Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial)

PLoS One. 2023 Jan 20;18(1):e0280479. doi: 10.1371/journal.pone.0280479. eCollection 2023.

Abstract

Background: Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa.

Methods: In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012-2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to "re-refer" people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up.

Results: Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47-2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07-7.48).

Conclusions: Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-HIV Agents* / therapeutic use
  • Female
  • HIV Infections* / diagnosis
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • HIV Testing
  • Humans
  • Male
  • Referral and Consultation
  • Rural Population
  • South Africa / epidemiology

Substances

  • Anti-HIV Agents

Grants and funding

The ANRS 12249 TasP trial was funded by the French National Agency for AIDS and Viral Hepatitis Research (ANRS; grant number, 2011-375), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ; grant number, 81151938), and the Bill & Melinda Gates Foundation through the 3ie Initiative. This trial was done with the support of Merck and Gilead Sciences, which provided the Atripla drug supply. The Africa Health Research Institute (previously Africa Centre for Population Health, University of KwaZulu-Natal, South Africa) receives core funding from the Wellcome Trust, which provides the platform for population-based and clinic-based research at the centre. Mélanie Plazy was supported by the French Charity Sidaction. NMcG is a recipient of an NIHR Research Professorship award (Ref: RP-2017-08-ST2-008).