The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa.
BACKGROUND
President's Emergency Plan for AIDS Relief (PEPFAR) funding changes have resulted in human immunodeficiency virus (HIV) clinic closures. We evaluated linkage to care following a large-scale patient transfer from a PEPFAR-funded, hospital-based HIV clinic to government-funded, community-based clinics in Durban.


METHODS
All adults were transferred between March and June 2012. Subjects were surveyed 5-10 months post-transfer to assess self-reported linkage to the target clinic. We validated self-reports by auditing records at 8 clinics. Overall success of transfer was estimated using linkage to care data for both reached and unreached subjects, adjusted for validation results.


RESULTS
Of the 3913 transferred patients, 756 (19%) were assigned to validation clinics; 659 (87%) of those patients were reached. Among those reached, 468 (71%) had a validated clinic record visit. Of the 46 who self-reported attending a different validation clinic than originally assigned, 39 (85%) had a validated visit. Of the 97 patients not reached, 59 (61%) had a validated visit at their assigned clinic. Based on the validation rates for reached and unreached patients, the estimated success of transfer for the cohort overall was 82%.


CONCLUSIONS
Most patients reported successful transfer to a community-based clinic, though a quarter attended a different clinic than assigned. Validation of attendance highlights that nearly 20% of patients may not have linked to care and may have experienced a treatment interruption. Optimizing transfers of HIV care to community sites requires collaboration with receiving clinics to ensure successful linkage to care.
McCord Hospital , Durban , South Africa.
Christie
C
Cloete
Division of General Medicine ; Medical Practice Evaluation Center, Department of Medicine.
Susan
S
Regan
McCord Hospital , Durban , South Africa.
Janet
J
Giddy
McCord Hospital , Durban , South Africa.
Tessa
T
Govender
Division of General Medicine ; Medical Practice Evaluation Center, Department of Medicine.
Alison
A
Erlwanger
Division of General Medicine ; Medical Practice Evaluation Center, Department of Medicine.
Melanie R
MR
Gaynes
Division of General Medicine ; Medical Practice Evaluation Center, Department of Medicine ; Division of Infectious Disease , Massachusetts General Hospital ; Harvard University Center for AIDS Research (CFAR) ; Departments of Biostatistics and Epidemiology , Boston University School of Public Health ; Departments of Epidemiology and Health Policy and Management , Harvard School of Public Health.
Kenneth A
KA
Freedberg
Departments of Epidemiology and Health Policy and Management , Harvard School of Public Health ; Division of Rheumatology, Department of Medicine, and Department of Orthopedic Surgery , Brigham and Women's Hospital.
Jeffrey N
JN
Katz
Division of General Medicine ; Medical Practice Evaluation Center, Department of Medicine ; Division of Infectious Disease , Massachusetts General Hospital ; Harvard University Center for AIDS Research (CFAR) ; Division of Infectious Disease , Brigham and Women's Hospital , Boston, Massachusetts.
Rochelle P
RP
Walensky
Medical Practice Evaluation Center, Department of Medicine ; Harvard University Center for AIDS Research (CFAR) ; Departments of Biostatistics and Epidemiology , Boston University School of Public Health ; Division of Rheumatology, Department of Medicine, and Department of Orthopedic Surgery , Brigham and Women's Hospital.
Elena
E
Losina
Division of General Medicine ; Medical Practice Evaluation Center, Department of Medicine ; Division of Infectious Disease , Massachusetts General Hospital ; Harvard University Center for AIDS Research (CFAR).
Ingrid V
IV
Bassett
PEPFAR; South Africa; community-based clinics; linkage to care; transfer of HIV care