Julien Aimée, Bashingwa Jean Juste Harrisson, Van Rie Annelies, Dufour Mi-Suk Kang, Masilela Nkosinathi, West Rebecca L, Rebombo Dumisani, Gómez-Olivé Francesc Xavier, Kahn Kathleen, Lippman Sheri A, Pettifor Audrey, Kabudula Chodziwadziwa Whiteson
Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Glob Health. 2025 Jul 1;15:04187. doi: 10.7189/jogh.15.04187.
BACKGROUND: Successful retention in care of people living with HIV remains a challenge and a cornerstone of ending the epidemic. A better understanding of retention predictors could guide an evidence-based approach to target interventions. We sought to characterise HIV care retention trajectories among individuals receiving antiretroviral therapy (ART) in a rural South Africa setting, and to determine factors associated with those trajectories. METHODS: We conducted a population-based cohort study of individuals receiving ART in ten health care facilities within the Agincourt Health and Socio-Demographic Surveillance System site in Mpumalanga, South Africa, in 2015-18. We used group-based trajectory modelling to identify clusters of individuals with similar retention trajectories and assessed the association between socio-demographic factors and trajectory groups using multinomial logistic regression. RESULTS: Among 1689 individuals receiving ART during the study period, five distinct trajectory groups were identified: 30.8% had gradually decreasing retention over time, 10.2% had late increasing retention, 20.7% had early increasing retention, 7.8% had early decreasing retention, and 30.5% had consistently high retention. Individuals in the consistently high retention group were more likely to be female and aged ≥40 years. In contrast, those in the early decreasing retention group were more likely to be male, aged <30 years, and with temporary resident status. Individuals in the early increasing retention group were more likely to be from villages included in a HIV Treatment as Prevention community mobilisation study. Education, marital status, and socioeconomic status were not significantly associated with group membership. Months on ART were weakly associated with group membership. CONCLUSIONS: Five distinct retention trajectories were observed and associated with specific sociodemographic factors. Our study offers a data-driven approach to inform the design of targeted interventions to improve HIV care retention. Interventions and policies addressing socioeconomic and system-level factors are essential to achieving better outcomes in high-burden areas.
背景：成功使艾滋病毒感染者持续接受治疗仍然是一项挑战，也是终结该流行病的基石。更好地了解治疗留存率的预测因素可为基于证据的针对性干预措施提供指导。我们试图描述南非农村地区接受抗逆转录病毒疗法（ART）的个体的艾滋病毒治疗留存轨迹，并确定与这些轨迹相关的因素。 方法：2015年至2018年，我们在南非姆普马兰加省阿金库尔健康与社会人口监测系统站点内的10个医疗机构中，对接受抗逆转录病毒疗法的个体进行了一项基于人群的队列研究。我们使用基于群体的轨迹模型来识别具有相似留存轨迹的个体集群，并使用多项逻辑回归评估社会人口因素与轨迹组之间的关联。 结果：在研究期间接受抗逆转录病毒疗法的1689名个体中，确定了五个不同的轨迹组：30.8%的个体随着时间推移留存率逐渐下降，10.2%的个体留存率后期上升，20.7%的个体留存率早期上升，7.8%的个体留存率早期下降，30.5%的个体留存率一直很高。留存率一直很高的组中的个体更可能为女性且年龄≥40岁。相比之下，留存率早期下降组中的个体更可能为男性，年龄<30岁，且具有临时居民身份。留存率早期上升组中的个体更可能来自“治疗即预防”社区动员研究中的村庄。教育程度、婚姻状况和社会经济地位与所属轨迹组无显著关联。接受抗逆转录病毒疗法的月数与所属轨迹组的关联较弱。 结论：观察到五个不同的留存轨迹，并与特定的社会人口因素相关。我们的研究提供了一种数据驱动的方法，为设计针对性干预措施以提高艾滋病毒治疗留存率提供信息。解决社会经济和系统层面因素的干预措施和政策对于在高负担地区取得更好的成果至关重要。
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