Linkage to Care and Loss to Follow-up for HIV Treatment in South Africa

Project Description

With the rapid expansion of access to antiretroviral therapy (ART) in sub-Saharan Africa, the number of HIV-positive people on treatment has increased dramatically. In South Africa, scale-up of services has put pressure on the ability of treatment programs to maintain care for existing patients while continuing to expand access to new patients. With increased demand and limited capacity, many HIV-positive patients never access care, and many who do discontinue treatment.

CGHD staff, local partners, and collaborators have conducted several highly influential systematic reviews to define and describe the HIV care cascade in sub-Saharan Africa and globally, as well as reviews of the effectiveness of interventions to reduce attrition from care. Further, we have conducted numerous epidemiologic analyses of primary data aimed at better understanding the care cascade and identifying predictors of drop out from different stages of HIV care. Finally we have been been designing and evaluating interventions to improve linkage to and retention in HIV care and reducing late presentation for treatment. These include the NIH funded RapIT study, a randomized trial of offering treatment initiation on the day of testing HIV positive for those ART eligible vs. current standard of care as well as a World Bank funded cluster randomized trial of South Africa’s National Treatment Adherence Strategy to improve retention in and adherence to HIV care and treatment.

The results of our work on linkage to care and loss to follow-up have been influential in demonstrating both that linkage to care and retention in HIV care programs in sub-Saharan Africa are sub-optimal and that many patients are still being lost from treatment programs leading to increased mortality.

Project Details

Principal Investigator Matthew Fox, Sydney Rosen
Boston University Co-Investigators Alana BrennanBruce LarsonWilliam Macleod, Jacob Bor
Country(ies) South Africa
Dates of Research 2006 – present