title: Adolescent Linkage to Care After a Large-scale Transfer From a Hospital-based HIV Clinic to the Public Sector in South Africa.
abstract: HIV clinics formerly supported by the President's Emergency Plan for AIDS Relief are transferring patients to public-sector clinics. We evaluated adolescent linkage to care after a large-scale transfer from a President's Emergency Plan for AIDS Relief-subsidized pediatric HIV clinic in Durban, South Africa. All adolescents (11-18 years) in care at a pediatric state-subsidized, hospital-based clinic (HBC) were transferred, from May to June 2012, to government sites [primary health care (PHC) clinic; community health center (CHC); and HBCs] or private clinics. Caregivers were surveyed 7-8 months after transfer to assess their adolescents' linkage to care and their reports were validated by clinic record audits in a subset of randomly selected clinics. Of the 309 (91%) caregivers reached, only 5 (2%) reported that their adolescent did not link. Of the 304 adolescents who linked, 105 (35%) were referred to a PHC, 73 (24%) to a CHC and 106 (35%) to a HBC. A total of 146 (48%) linked adolescents attended a different clinic than that assigned. Thirty-five (20%) of the 178 who linked and were assigned to a PHC or CHC ultimately attended a HBC. Based on clinic validation, the estimated transfer success was 88% (95% confidence interval: 77%-97%). The large majority of adolescents successfully transferred to a new HIV clinic, although nearly half attended a clinic other than that assigned.
authors.affiliation: From the *Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California at San Francisco, San Francisco, California; †Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; ‡Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; §McCord Hospital, Durban, South Africa; ¶Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, South Africa; ‖Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts; **Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts; ††Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts; ‡‡Departments of Epidemiology and Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts; §§Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; ¶¶Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; and ‖‖Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Lynn
authors.initials: L
authors.lastname: Ramirez-Avila
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.forename: Christie
authors.initials: C
authors.lastname: Cloete
authors.forename: Tamaryn
authors.initials: T
authors.lastname: Crankshaw
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Robert A
authors.initials: RA
authors.lastname: Parker
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D017028:Caregivers; D002648:Child; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D008297:Male; D017150:Public Sector; D013019:South Africa