Need for improvements in clinical practice to retain patients in pre-antiretroviral therapy care: Data from rural clinics in North West Province, South Africa.
We examined current challenges with patient engagement in HIV prevention and care in South Africa by assessing the procedures of eight public health clinics in the North West Province. Procedures consisted of (1) an inventory/audit of the HIV Counseling and Testing, pre-antiretroviral therapy (pre-ART), and antiretroviral therapy (ART) patient registers; (2) extraction of data from a convenience sample of 39 HIV-positive patient files; and (3) 13 key informant interviews with clinic staff to characterize retention and re-engagement practices for patients. Incomplete registers revealed little evidence of follow-up services, particularly for pre-ART patients. The more detailed examination of patient files indicated substantial disparities in the proportion of pre-ART versus ART patients retained in care. Key informant interviews contextualized the data, with providers describing multiple procedures for tracking and ensuring service delivery for ART patients and fewer procedures to retain pre-ART patients. These findings suggest that enhanced strategies are needed for ensuring continued engagement in HIV care, with a particular emphasis on improving the retention of pre-ART patients. The preventive benefits of ART scale-up may not be achieved if improvements are not made in the proportion of earlier-stage HIV-positive patients who are successfully engaged in care.
a International Training and Education Center for Health (I-TECH), Department of Global Health , University of Washington , Seattle , WA , USA.
Jennifer M
JM
Gilvydis
b Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , CA , USA.
Wayne T
WT
Steward
b Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , CA , USA.
Parya
P
Saberi
c Department of Family Medicine and Primary Health Care , University of Limpopo-Medical University of Southern Africa Campus , Medunsa , South Africa.
John
J
Tumbo
d International Training and Education Center for Health , University of Washington , Pretoria , South Africa.
Jeri
J
Sumitani
b Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , CA , USA.
Scott
S
Barnhart
b Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , CA , USA.
Sheri A
SA
Lippman
D000554:Ambulatory Care Facilities / Q000592:standards*; D023241:Antiretroviral Therapy, Highly Active; D003376:Counseling; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D010352:Patient Dropouts; D011785:Quality Assurance, Health Care; D012424:Rural Population; D013019:South Africa
ART; South Africa; lost to follow-up; pre-ART; retention in care