Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa.
| Title: | Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa. |
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| Authors: | Jacob Bor, Matthew P Fox, Sydney Rosen, Atheendar Venkataramani, Frank Tanser, Deenan Pillay, Till Bärnighausen |
| Source: | PLoS Medicine, Vol 14, Iss 11, p e1002463 (2017) |
| Publisher Information: | Public Library of Science (PLoS), 2017. |
| Publication Year: | 2017 |
| Collection: | LCC:Medicine |
| Subject Terms: | Medicine |
| More Details: | BACKGROUND:Loss to follow-up is high among HIV patients not yet receiving antiretroviral therapy (ART). Clinical trials have demonstrated the clinical efficacy of early ART; however, these trials may miss an important real-world consequence of providing ART at diagnosis: its impact on retention in care. METHODS AND FINDINGS:We examined the effect of immediate (versus deferred) ART on retention in care using a regression discontinuity design. The analysis included all patients (N = 11,306) entering clinical HIV care with a first CD4 count between 12 August 2011 and 31 December 2012 in a public-sector HIV care and treatment program in rural South Africa. Patients were assigned to immediate versus deferred ART eligibility, as determined by a CD4 count < 350 cells/μl, per South African national guidelines. Patients referred to pre-ART care were instructed to return every 6 months for CD4 monitoring. Patients initiated on ART were instructed to return at 6 and 12 months post-initiation and annually thereafter for CD4 and viral load monitoring. We assessed retention in HIV care at 12 months, as measured by the presence of a clinic visit, lab test, or ART initiation 6 to 18 months after initial CD4 test. Differences in retention between patients presenting with CD4 counts just above versus just below the 350-cells/μl threshold were estimated using local linear regression models with a data-driven bandwidth and with the algorithm for selecting the bandwidth chosen ex ante. Among patients with CD4 counts close to the 350-cells/μl threshold, having an ART-eligible CD4 count ( |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 1549-1277 1549-1676 |
| Relation: | http://europepmc.org/articles/PMC5705070?pdf=render; https://doaj.org/toc/1549-1277; https://doaj.org/toc/1549-1676 |
| DOI: | 10.1371/journal.pmed.1002463 |
| Access URL: | https://doaj.org/article/2568fd8fed8642ddb8b1c6e585efec39 |
| Accession Number: | edsdoj.2568fd8fed8642ddb8b1c6e585efec39 |
| Database: | Directory of Open Access Journals |
| ISSN: | 15491277 15491676 |
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| DOI: | 10.1371/journal.pmed.1002463 |
| Published in: | PLoS Medicine |
| Language: | English |