Title
Integration of HIV care into primary care in South Africa : effect on survival of patients needing antiretroviral treatment Integration of HIV care into primary care in South Africa : effect on survival of patients needing antiretroviral treatment
Author
Faculty/Department
Faculty of Social Sciences. Sociology
Publication type
article
Publication
Philadelphia, Pa ,
Subject
Human medicine
Source (journal)
JAIDS. - Philadelphia, Pa
Volume/pages
63(2013) :3 , p. 94-100
ISSN
1525-4135
ISI
000330448700002
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Background: Integration of HIV care into primary care is a potential strategy to improve access to antiretroviral therapy (ART) in high-burden countries. This study was conducted to determine the effect of integration of HIV care on the survival of patients needing ART. Methods: A questionnaire was used to measure the integration of HIV care into primary care during a randomized controlled trial of task shifting and decentralization of HIV care in South Africa. Cox proportional hazard ratios (HRs) were estimated for the effect of 5 different integration scores (total, pre-ART, ART, mainstreaming HIV, and internal integration) on the survival of patients with CD4 count <= 350 cells per microliter and not yet on ART. Results: A total of 9252 patients were followed up for 12-18 months. Cox proportional HRs adjusted for patient and clinic characteristics showed decreased risk of mortality in clinics with high scores for total integration [HR, 0.97; 95% confidence interval (CI), 0.95 to 0.98; P < 0.001], ART integration (HR, 0.94; 95% CI, 0.90 to 0.99; P = 0.013), and internal integration (HR, 0.97; 95% CI, 0.95 to 1.00; P = 0.041). Analysis of the effect of component scores adjusted for patient characteristics only showed decreased risk of mortality in clinics with high scores for total integration (HR, 0.97; 95% CI, 0.94 to 1.00; P = 0.032), pre-ART integration (HR, 0.92; 95% CI, 0.85 to 0.99; P = 0.027), ART integration (HR, 0.95; 95% CI, 0.93 to 0.98; P = 0.001), and mainstreaming HIV (HR, 0.90; 95% CI, 0.83 to 0.97; P = 0.007). Conclusion: In a context of task shifting and decentralization of care, integration of HIV care into primary care is associated with improved survival of HIV-positive patients needing ART.
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