Need for improvements in clinical practice to retain patients in pre-antiretroviral therapy care: Data from rural clinics in North West Province, South Africa

Abstract

We examined current challenges with patient engagement in HIV prevention and care in South Africa by assessing the procedures of eight public health clinics in the North West Province. Procedures consisted of (1) an inventory/audit of the HIV Counseling and Testing, pre-antiretroviral therapy (pre-ART), and antiretroviral therapy (ART) patient registers; (2) extraction of data from a convenience sample of 39 HIV-positive patient files; and (3) 13 key informant interviews with clinic staff to characterize retention and re-engagement practices for patients. Incomplete registers revealed little evidence of follow-up services, particularly for pre-ART patients. The more detailed examination of patient files indicated substantial disparities in the proportion of pre-ART versus ART patients retained in care. Key informant interviews contextualized the data, with providers describing multiple procedures for tracking and ensuring service delivery for ART patients and fewer procedures to retain pre-ART patients. These findings suggest that enhanced strategies are needed for ensuring continued engagement in HIV care, with a particular emphasis on improving the retention of pre-ART patients. The preventive benefits of ART scale-up may not be achieved if improvements are not made in the proportion of earlier-stage HIV-positive patients who are successfully engaged in care.

Keywords:

• retention in care
• lost to follow-up
• pre-ART
• ART
• South Africa

Acknowledgements

The authors would like to thank the government staff who worked with us to implement this research and for their ongoing dedication to improving South African quality of care. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the views of HRSA or the NIMH. All authors contributed to the interpretation of the findings and article revisions.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This was supported by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) Cooperative Agreement U91HA06801. Dr Saberi was supported by an early career development award from the National Institute of Mental Health [NIMH grant number K23MH097649].