachusetts General Hospital
Uhler, Lauren M.
United States, Boston
Massachusetts General Hospital
Katz, Jeffrey Neil
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard T.h. Chan School of Public Health
Holst, Helga
South Africa, Durban
Mccord Hospital
Freedberg, Kenneth A.
United States, Boston
Massachusetts General Hospital
United States, Boston
School of Public Health
United States, Boston
Harvard Medical School
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 212
Authors: 12
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0009538
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa