Gosset A., Protopopescu C., Larmarange Joseph, Orne-Gliemann J., McGrath N., Pillay D., Dabis F., Iwuji C., Boyer S. (2019). Retention in care trajectories of HIV-positive individuals participating in a universal test-and-treat program in rural South Africa (ANRS 12249 TasP Trial). JAIDS.Journal of Acquired Immune Deficiency Syndromes, 80 (4), p. 375-385. ISSN 1525-4135.
Titre du document
Retention in care trajectories of HIV-positive individuals participating in a universal test-and-treat program in rural South Africa (ANRS 12249 TasP Trial)
Année de publication
Gosset A., Protopopescu C., Larmarange Joseph, Orne-Gliemann J., McGrath N., Pillay D., Dabis F., Iwuji C., Boyer S.
JAIDS.Journal of Acquired Immune Deficiency Syndromes, 2019,
80 (4), p. 375-385 ISSN 1525-4135
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.
Plan de classement
Entomologie médicale / Parasitologie / Virologie 
Santé : aspects socioculturels, économiques et politiques 
AFRIQUE DU SUD
Fonds IRD [F B010076589]