Department of Global Health, School of Public Health, Boston University, USA.
Department of Global Health, School of Public Health, Boston University, USA; School of Public Health, University of the Western Cape, Cape Town, South Africa.
S Afr Med J. 2023 Dec 31;114(1):44-50. doi: 10.7196/SAMJ.2024.v114i1.810.
Research on the impact of the US President's Emergency Plan for AIDS Relief (PEPFAR) transition in South Africa (SA) in 2012 found varying results in retention in care (RIC) of people living with HIV (PLWH).
To investigate the factors that impacted RIC during the PEPFAR transition in Western Cape Province, SA, in 2012.
We used aggregate data from 61 facilities supported by four non-governmental organisations from 2007 to 2015. The main outcome was RIC 12 months after antiretroviral therapy initiation for two periods - during PEPFAR and post PEPFAR. We used adjusted quantile regression to estimate the effect of the PEPFAR pull-out on RIC.
Regression models (50th quantile) for 12-month RIC showed a 4.0% (95% CI -7.7 - -0.4%) decline in RIC post-direct service. Facilities supported by Anova/Kheth'impilo fared worst post PEFPAR, with a decline in RIC of -4.9% (95% CI -8.8 - -1.0%), while TB, HIV/AIDS, Treatment Support, and Integrated Therapy (that'sit) fared best (3.6% increase in RIC; 95% CI: -0.2 - 7.3%). There was a decrease in RIC when comparing urban with rural areas (-7.8%; 95% CI -12.8 - -2.9%). City of Cape Town combined with Western Cape Government health facilities showed a substantial decrease (-6.1%; 95% CI -10.6 - -1.7%), while community health clinic (v. central day clinics) declined (-6.4; 95% CI -10.6 - -2.1%) 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 organisations that understand the local context, joint planning and co-ordination are required.
2012 年，针对美国总统艾滋病紧急救援计划（PEPFAR）在南非（SA）过渡的影响开展的研究发现，艾滋病毒感染者（PLWH）的护理保留率（RIC）存在不同结果。
调查 2012 年南非西开普省 PEPFAR 过渡期间影响 RIC 的因素。
我们使用了 2007 年至 2015 年期间由四个非政府组织支持的 61 个设施的汇总数据。主要结局是抗逆转录病毒治疗开始后 12 个月的 RIC，分为 PEPFAR 期间和 PEPFAR 之后两个时期。我们使用调整后的分位数回归来估计 PEPFAR 撤出对 RIC 的影响。
12 个月 RIC 的回归模型（第 50 分位数）显示，直接服务后 RIC 下降了 4.0%（95%CI-7.7%至-0.4%）。在 PEPFAR 之后，Anova/Kheth'impilo 支持的设施表现最差，RIC 下降了-4.9%（95%CI-8.8%至-1.0%），而结核病、艾滋病毒/艾滋病、治疗支持和综合疗法（即 it）表现最好（RIC 增加 3.6%；95%CI：0.2%至 7.3%）。与农村地区相比，城市地区的 RIC 下降（-7.8%；95%CI-12.8%至-2.9%）。开普敦市与西开普省政府卫生设施相结合的地区显示出显著下降（-6.1%；95%CI-10.6%至-1.7%），而社区卫生诊所（与中央日间诊所相比）的 RIC 下降（-6.4%；95%CI-10.6%至-2.1%）。我们没有观察到设施规模的 RIC 差异，当两个或更多人力资源从 PEPFAR 过渡到政府时，RIC 略有增加。
2012 年 PEPFAR 供资减少时，RIC 下降。当主要供资者撤出充足和稳定的过渡资源时，为确保艾滋病毒护理的连续性，需要对了解当地情况的组织进行投资，进行联合规划和协调。
