Investigating clinic transfers among HIV patients considered lost to follow-up to improve understanding of the HIV care cascade: Findings from a cohort study in rural north-eastern South Africa.
Investigating clinic transfers among HIV patients considered lost to follow-up to improve understanding of the HIV care cascade: Findings from a cohort study in rural north-eastern South Africa.
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DOI：
10.1371/journal.pgph.0000296
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发表时间：
2022
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调查 HIV 患者的临床转移对于准确估计保留情况并为支持患者的干预措施提供信息非常重要。我们调查了南非阿金库尔健康和人口监测系统 (HDSS) 八个艾滋病毒护理机构中报告失访 (LTFU) 的成年人的转移情况。使用链接的诊所和 HDSS 记录，通过诊所和常规追踪记录审查、HDSS 数据和补充追踪来确定上次预定诊所就诊迟到 90 天以上的成年人的结果。通过 Cox 回归模型确定与转移到另一家诊所相关的因素。传输以图形和地理空间方式可视化。对于女性、距离诊所较远的患者以及基线 CD4 细胞计数较高的患者，转移更为常见。转移到 HDSS 内的诊所的情况更有可能是无证的，而且对于开始 ART 时怀孕的妇女来说，这种情况的可能性要大得多。 HDSS 之外的转移集中在经济中心周围。转入 HDSS 内医疗机构的患者可能是为了寻求更好的护理，而转出 HDSS 的患者可能是为了工作而迁移。治疗计划应促进患者的转移过程，确保转移者护理的连续性，并改善对无证转移的追踪。
Investigating clinical transfers of HIV patients is important for accurate estimates of retention and informing interventions to support patients. We investigate transfers for adults reported as lost to follow-up (LTFU) from eight HIV care facilities in the Agincourt health and demographic surveillance system (HDSS), South Africa. Using linked clinic and HDSS records, outcomes of adults more than 90 days late for their last scheduled clinic visit were determined through clinic and routine tracing record reviews, HDSS data, and supplementary tracing. Factors associated with transferring to another clinic were determined through Cox regression models. Transfers were graphically and geospatially visualised. Transfers were more common for women, patients living further from the clinic, and patients with higher baseline CD4 cell counts. Transfers to clinics within the HDSS were more likely to be undocumented and were significantly more likely for women pregnant at ART initiation. Transfers outside the HDSS clustered around economic hubs. Patients transferring to health facilities within the HDSS may be shopping for better care, whereas those who transfer out of the HDSS may be migrating for work. Treatment programmes should facilitate transfer processes for patients, ensure continuity of care among those migrating, and improve tracking of undocumented transfers.