Retention in care among HIV-positive clients on anti-retroviral therapy who inject drugs in three South African districts
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Date
2024
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Publisher
University of the Western Cape
Abstract
Background: South Africa is part of numerous trade routes for illicit drugs and this has led to increased drug trafficking over the years. Furthermore, South Africa also has the highest prevalence of human immunodeficiency virus (HIV) globally. People who inject drugs (PWID) are identified as a key population in the fight against the HIV pandemic. It is well noted that PWID report poor adherence and low retention in care on anti-retroviral therapy (ART). Optimal adherence to ART and remaining engaged in care are critical for people living with HIV to achieve viral suppression. The current study aimed to determine retention in care and its risk factors among PWID initiated on ART in three South African district municipalities. Methodology: A retrospective cohort study was conducted with 333 PWID, aged 18 years and older, who were initiated on ART between July 2022 and March 2023 in three district municipalities. Routine health data and opioid substitution therapy (OST) data were extracted from Tier.net database for each participant. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 28. Survival analysis was conducted using Stata 15. Cox proportional hazard model was used to determine factors associated with retention in care. Results: Retention in care for PWID after six months on ART was low at 40% (n=132). In the bivariate analysis, duration on ART (p<0.001*), baseline CD4 count (p=0.0002*), and treatment support (p<0.001*) for those on OST were all significantly associated with retention in care. From the Cox proportional analysis, only housing and enrolment in OST were predictors of loss to follow-up. The probability of loss to follow-up increased with unstable housing (Adjusted Hazards Ratio (AHR) = 4.94; CI: 2.35–10.35) and was significantly lower among those enrolled in OST (AHR = 0.25; CI: 0.10–0.60).
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Keywords
AIDS, Anti-retroviral therapy, HIV, Opioid substitution therapy, Viral suppression