PMID- 28225717
OWN - NLM
STAT- MEDLINE
DCOM- 20170612
LR  - 20200930
IS  - 1944-7884 (Electronic)
IS  - 1525-4135 (Print)
IS  - 1525-4135 (Linking)
VI  - 74
IP  - 4
DP  - 2017 Apr 1
TI  - Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care 
      in South Africa.
PG  - 383-389
LID - 10.1097/QAI.0000000000001284 [doi]
AB  - OBJECTIVE: Retention in HIV care, particularly among postpartum women, is a 
      challenge to national antiretroviral therapy programs. Retention estimates may be 
      underestimated because of unreported transfers. We explored mobility and clinic 
      switching among patients considered lost to follow-up (LTFU). DESIGN: 
      Observational cohort study. METHODS: Of 788 women initiating antiretroviral 
      therapy during pregnancy at 6 public clinics in Johannesburg, South Africa, 300 
      (38.1%) were LTFU (no visit >/=3 months). We manually searched for these women in 
      the South African National Health Laboratory Services database to assess 
      continuity of HIV care. We used geographic information system tools to map 
      mobility to new facilities. RESULTS: Over one-third (37.6%) of women showed 
      evidence of continued HIV care after LTFU. Of these, 67.0% continued care in the 
      same province as the origin clinic. Compared with those who traveled outside of 
      the province for care, these same-province "clinic shoppers" stayed out-of-care 
      longer median 373 days [interquartile range (IQR): 175-790] vs. 175.5 days (IQR: 
      74-371) and had a lower CD4 cell count on re-entry [median 327 cells/muL (IQR: 
      196-576) vs. 493 cells/muL (IQR: 213-557). When considering all women with 
      additional evidence of care as engaged in care, cohort LTFU dropped from 38.1% to 
      25.0%. CONCLUSIONS: We found evidence of continued care after LTFU and identified 
      local and national clinic mobility among postpartum women. Laboratory records do 
      not show all clinic visits and manual matching may have been under- or 
      overestimated. A national health database linked to a unique identifier is 
      necessary to improve reporting and patient care among highly mobile populations.
FAU - Clouse, Kate
AU  - Clouse K
AD  - *Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, 
      TN;daggerDivision of Infectious Diseases, Department of Medicine, Vanderbilt 
      University, Nashville, TN;double daggerHealth Economics and Epidemiology Research Office 
      (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of 
      Health Sciences, University of the Witwatersrand, Johannesburg, South 
      Africa; section signDepartment of Pediatrics, Vanderbilt University, Nashville, 
      TN; ||Department of Epidemiology, Brown University School of Public Health, 
      Providence, RI; paragraph signDepartment of Global Health, Boston University, Boston, 
      MA;#Department of Molecular Medicine and Haematology, School of Pathology Faculty 
      of Health Sciences, University of the Witwatersrand South Africa National 
      Laboratory Health Service, Johannesburg, South Africa;**Department of Paediatrics 
      and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 
      Johannesburg, South Africa;daggerdaggerCentre for HIV and STI, National Institute for 
      Communicable Diseases, Johannesburg, South Africa; anddouble daggerdouble daggerDepartment of 
      Epidemiology, Boston University School of Public Health, Boston University, 
      Boston, MA.
FAU - Vermund, Sten H
AU  - Vermund SH
FAU - Maskew, Mhairi
AU  - Maskew M
FAU - Lurie, Mark N
AU  - Lurie MN
FAU - MacLeod, William
AU  - MacLeod W
FAU - Malete, Given
AU  - Malete G
FAU - Carmona, Sergio
AU  - Carmona S
FAU - Sherman, Gayle
AU  - Sherman G
FAU - Fox, Matthew P
AU  - Fox MP
LA  - eng
GR  - K01 MH107256/MH/NIMH NIH HHS/United States
GR  - R01 AI115979/AI/NIAID NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - J Acquir Immune Defic Syndr
JT  - Journal of acquired immune deficiency syndromes (1999)
JID - 100892005
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Ambulatory Care Facilities/*statistics & numerical data
MH  - Anti-HIV Agents/therapeutic use
MH  - CD4 Lymphocyte Count
MH  - *Community Health Services
MH  - *Continuity of Patient Care
MH  - Female
MH  - HIV Infections/blood/*drug therapy/epidemiology
MH  - Humans
MH  - *Lost to Follow-Up
MH  - *Postpartum Period
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/blood/*drug therapy/epidemiology
MH  - South Africa/epidemiology
PMC - PMC5324708
MID - NIHMS839557
COIS- Conflicts of interest: The authors declare no conflicts of interest.
EDAT- 2017/02/23 06:00
MHDA- 2017/06/13 06:00
PMCR- 2018/04/01
CRDT- 2017/02/23 06:00
PHST- 2017/02/23 06:00 [entrez]
PHST- 2017/02/23 06:00 [pubmed]
PHST- 2017/06/13 06:00 [medline]
PHST- 2018/04/01 00:00 [pmc-release]
AID - 00126334-201704010-00006 [pii]
AID - 10.1097/QAI.0000000000001284 [doi]
PST - ppublish
SO  - J Acquir Immune Defic Syndr. 2017 Apr 1;74(4):383-389. doi: 
      10.1097/QAI.0000000000001284.