Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i1.810Keywords:
PEPFAR, HIV, retention, South AfricaAbstract
Background. Research on the impact of the US President’s Emergency Plan for AIDS Relief (PEPFAR) transition in South Africa (SA) in 2012 found varying results in retention in care (RIC) of people living with HIV (PLWH).
Objectives. To investigate the factors that impacted RIC during the PEPFAR transition in Western Cape Province, SA, in 2012.
Methods. We used aggregate data from 61 facilities supported by four non-governmental organisations from 2007 to 2015. The main outcome was RIC 12 months after antiretroviral therapy initiation for two periods – during PEPFAR and post PEPFAR. We used adjusted quantile regression to estimate the effect of the PEPFAR pull-out on RIC.
Results. Regression models (50th quantile) for 12-month RIC showed a 4.0% (95% CI –7.7 - –0.4%) decline in RIC post-direct service. Facilities supported by Anova/Kheth’impilo fared worst post PEFPAR, with a decline in RIC of –4.9% (95% CI –8.8 - –1.0%), while TB, HIV/AIDS, Treatment Support, and Integrated Therapy (that’sit) fared best (3.6% increase in RIC; 95% CI: –0.2 - 7.3%). There was a decrease in RIC when comparing urban with rural areas (–7.8%; 95% CI –12.8 - –2.9%). City of Cape Town combined with Western Cape Government health facilities showed a substantial decrease (–6.1%; 95% CI –10.6 - –1.7%), while community health clinic (v. central day clinics) declined (–6.4; 95% CI –10.6 - –2.1%) in RIC. We observed no RIC difference by facility size and a slight increase when two or more human resources transitioned from PEPFAR to the government.
Conclusion. When PEPFAR funding decreased in 2012, there was a decrease in RIC. To ensure the continuity of HIV care when a major funder withdraws sufficient and stable transition resources, investment in organisations that understand the local context, joint planning and co-ordination are required.
References
Institute of Medicine. PEPFAR evaluation. The National Academies Press, 2013. https://nap. nationalacademies.org/catalog/18256/evaluation-of-pepfar (accessed 7 September 2016).
amfAR. PEPFAR Country/Regional Operational Plans (COPs/ROPs) Database. https://copsdata. amfar.org/ (accessed 3 July 2016).
Wools-Kaloustian K, Kimaiyo S, Musick B, et al. The impact of the President’s Emergency Plan for AIDS Relief on expansion of HIV care services for adult patients in western Kenya. AIDS 2009;23(2):195- 201. https://doi.org/10.1097/QAD.0b013e32831cc0e6
Bendavid E, Bhattacharya J. The President’s Emergency Plan for AIDS Relief in Africa: an evaluation of outcomes. Ann Intern Med 2009;150(10):688-695. https://doi.org/10.7326/0003-4819-150-10- 200905190-00117
Bendavid E, Holmes CB, Bhattacharya J, Miller G. HIV development assistance and adult mortality in Africa. JAMA 2012;307(19):2060-2067. https://doi.org/10.1001/jama.2012.2001
Joint United Nations Programme on HIV and AIDS. South Africa Country Facts. UNAIDS, 2019. https://www.unaids.org/en/regionscountries/countries/southafrica (accessed 22 April 2021).
Health Systems Trust. District Health Barometer 2017/18: Section 11. HST: Westville, 2019. https:// www.hst.org.za/publications/Pages/DHB20172018.aspx (accessed 4 June 2019).
Kavanagh MM. The politics of transition & the economics of HIV-AIDS & PEPFAR in South Africa. Health-e, 2014. http://www.health-e.org.za/wp-content/uploads/2014/01/Politics-of-Transition-Report- AIDS-South-Africa.pdf (accessed 5 July 2016).
Katz IT, Bassett IV, Wright AA. PEPFAR in transition – implications for HIV care in South Africa. N Engl J Med 2013;369(15):1385-1387. https://doi.org/10.1056/NEJMp1310982
Kavanagh MM. The politics and epidemiology of transition: PEPFAR and AIDS in South Africa. J Acquir Immune Defic Syndr 2014;65(3):247-250. http://europepmc.org/abstract/MED/24346642 (accessed 6 December 2023).
Simelela NP, Venter WD. A brief history of South Africa’s response to AIDS. S Afr Med J 2014;104(3 Suppl 1):S249-S251. https://doi.org/10.7196/samj.7700
Brundage S. Terra Nova: How to achieve a successful PEPFAR transition in South Africa. A Report of the CSIS Global Health Policy Center. Center for Strategic and International Studies. A Report of the CSIS Global Health Policy Center. Center for Strategic and International Studies, March 2013. https:// www.hst.org.za/publications/NonHST%20Publications/130313_Morrison_SouthAfricaHIV_Web.pdf (accessed 21 July 2018).
President’s Emergency Plan for AIDS Relief. Partnership framework implementation plan in support of South Africa’s National HIV, STI & TB response between the Government of the Republic of South Africa and the Government of the United States of America. PEPFAR, 2012. https://www.state.gov/ countries-areas/south-africa/ (accessed 18 October 2016).
Cloete C, Regan S, Giddy J, Govender T, et al. The linkage outcomes of a large-scale, rapid transfer of HIV-infected patients from hospital-based to community-based clinics in South Africa. Open Forum Infect Dis 2014;1(2):ofu058. https://doi.org/10.1093/ofid/ofu058
President’s Emergency Plan for AIDS Relief. Country operational plan strategic direction summary. PEPFAR, 2015. https://www.state.gov/countries-areas/south-africa/ (accessed 30 November 2017).
Chiliza J. Life after PEPFAR’s direct service support: Program sustainability among South African HIV/ AIDS organizations funded by PEPFAR. https://hdl.handle.net/2144/39529 (accessed 6 December 2023). 17. Katz IT, Bogart LM, Cloete C, Crankshaw TL, et al. Understanding HIV-infected patients’ experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal, South Africa:
A qualitative study. AIDS Care 2015;27(10):1298-1303. https://doi.org/10.1080/09540121.2015.1051502 18. Lince-Deroche N, Leuner R, Meyer-Rath G, Pillay Y, Long L. When donor funding leaves: An interrupted time-series analysis of the impact of integrating direct HIV care and treatment into public health services in a region of Johannesburg. Cost Eff Resour Alloc 2019;17:24. https://10.1186/s12962-
-0192-5
Fox MP, Rosen S. Retention of adult patients on antiretroviral therapy in low- and middle- income countries: Systematic review and meta-analysis 2008-2013. J Acquir Immune Defic Syndr 2015;69(1):98-108. https://doi.org/10.1097/QAI.0000000000000553
Fox MP, Bor J, Brennan AT, MacLeod WB, Maskew M, Stevens WS, Carmona S. Correction: Estimating retention in HIV care accounting for patient transfers: A national laboratory cohort study in South Africa. PLoS Med 2018;15(8):e1002643. https://doi.org/10.1371/journal.pmed.1002643. Erratum for: PLoS Med 2018;15(6):e1002589.
University of Washington. Paper health registers project case study: South Africa’s 3-tiered antiretroviral treatment monitoring system country profile. www.Tech-21.org, 2014. http://uwstartcenter.org/wp- content/uploads/2015/12/START_43_HR_SouthAfricaCaseStudy_FINAL_2014-06-05.pdf(accessed 8 July 2016).
Fox MP, Brennan A, Maskew M, MacPhail P, Sanne I. Using vital registration data to update mortality among patients lost to follow-up from ART programmes: Evidence from the Themba Lethu Clinic, South Africa. Trop Med Int Health 2010;15(4):405-413. https://doi.org/10.1111/j.1365- 3156.2010.02473.x
National Department of Health, South Africa. The South African Antiretroviral Treatment Guidelines 2010. Pretoria: South African National AIDS Council, 2010. https://sahivsoc.org/Files/Summary_ The_South_African_Antiretroviral_Treatment_2010.pdf (accessed 1 September 2016).
Nglazi MD, Lawn SD, Kaplan R, et al. Changes in programmatic outcomes during 7 years of scale-up at a community-based antiretroviral treatment service in South Africa. J Acquir Immune Defic Syndr 2011;56(1):e1-8. https://doi.org/10.1097/QAI.0b013e3181ff0bdc
Chiliza J, Laing R, Feeley FG III, Borba CPC. Program sustainability post PEPFAR direct service support in the Western Cape, South Africa. PLoS One 2021;16(5):e0251230. https://doi.org/10.1371/ journal.pone.0251230
Gilson L, Pienaar D, Brady L, et al. Development of the health system in the Western Cape: Experiences since 1994. S Afr Health Rev 2017;2017:59-69. https://www.hst.org.za/publications/South%20 African%20Health%20Reviews/6_Development%20of%20the%20health%20system%20in%20 the%20Western%20Cape_experiences%20since%201994.pdf (accessed 6 December 2023).
Julien A, Anthierens S, Van Rie A, et al. Health care providers’ challenges to high-quality HIV care and antiretroviral treatment retention in rural South Africa. Qual Health Res 2021;31(4):722-735. https:// doi.org/10.1177/1049732320983270
Johnson L, Dorrington RE, Moolla H. HIV epidemic drivers in South Africa: A model-based evaluation of factors accounting for inter-provincial differences in HIV prevalence and incidence trends. South Afr J HIV Med 2017;18(1):695. https://doi.org/10.4102/sajhivmed.v18i1.695
Bengtson A, Colvin C, Kirwa K, Cornell M, Lurie MN. Estimating retention in HIV care accounting for clinic transfers using electronic medical records: Evidence from a large antiretroviral treatment programme in the Western Cape, South Africa. Trop Med Int Health 2020;5(8):936-943. https://doi. org/10.1111/tmi.13412
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