Factors Associated With Poor Linkage to HIV Care in South Africa: Secondary Analysis of Data From the Thol'impilo Trial

Jienchi Dorward, Tonderai Mabuto, Salome Charalambous, Katherine L. Fielding, Christopher Hoffmann

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Poor linkage to HIV care is impeding achievement of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets. This study aims to identify risk factors for poor linkage-to-care after HIV counseling and testing, thereby informing strategies to achieve 90-90-90.

SETTING: The Thol'impilo trial was a large randomized controlled trial performed between 2012 and 2015 in South Africa, comparing different strategies to improve linkage-to-care among adults aged ≥18 years who tested HIV-positive at mobile clinic HIV counseling and testing.

METHODS: In this secondary analysis, sociodemographic factors associated with time to linkage-to-care were identified using Cox regression.

RESULTS: Of 2398 participants, 61% were female, with median age 33 years (interquartile range: 27-41) and median CD4 count 427 cells/mm (interquartile range: 287-595). One thousand one hundred one participants (46%) had clinic verified linkage-to-care within 365 days of testing HIV-positive. In adjusted analysis, younger age [≤30 vs >40 years: adjusted hazard ratio (aHR): 0.58, 95% CI: 0.50 to 0.68; 31-40 vs >40 years: aHR: 0.81, 95% CI: 0.70 to 0.94, test for trend P < 0.001], being male (aHR: 0.86, 95% CI: 0.76 to 0.98, P = 0.028), not being South African (aHR: 0.79, 95% CI: 0.66 to 0.96, P = 0.014), urban district (aHR: 0.82, 95% CI: 0.73 to 0.93, P = 0.002), being employed (aHR: 0.81, 95% CI: 0.72 to 0.92, P = 0.001), nondisclosure of HIV (aHR: 0.63, 95% CI: 0.56 to 0.72, P < 0.001), and having higher CD4 counts (test for trend P < 0.001) were all associated with decreased hazard of linkage-to-care.

CONCLUSION: Linkage-to-care was low in this relatively large cohort. Increasing linkage-to-care requires innovative, evidence-based interventions particularly targeting individuals who are younger, male, immigrant, urban, employed, and reluctant to disclose their HIV status.

Original languageEnglish (US)
Pages (from-to)453-460
Number of pages8
JournalJournal of acquired immune deficiency syndromes (1999)
Volume76
Issue number5
DOIs
StatePublished - Dec 15 2017

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South Africa
HIV
CD4 Lymphocyte Count
Counseling
Mobile Health Units
United Nations
Statistical Factor Analysis
Acquired Immunodeficiency Syndrome
Randomized Controlled Trials
Joints

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Factors Associated With Poor Linkage to HIV Care in South Africa : Secondary Analysis of Data From the Thol'impilo Trial. / Dorward, Jienchi; Mabuto, Tonderai; Charalambous, Salome; Fielding, Katherine L.; Hoffmann, Christopher.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 76, No. 5, 15.12.2017, p. 453-460.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Poor linkage to HIV care is impeding achievement of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets. This study aims to identify risk factors for poor linkage-to-care after HIV counseling and testing, thereby informing strategies to achieve 90-90-90.SETTING: The Thol'impilo trial was a large randomized controlled trial performed between 2012 and 2015 in South Africa, comparing different strategies to improve linkage-to-care among adults aged ≥18 years who tested HIV-positive at mobile clinic HIV counseling and testing.METHODS: In this secondary analysis, sociodemographic factors associated with time to linkage-to-care were identified using Cox regression.RESULTS: Of 2398 participants, 61{\%} were female, with median age 33 years (interquartile range: 27-41) and median CD4 count 427 cells/mm (interquartile range: 287-595). One thousand one hundred one participants (46{\%}) had clinic verified linkage-to-care within 365 days of testing HIV-positive. In adjusted analysis, younger age [≤30 vs >40 years: adjusted hazard ratio (aHR): 0.58, 95{\%} CI: 0.50 to 0.68; 31-40 vs >40 years: aHR: 0.81, 95{\%} CI: 0.70 to 0.94, test for trend P < 0.001], being male (aHR: 0.86, 95{\%} CI: 0.76 to 0.98, P = 0.028), not being South African (aHR: 0.79, 95{\%} CI: 0.66 to 0.96, P = 0.014), urban district (aHR: 0.82, 95{\%} CI: 0.73 to 0.93, P = 0.002), being employed (aHR: 0.81, 95{\%} CI: 0.72 to 0.92, P = 0.001), nondisclosure of HIV (aHR: 0.63, 95{\%} CI: 0.56 to 0.72, P < 0.001), and having higher CD4 counts (test for trend P < 0.001) were all associated with decreased hazard of linkage-to-care.CONCLUSION: Linkage-to-care was low in this relatively large cohort. Increasing linkage-to-care requires innovative, evidence-based interventions particularly targeting individuals who are younger, male, immigrant, urban, employed, and reluctant to disclose their HIV status.",
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T1 - Factors Associated With Poor Linkage to HIV Care in South Africa

T2 - Secondary Analysis of Data From the Thol'impilo Trial

AU - Dorward, Jienchi

AU - Mabuto, Tonderai

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AU - Fielding, Katherine L.

AU - Hoffmann, Christopher

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N2 - BACKGROUND: Poor linkage to HIV care is impeding achievement of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets. This study aims to identify risk factors for poor linkage-to-care after HIV counseling and testing, thereby informing strategies to achieve 90-90-90.SETTING: The Thol'impilo trial was a large randomized controlled trial performed between 2012 and 2015 in South Africa, comparing different strategies to improve linkage-to-care among adults aged ≥18 years who tested HIV-positive at mobile clinic HIV counseling and testing.METHODS: In this secondary analysis, sociodemographic factors associated with time to linkage-to-care were identified using Cox regression.RESULTS: Of 2398 participants, 61% were female, with median age 33 years (interquartile range: 27-41) and median CD4 count 427 cells/mm (interquartile range: 287-595). One thousand one hundred one participants (46%) had clinic verified linkage-to-care within 365 days of testing HIV-positive. In adjusted analysis, younger age [≤30 vs >40 years: adjusted hazard ratio (aHR): 0.58, 95% CI: 0.50 to 0.68; 31-40 vs >40 years: aHR: 0.81, 95% CI: 0.70 to 0.94, test for trend P < 0.001], being male (aHR: 0.86, 95% CI: 0.76 to 0.98, P = 0.028), not being South African (aHR: 0.79, 95% CI: 0.66 to 0.96, P = 0.014), urban district (aHR: 0.82, 95% CI: 0.73 to 0.93, P = 0.002), being employed (aHR: 0.81, 95% CI: 0.72 to 0.92, P = 0.001), nondisclosure of HIV (aHR: 0.63, 95% CI: 0.56 to 0.72, P < 0.001), and having higher CD4 counts (test for trend P < 0.001) were all associated with decreased hazard of linkage-to-care.CONCLUSION: Linkage-to-care was low in this relatively large cohort. Increasing linkage-to-care requires innovative, evidence-based interventions particularly targeting individuals who are younger, male, immigrant, urban, employed, and reluctant to disclose their HIV status.

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