Chiliza Jessica, Brennan Alana T, Laing Richard, Feeley Frank Goodrich
Department of Global Health, School of Public Health, Boston University, Massachusetts, Boston, USA.
School of Public Health, University of Western Cape, Bellville, South Africa.
medRxiv. 2023 Apr 14:2023.01.20.23284819. doi: 10.1101/2023.01.20.23284819.
Research on the impact of the PEPFAR transition in South Africa (SA) in 2012 found varying results in retention in care (RIC) of people living with HIV (PLWH).
We investigated the factors that impacted RIC during the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) transition in Western Cape, South Africa in 2012.
We used aggregate data from 61 facilities supported by four non-governmental organizations from to 2007-2015. The main outcome was RIC at 12-months after antiretroviral therapy initiation for two time periods. We used quantile regression to estimate the effect of the PEPFAR pull-out and other predictors on RIC. The models were adjusted for various covariates.
Regression models (50 quantile) for 12-month RIC showed a 4.6% (95%CI: -8.4, -0.8%) decline in RIC post direct service. Facilities supported by Anova/Kheth'impilo fared worst post PEFPAR; a decline in RIC of (-5.8%; 95% CI: -9.7, -1.8%), while that'sit fared best (6.3% increase in RIC; 95% CI:2.5,10.1%). There was a decrease in RIC when comparing urban to rural areas (-5.8%; 95% CI: -10.1, -1.5%). City of Cape town combined with Western Cape Government Health facilities showed a substantial decrease (-9.1%; 95% CI: -12.3, -5.9%), while community health clinic (vs. primary health clinic) declined slightly (-4.4; 95% CI: -9.6, 0.9%) in RIC. We observed no RIC difference by facility size and a slight increase when two or more human resources transitioned from PEPFAR to the government.
When PEPFAR funding decreased in 2012, there was a decrease in RIC. To ensure the continuity of HIV care when a major funder withdraws sufficient and stable transition resources, investment in organizations that understand the local context, joint planning, and coordination are required.
2012年关于南非总统防治艾滋病紧急救援计划（PEPFAR）过渡影响的研究发现，艾滋病毒感染者（PLWH）的治疗留存率（RIC）结果各异。
我们调查了2012年南非西开普省在美国总统防治艾滋病紧急救援计划（PEPFAR）过渡期间影响治疗留存率的因素。
我们使用了来自四个非政府组织在2007年至2015年期间支持的61个机构的汇总数据。主要结果是两个时间段内抗逆转录病毒治疗开始后12个月的治疗留存率。我们使用分位数回归来估计PEPFAR撤出及其他预测因素对治疗留存率的影响。模型针对各种协变量进行了调整。
12个月治疗留存率的回归模型（第50分位数）显示，直接服务后治疗留存率下降了4.6%（95%置信区间：-8.4，-0.8%）。由Anova/Kheth'impilo支持的机构在PEPFAR之后情况最差；治疗留存率下降了（-5.8%；95%置信区间：-9.7，-1.8%），而that'sit表现最佳（治疗留存率增加6.3%；95%置信区间：2.5，10.1%）。与农村地区相比，城市地区的治疗留存率有所下降（-5.8%；95%置信区间：-10.1，-1.5%）。开普敦市与西开普省政府卫生设施相结合显示出大幅下降（-9.1%；95%置信区间：-12.3，-5.9%），而社区卫生诊所（与初级卫生诊所相比）的治疗留存率略有下降（-4.4；95%置信区间：-9.6，0.9%）。我们观察到机构规模对治疗留存率没有差异，并且当两个或更多人力资源从PEPFAR过渡到政府时，治疗留存率略有增加。
2012年PEPFAR资金减少时，治疗留存率下降。为了在主要资助者撤出时确保艾滋病毒治疗的连续性，需要有足够和稳定的过渡资源，对了解当地情况的组织进行投资、联合规划和协调。
