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. 2014 Aug 12;1(2):ofu058.
doi: 10.1093/ofid/ofu058. eCollection 2014 Sep.

The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa

Christie Cloete  1 , Susan Regan  2 , Janet Giddy  1 , Tessa Govender  1 , Alison Erlwanger  2 , Melanie R Gaynes  2 , Kenneth A Freedberg  3 , Jeffrey N Katz  4 , Rochelle P Walensky  5 , Elena Losina  6 , Ingrid V Bassett  7
Affiliations

The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa

Christie Cloete et al. Open Forum Infect Dis. .

Abstract

Background: President's Emergency Plan for AIDS Relief (PEPFAR) funding changes have resulted in human immunodeficiency virus (HIV) clinic closures. We evaluated linkage to care following a large-scale patient transfer from a PEPFAR-funded, hospital-based HIV clinic to government-funded, community-based clinics in Durban.

Methods: All adults were transferred between March and June 2012. Subjects were surveyed 5-10 months post-transfer to assess self-reported linkage to the target clinic. We validated self-reports by auditing records at 8 clinics. Overall success of transfer was estimated using linkage to care data for both reached and unreached subjects, adjusted for validation results.

Results: Of the 3913 transferred patients, 756 (19%) were assigned to validation clinics; 659 (87%) of those patients were reached. Among those reached, 468 (71%) had a validated clinic record visit. Of the 46 who self-reported attending a different validation clinic than originally assigned, 39 (85%) had a validated visit. Of the 97 patients not reached, 59 (61%) had a validated visit at their assigned clinic. Based on the validation rates for reached and unreached patients, the estimated success of transfer for the cohort overall was 82%.

Conclusions: Most patients reported successful transfer to a community-based clinic, though a quarter attended a different clinic than assigned. Validation of attendance highlights that nearly 20% of patients may not have linked to care and may have experienced a treatment interruption. Optimizing transfers of HIV care to community sites requires collaboration with receiving clinics to ensure successful linkage to care.

Keywords: PEPFAR; South Africa; community-based clinics; linkage to care; transfer of HIV care.

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Figures

Fig. 1.
Fig. 1.
Map showing the location of transfer clinics within 40 km of McCord Hospital, Durban, South Africa, and the relative number of people transferred to that clinic (indicated by purple circle size). The inset includes points (red circles) for all transfer clinics and their geographic distribution. Clinics depicted are those with street addresses for which GPS coordinates could be generated. Abbreviation: GPS, global positioning system.
Fig. 2.
Fig. 2.
Schematic of patient transfers and clinic attendance. (A) Patients eligible for transfer who had a visit and were reached after transfer. (B) Self-reported outcomes for reached patients.
Fig. 3.
Fig. 3.
Number and proportion of patients reached and unreached by phone following transfer, including only the 756 patients assigned to the validation clinics. Patients are further delineated by whether they were found in the clinic record at the validation clinic, were not found in the record, or reported going elsewhere.
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