title: Increasing transfers-out from an antiretroviral treatment service in South Africa: patient characteristics and rates of virological non-suppression.
abstract: OBJECTIVE
  To determine the proportion, characteristics and outcomes of patients who transfer-out from an antiretroviral therapy (ART) service in a South African township.
  
  
  METHODS
  This retrospective cohort study included all patients aged ≥15 years who enrolled between September 2002 and December 2009. Follow-up data were censored in December 2010. Kaplan-Meier survival analysis was used to describe time to transfer-out and cox proportional hazard analysis was used to determine associated risk factors.
  
  
  RESULTS
  4511 patients (4003 ART-naïve and 508 non-naïve at baseline) received ART during the study period. Overall, 597 (13.2%) transferred out. The probability of transferring out by one year of ART steadily increased from 1.4% in 2002/2004 cohort to 8.9% for the 2009 cohort. Independent risk factors for transfer-out were more recent calendar year of enrolment, younger age (≤25 years) and being ART non-naïve at baseline (i.e., having previously transferred into this clinic from another facility). The proportions of patients transferred out who had a CD4 cell count <200 cells/µL and/or a viral load ≥1000 copies/mL were 19% and 20%, respectively.
  
  
  CONCLUSIONS
  With scale-up of ART over time, an increasing proportion of patients are transferring between ART services and information systems are needed to track patients. Approximately one-fifth of these have viral loads >1000 copies/mL around the time of transfer, suggesting the need for careful adherence counseling and assessment of medication supplies among those planning transfer.
authors.affiliation: The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, and the Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Mweete.Nglazi@hiv-research.org.za
authors.forename: Mweete D
authors.initials: MD
authors.lastname: Nglazi
authors.forename: Richard
authors.initials: R
authors.lastname: Kaplan
authors.forename: Catherine
authors.initials: C
authors.lastname: Orrell
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003140:Communicable Disease Control / Q000379:methods; D003153:Community Health Services / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents