Outcomes from the implementation of a counselling model supporting rapid antiretroviral treatment initiation in a primary healthcare clinic in Khayelitsha, South Africa.

Lynne Wilkinson,Gabriela Patten,Shariefa Patel,Suhair Solomon,Saar Baert,Helene Duvivier,Virginia De Azevedo,Leticia Mdani

doi:10.4102/sajhivmed.v16i1.367

Lynne Wilkinson, Gabriela Patten + Show 6 more

Open Access

https://doi.org/10.4102/sajhivmed.v16i1.367

Copy DOI

Abstract

BackgroundLengthy antiretroviral treatment (ART) preparation contributes to high losses to care between communicating ART eligibility and initiating ART. To address this shortfall, Médecins Sans Frontières implemented a revised approach to ART initiation counselling preparation (integrated for TB co-infected patients), shifting the emphasis from pre-initiation sessions to addressing common barriers to adherence and strengthening post-initiation support in a primary healthcare facility in Khayelitsha, South Africa.MethodsAn observational cohort study was conducted using routinely collected data for all ART-eligible patients attending their first counselling session between 23 July 2012 and 30 April 2013 to assess losses to care prior to and post ART initiation. Viral load completion and suppression rates of those retained on ART were also calculated.ResultsOverall, 449 patients enrolled in the study, of whom 3.6% did not return to the facility to initiate ART. Of those who were initiated, 96.7% were retained at their first ART refill visit and 85.9% were retained 6 months post ART initiation. Of those retained, 80.2% had a viral load taken within 6 months of initiating ART, with 95.4% achieving viral load suppression.ConclusionsAdapting counselling to enable rapid ART initiation is feasible and has the potential to reduce losses to care prior to ART initiation without increasing short-term losses thereafter or compromising patient adherence.

Highlights

One-third of antiretroviral treatment (ART)-eligible patients are estimated to be lost to care between communicating ART eligibility and initiating ART1 – the so-called ‘third stage’ of pre-ART care2 – increasing the risk of morbidity and mortality.[3]
It further recommended that patients with CD4 counts < 200 cells/mm[3] and pregnant women be started on the same day that ART eligibility is ascertained
The aim of the present study is to describe the intervention and determine the retention outcomes during the third stage of pre-ART care and post ART initiation of patients who

Summary

Introduction

One-third of antiretroviral treatment (ART)-eligible patients are estimated to be lost to care between communicating ART eligibility and initiating ART1 – the so-called ‘third stage’ of pre-ART care2 – increasing the risk of morbidity and mortality.[3]. Some facilities provide minimal ART preparation owing to prioritising fast-tracking, whilst others continue to require prior attendance of 3 (and sometimes more when co-infected with TB) education and adherence counselling sessions. Lengthy antiretroviral treatment (ART) preparation contributes to high losses to care between communicating ART eligibility and initiating ART To address this shortfall, Médecins Sans Frontières implemented a revised approach to ART initiation counselling preparation (integrated for TB co-infected patients), shifting the emphasis from pre-initiation sessions to addressing common barriers to adherence and strengthening post-initiation support in a primary healthcare facility in Khayelitsha, South Africa

Objectives

Methods

Results

Conclusion