%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Gosset, A.
%A Protopopescu, C.
%A Larmarange, Joseph
%A Orne-Gliemann, J.
%A McGrath, N.
%A Pillay, D.
%A Dabis, F.
%A Iwuji, C.
%A Boyer, S.
%T Retention in care trajectories of HIV-positive individuals participating in a universal test-and-treat program in rural South Africa (ANRS 12249 TasP Trial)
%D 2019
%L fdi:010076589
%G ENG
%J JAIDS.Journal of Acquired Immune Deficiency Syndromes
%@ 1525-4135
%K universal test and treat ; HIV ; South Africa ; retention in care trajectories
%K AFRIQUE DU SUD
%M ISI:000480763600005
%N 4
%P 375-385
%R 10.1097/qai.0000000000001938
%U https://www.documentation.ird.fr/hor/fdi:010076589
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers19-08/010076589.pdf
%V 80
%W Horizon (IRD)
%X Objective: To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral therapy (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012-2016). Design: A cluster-randomized trial whereby individuals identified HIV positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control). Methods: Exiting care was defined as >= 3 months late for a clinic appointment, transferring elsewhere, or death. Group-based trajectory modeling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients. Results: Four RIC trajectory groups were identified: (1) group 1 "remained" in care (reference, n = 554, 71.3%), (2) group 2 exited care then "returned" after [median (interquartile range)] 4 (3-9) months (n = 40, 5.2%), (3) group 3 "exited care rapidly" [after 4 (4-6) months, n = 98, 12.6%], and (4) group 4 "exited care later" [after 11 (9-13) months, n = 85, 10.9%]. Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young (<29 years), without a regular partner, and to have a CD4 count >350 cells/mm(3). Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged 39 years or younger. Conclusions: High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed patients with HIV are needed to maximize RIC.
%$ 056 ; 052