Mutyambizi Chipo, Rees Kate, Grimsrud Anna, Ndou Rendani, Wilkinson Lynne S
Anova Health Institute, Johannesburg, South Africa.
Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2024 Dec;27(12):e26395. doi: 10.1002/jia2.26395.
Disengagement and re-engagement with antiretroviral therapy (ART) are common in South Africa, but routine monitoring is insufficient to inform policy development. To address this gap, Anova implemented the 2020 National Adherence Guidelines' re-engagement standard operating procedure (re-engagement SOP) and collected additional data to describe the characteristics of re-engagement visits to inform HIV programmes.
Between July and December 2022, we conducted a study at nine primary healthcare facilities in Johannesburg. Staff were trained on the re-engagement SOP and provided with job aides to support implementation. Administration clerks categorized visits based on the time elapsed since the missed appointment: ≤14days and >14 days, with the latter identified as re-engaging. For these clients, clinicians filled out "re-engagement clinical assessment forms" that included visit dates, both clinician-assessed and self-reported treatment interruptions, and clinical details. Data on missed appointments and previous viral loads were extracted from medical records. The information was entered into REDCap. We present data from three out of the nine facilities, selected for their comprehensive data collection and high coverage of all re-engaging clients.
A total of 2342 clients returned following a missed scheduled appointment. The majority, 1523 (65%), missed their appointments by ≤ 14 days, while 819 (35%) were >14 days late (re-engaging). Among those re-engaging, 635 (78%) re-engagement clinical assessment forms were completed. A missed appointment date was available for 623 with 25% (n = 161) returning 2-4 weeks late, 47% (n = 298) 4-12 weeks and 26% (n = 164) >12 weeks late. Self-reported ART interruption, available for 89% (567/635), indicated the majority (54%, n = 304) experienced no interruption. Clinical concerns were identified in 65 (10%) cases. A majority (79%, 504/635) had prior viral load results, with 73% (370/504) below 50 copies/ml.
Clients frequently return to care shortly after missed appointments. Despite missing scheduled ART refill dates, many report not interrupting treatment, either having treatment on hand or sourcing ART elsewhere. Most re-engaging clients were adherent prior to disengagement, and clinical concerns are rare. A differentiated service delivery approach, prioritizing flexibility and reduced healthcare burden, is required to support client's needs and preferences at re-engagement.
在南非，抗逆转录病毒疗法（ART）的脱失和重新参与治疗的情况很常见，但常规监测不足以指导政策制定。为了填补这一空白，阿诺瓦实施了2020年国家依从性指南的重新参与治疗标准操作程序（重新参与治疗SOP），并收集了额外数据以描述重新参与治疗访视的特征，为艾滋病项目提供参考。
2022年7月至12月期间，我们在约翰内斯堡的九个初级医疗保健机构开展了一项研究。工作人员接受了重新参与治疗SOP的培训，并配备了工作辅助工具以支持实施。行政文员根据错过预约后的时间对访视进行分类：≤14天和>14天，后者被确定为重新参与治疗。对于这些客户，临床医生填写了“重新参与治疗临床评估表”，其中包括访视日期、临床医生评估和自我报告的治疗中断情况以及临床细节。错过预约和之前病毒载量的数据从病历中提取。信息录入REDCap。我们展示了九个机构中三个机构的数据，这些机构因其全面的数据收集和对所有重新参与治疗的客户的高覆盖率而被选中。
共有2342名客户在错过预约后返回。大多数人，即1523名（65%），错过预约的时间≤14天，而819名（35%）迟到超过14天（重新参与治疗）。在那些重新参与治疗的客户中，635份（78%）重新参与治疗临床评估表被填写。623名客户有错过的预约日期，其中25%（n = 161）在2 - 4周后返回，47%（n = 298）在4 - 12周后返回，26%（n = 164）在超过12周后返回。89%（567/635）的客户有自我报告的抗逆转录病毒疗法中断情况，表明大多数（54%，n = 304）没有经历中断。65例（10%）发现有临床问题。大多数（79%，504/635）有之前的病毒载量结果，其中73%（370/504）低于50拷贝/毫升。
客户在错过预约后不久经常会重新接受治疗。尽管错过了抗逆转录病毒疗法的预定补充日期，但许多人报告没有中断治疗，要么手头有治疗药物，要么在其他地方获取了抗逆转录病毒疗法药物。大多数重新参与治疗的客户在脱失之前是依从的，并且临床问题很少见。需要一种差异化的服务提供方式，优先考虑灵活性并减轻医疗负担，以支持客户在重新参与治疗时的需求和偏好。
