Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial)
Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial)
Background: timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa.
Methods: in the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012–2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to “re-refer” people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up.
Results: among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47–2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07–7.48).
Conclusions: phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets.
Plazy, Melanie
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Diallo, Adama
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Hlabisa, Thabile
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Okesola, Nonhlanhla
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Iwuji, Collins
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Herbst, Kobus
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Boyer, Sylvie
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Lert, France
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Mcgrath, Nuala
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Pillay, Deenan
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Dabis, François
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Lamarange, Joseph
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Orne-Gliemann, Joanna
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20 January 2023
Plazy, Melanie
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Diallo, Adama
ec175d9a-8702-4064-a36e-958ea7e85fc7
Hlabisa, Thabile
daa156fb-16a9-4aac-a973-83bef1501c6d
Okesola, Nonhlanhla
0a55eb44-591c-4c9f-85a1-bd9268d845fc
Iwuji, Collins
9172710f-6d53-4fc4-8948-2db34293c7ed
Herbst, Kobus
fab67269-11ef-4c52-91bc-635b00065504
Boyer, Sylvie
ac92cdf4-6029-44dd-8a57-11fea71b7077
Lert, France
665403dd-01be-4ed8-a91f-11666e75a6c4
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Pillay, Deenan
9b4da6c6-2220-4c60-aaca-f0f1a37c2ca8
Dabis, François
90f9de2e-aaba-4392-97d6-18776521b99f
Lamarange, Joseph
f3bcaebb-a3d3-49f5-97ef-a18161186bac
Orne-Gliemann, Joanna
2124c323-6911-49d3-9e50-bddb35f521f8
Plazy, Melanie, Diallo, Adama, Hlabisa, Thabile, Okesola, Nonhlanhla, Iwuji, Collins, Herbst, Kobus, Boyer, Sylvie, Lert, France, Mcgrath, Nuala, Pillay, Deenan, Dabis, François, Lamarange, Joseph and Orne-Gliemann, Joanna
,
ANRS TasP Study Group
(2023)
Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial).
PLoS ONE, 18 (1 January), [e0280479].
(doi:10.1371/journal.pone.0280479).
Abstract
Background: timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa.
Methods: in the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012–2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to “re-refer” people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up.
Results: among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47–2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07–7.48).
Conclusions: phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets.
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Accepted/In Press date: 3 January 2023
Published date: 20 January 2023
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© 2023 Plazy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Local EPrints ID: 481397
URI: http://eprints.soton.ac.uk/id/eprint/481397
ISSN: 1932-6203
PURE UUID: c39a4cfb-ebb9-4b9c-b742-ce8654358b85
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Date deposited: 25 Aug 2023 16:34
Last modified: 18 Mar 2024 03:25
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Contributors
Author:
Melanie Plazy
Author:
Adama Diallo
Author:
Thabile Hlabisa
Author:
Nonhlanhla Okesola
Author:
Collins Iwuji
Author:
Kobus Herbst
Author:
Sylvie Boyer
Author:
France Lert
Author:
Deenan Pillay
Author:
François Dabis
Author:
Joseph Lamarange
Author:
Joanna Orne-Gliemann
Corporate Author: ANRS TasP Study Group
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