Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
BMC Health Serv Res. 2022 Dec 26;22(1):1584. doi: 10.1186/s12913-022-08962-8.
Continuity of care is an attribute of high-quality health systems and a necessary component of chronic disease management. Assessment of health information systems for HIV care in South Africa has identified substantial rates of clinic transfer, much of it undocumented. Understanding the reasons for changing sources of care and the implications for patient outcomes is important in informing policy responses.
In this secondary analysis of the 2014 - 2016 I-Care trial, we examined self-reported changes in source of HIV care among a cohort of individuals living with HIV and in care in North West Province, South Africa. Individuals were enrolled in the study within 1 year of diagnosis; participants completed surveys at 6 and 12 months including items on sources of care. Clinical data were extracted from records at participants' original clinic for 12 months following enrollment. We assessed frequency and reason for changing clinics and compared the demographics and care outcomes of those changing and not changing source of care.
Six hundred seventy-five (89.8%) of 752 study participants completed follow-up surveys with information on sources of HIV care; 101 (15%) reported receiving care at a different facility by month 12 of follow-up. The primary reason for changing was mobility (N=78, 77%). Those who changed clinics were more likely to be young adults, non-citizens, and pregnant at time of diagnosis. Self-reported clinic attendance and ART adherence did not differ based on changing clinics. Those on ART not changing clinics reported 0.66 visits more on average than were documented in clinic records.
At least 1 in 6 participants in HIV care changed clinics within 2 years of diagnosis, mainly driven by mobility; while most appeared lost to follow-up based on records from the original clinic, self-reported visits and adherence were equivalent to those not changing clinics. Routine clinic visits could incorporate questions about care at other locations as well as potential relocation, particularly for younger, pregnant, and non-citizen patients, to support existing efforts to make HIV care records portable and facilitate continuity of care across clinics.
The original trial was registered with ClinicalTrials.gov , NCT02417233, on 12 December 2014.
连续性护理是高质量卫生系统的一个属性，也是慢性病管理的必要组成部分。对南非艾滋病毒护理卫生信息系统的评估发现，大量患者转至其他诊所治疗，其中许多情况并未记录在案。了解改变护理来源的原因及其对患者预后的影响，对于制定政策应对措施具有重要意义。
在对 2014 年至 2016 年 I-Care 试验的二次分析中，我们检查了居住在南非西北省并接受艾滋病毒护理的患者队列中自我报告的艾滋病毒护理来源变化。在诊断后 1 年内，参与者入组本研究；参与者在 6 个月和 12 个月时完成了包括护理来源项目的调查。从参与者原始诊所的记录中提取了入组后 12 个月的临床数据。我们评估了转至其他诊所的频率和原因，并比较了改变和未改变护理来源的参与者的人口统计学和护理结果。
在 752 名研究参与者中，有 675 名（89.8%）完成了包含艾滋病毒护理来源信息的随访调查；在随访的第 12 个月，有 101 名（15%）报告在不同的机构接受护理。改变的主要原因是流动性（N=78，77%）。与未改变诊所的参与者相比，改变诊所的参与者更年轻、非公民和在诊断时怀孕。自我报告的就诊率和抗逆转录病毒治疗（ART）依从性与改变诊所无差异。未改变诊所的接受 ART 治疗的参与者报告的就诊次数平均比诊所记录多 0.66 次。
在诊断后 2 年内，至少有 1/6 的艾滋病毒护理参与者转至其他诊所，主要原因是流动性；尽管根据原始诊所的记录，大多数人似乎已失访，但自我报告的就诊次数和依从性与未改变诊所的参与者相当。常规诊所就诊时可以询问患者在其他地点的护理情况以及潜在的搬迁情况，特别是对于年轻、怀孕和非公民患者，这有助于实现使艾滋病毒护理记录便携化并促进诊所间连续性护理的现有努力。
原始试验于 2014 年 12 月 12 日在 ClinicalTrials.gov 注册，编号为 NCT02417233。
