Background
Methods
Setting and data sources
Demographic surveillance
Point-of-contact interactive record linkage (PIRL)
Record review and patient tracing study
Data preparation and statistical analysis
Seroconversions and ART initiation
Sequence states and outcomes
State | Definition |
---|---|
Unknown HIV | No health facility records of an HIV diagnosis, or ART initiation before the pregnancy or breastfeeding period. |
HIV+ no ART | Following HIV diagnosis, ART not initiated, or ART initiated but without any follow-up visits immediately following ART initiation. |
On ART | At least one health facility visit following the ART initiation visit. Women remained on ART up to their next scheduled visit. |
Late | Between 7 and 90 days late for a scheduled health facility visit following ART initiation. |
LTFU | More than 90 days late for a scheduled health facility visit following ART initiation. |
Deceased | From the date of death extracted from HDSS records. |
Transferred | A record of treatment collection from a health facility within the Agincourt HDSS other than where ART initiation occurred. |
Reengaged | Restarted treatment at the same health facility where ART initiation occurred following LTFU. |
Migration | Out migrated from the HDSS with no evidence of health facility visits following the migration date. |
Factors associated with ART resumption
Results
Population characteristics
Not linked to HIV-related health record (%) | First recorded HIV+ test | Total (%) | ||||
---|---|---|---|---|---|---|
Before conception (%) | During pregnancy (%) | During breastfeeding period (%) | After breastfeeding period (%) | |||
Pregnancies | 9107 (84.8) | 823 (7.7) | 585 (5.4) | 127 (1.2) | 93 (0.9) | 10,735 |
Delivery year | ||||||
2014 | 2248 (83.9) | 154 (5.8) | 156 (5.8) | 53 (2.0) | 67 (2.5) | 2673 |
2015 | 2046 (84.4) | 167 (6.9) | 145 (6.0) | 39 (1.6) | 26 (1.1) | 2423 |
2016 | 1888 (84.6) | 182 (8.2) | 139 (6.2) | 23 (1.0) | 0 (0) | 2232 |
2017 | 1749 (85.7) | 185 (9.1) | 94 (4.6) | 12 (0.6) | 0 (0) | 2040 |
2018 | 1176 (86.3) | 135 (9.9) | 51 (3.7) | 0 (0) | 0 (0) | 1362 |
Age group | ||||||
10–14 | 32 (100.0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 32 |
15–19 | 1663 (95.0) | 20 (1.1) | 33 (1.9) | 18 (1.0) | 17 (1.0) | 1751 |
20–24 | 2517 (89.8) | 96 (3.4) | 132 (4.7) | 32 (1.1) | 27 (1.0) | 2804 |
25–29 | 2244 (84.0) | 185 (6.9) | 184 (6.9) | 34 (1.3) | 24 (0.9) | 2671 |
30–34 | 1517 (78.0) | 244 (12.5) | 141 (7.2) | 26 (1.3) | 17 (0.9) | 1945 |
35–39 | 804 (73.4) | 202 (18.4) | 72 (6.6) | 10 (0.9) | 7 (0.6) | 1095 |
40+ | 330 (75.5) | 76 (17.4) | 23 (5.3) | 7 (1.6) | 1 (0.2) | 437 |
Gravida | ||||||
1 | 6462 (88.9) | 315 (4.3) | 345 (4.7) | 83 (1.1) | 61 (0.8) | 7266 |
2 | 1961 (78.3) | 318 (12.7) | 171 (6.8) | 29 (1.2) | 26 (1.0) | 2505 |
3 | 474 (71.2) | 135 (20.3) | 47 (7.1) | 8 (1.2) | 2 (0.3) | 666 |
4 | 133 (66.5) | 41 (20.5) | 17 (8.5) | 6 (3.0) | 3 (1.5) | 200 |
5 | 45 (71.4) | 11 (17.5) | 5 (7.9) | 1 (1.6) | 1 (1.6) | 63 |
6 | 24 (88.9) | 3 (11.1) | 0 (0) | 0 (0) | 0 (0) | 27 |
7 | 6 (100.0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 6 |
8 | 2 (100.0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 |
Planned pregnancy | ||||||
No | 4170 (85.2) | 357 (7.3) | 258 (5.3) | 65 (1.3) | 44 (0.9) | 4894 |
Yes | 3998 (83.7) | 398 (8.3) | 282 (5.9) | 53 (1.1) | 46 (1.0) | 4777 |
Missing | 939 (88.3) | 68 (6.4) | 45 (4.2) | 9 (0.8) | 3 (0.3) | 1064 |
Education | ||||||
No formal education | 97 (76.4) | 15 (11.8) | 9 (7.1) | 4 (3.1) | 2 (1.6) | 127 |
Primary | 1289 (79.2) | 172 (10.6) | 118 (7.2) | 28 (1.7) | 21 (1.3) | 1628 |
Secondary | 6303 (85.8) | 524 (7.1) | 385 (5.2) | 77 (1.0) | 56 (0.8) | 7345 |
Tertiary | 599 (92.7) | 21 (3.3) | 22 (3.4) | 3 (0.5) | 1 (0.2) | 646 |
Missing | 819 (82.8) | 91 (9.2) | 51 (5.2) | 15 (1.5) | 13 (1.3) | 989 |
Marital status | ||||||
Single | 5902 (85.4) | 492 (7.1) | 369 (5.3) | 89 (1.3) | 58 (0.8) | 6910 |
Married | 1312 (88.8) | 91 (6.2) | 56 (3.8) | 11 (0.7) | 8 (0.5) | 1478 |
Informal union | 1390 (84.2) | 129 (7.8) | 98 (5.9) | 16 (1.0) | 18 (1.1) | 1651 |
Separated | 359 (77.9) | 57 (12.4) | 33 (7.2) | 4 (0.9) | 8 (1.7) | 461 |
Divorced | 78 (60.9) | 28 (21.9) | 17 (13.3) | 4 (3.1) | 1 (0.8) | 128 |
Widowed | 66 (61.7) | 26 (24.3) | 12 (11.2) | 3 (2.8) | 0 (0) | 107 |
Wealth quintiles | ||||||
1 | 1369 (82.2) | 156 (9.4) | 103 (6.2) | 25 (1.5) | 12 (0.7) | 1665 |
2 | 1607 (82.4) | 167 (8.6) | 130 (6.7) | 26 (1.3) | 21 (1.1) | 1951 |
3 | 1715 (85.0) | 150 (7.4) | 105 (5.2) | 24 (1.2) | 24 (1.2) | 2018 |
4 | 1895 (85.2) | 167 (7.5) | 117 (5.3) | 25 (1.1) | 21 (0.9) | 2225 |
5 | 1967 (88.2) | 135 (6.1) | 98 (4.4) | 20 (0.9) | 10 (0.4) | 2230 |
Missing | 554 (85.8) | 48 (7.4) | 32 (5.0) | 7 (1.1) | 5 (0.8) | 646 |
Seroconversions and ART initiation
Engagement sequences and clusters
Factors associated with ART resumption
LTFU | HR (95% CI) | p-value | aHR (95% CI) | p-value | |
---|---|---|---|---|---|
705 | |||||
N (%) | |||||
Pregnancy during follow-up time | |||||
No | 621 (88.1) | Reference | __ | Reference | __ |
Yes | 84 (11.9) | 2.85 (1.50, 5.43) | 0.001 | 2.79 (1.31, 5.95) | 0.008 |
Age | |||||
18–24 | 117 (16.6) | 0.81 (0.44, 1.50) | 0.511 | ||
25–34 | 379 (53.8) | Reference | __ | ||
35–44 | 161 (22.8) | 1.01 (0.78, 1.31) | 0.927 | ||
45–51 | 48 (6.8) | 0.88 (0.62, 1.24) | 0.462 | ||
ART reason | |||||
Non-PMTCT | 426 (60.4) | Reference | __ | ||
PMTCT | 279 (39.6) | 0.78 (0.66, 0.92) | 0.003 | ||
ART start year | |||||
2014 | 144 (20.4) | 1.18 (0.69, 1.99) | 0.545 | 0.88 (0.48, 1.63) | 0.69 |
2015 | 288 (40.8) | Reference | __ | Reference | __ |
2016 | 248 (35.2) | 1.36 (1.07, 1.71) | 0.011 | 2.17 (1.28, 3.67) | 0.004 |
2017 | 25 (3.6) | 1.38 (0.72, 2.64) | 0.324 | 3.08 (1.07, 8.84) | 0.037 |
Time on ART | |||||
≤ 3 months | 208 (29.5) | Reference | __ | Reference | __ |
3–6 months | 150 (21.3) | 0.90 (0.61, 1.33) | 0.599 | 1.06 (0.71, 1.58) | 0.78 |
6–12 months | 174 (24.7) | 1.70 (1.09, 2.65) | 0.018 | 1.98 (1.20, 3.26) | 0.008 |
12–24 months | 139 (19.7) | 3.29 (1.44, 7.51) | 0.005 | 4.43 (1.66, 11.84) | 0.003 |
> 24 months | 34 (4.8) | 5.73 (3.60, 9.10) | < 0.001 | 7.90 (3.56, 17.51) | < 0.001 |
Baseline CD4 | |||||
< 100 | 105 (15.4) | 0.67 (0.34, 1.32) | 0.244 | 0.76 (0.37, 1.59) | 0.474 |
100–199 | 107 (15.7) | 0.82 (0.62, 1.08) | 0.152 | 0.87 (0.62, 1.22) | 0.416 |
200–349 | 183 (26.9) | Reference | __ | Reference | __ |
350–499 | 159 (23.4) | 0.90 (0.68, 1.19) | 0.461 | 1.17 (0.82, 1.67) | 0.395 |
500+ | 126 (18.5) | 1.48 (1.01, 2.17) | 0.044 | 1.76 (1.40, 2.20) | < 0.001 |
Baseline WHO stage | |||||
I | 554 (79.6) | Reference | __ | ||
II | 75 (10.8) | 1.27 (0.93, 1.73) | 0.136 | ||
III | 62 (8.9) | 1.29 (0.60, 2.74) | 0.512 | ||
IV | 5 (0.7) | 0.91 (0.24, 3.43) | 0.885 | ||
Refill schedule | |||||
1 month | 469 (66.5) | Reference | __ | Reference | __ |
2 months | 157 (22.3) | 0.93 (0.56, 1.56) | 0.791 | 0.86 (0.47, 1.60) | 0.646 |
3 months | 60 (8.5) | 1.29 (0.94, 1.78) | 0.112 | 0.88 (0.54, 1.44) | 0.604 |
> 3 months | 19 (2.7) | 6.42 (4.24, 9.73) | < 0.001 | 2.79 (2.11, 3.69) | < 0.001 |
Health Facility | |||||
Agincourt | 195 (27.7) | Reference | __ | Reference | __ |
Belfast | 135 (19.2) | 0.36 (0.34, 0.39) | < 0.001 | 0.48 (0.41, 0.57) | < 0.001 |
Cunningmore | 44 (6.2) | 0.37 (0.35, 0.40) | < 0.001 | 0.65 (0.53, 0.80) | 0.001 |
Justicia | 75 (10.6) | 0.32 (0.28, 0.36) | < 0.001 | 0.53 (0.45, 0.61) | < 0.001 |
Kildare | 75 (10.6) | 0.84 (0.83, 0.86) | < 0.001 | 0.96 (0.73, 1.27) | 0.804 |
Lillydale | 110 (15.6) | 0.65 (0.62, 0.68) | < 0.001 | 1.01 (0.88, 1.16) | 0.854 |
Thulamahashe | 21 (3.0) | 0.64 (0.63, 0.65) | < 0.001 | 0.67 (0.56, 0.81) | < 0.001 |
Xanthia | 50 (7.1) | 0.60 (0.59, 0.61) | < 0.001 | 0.59 (0.45, 0.76) | < 0.001 |
Time since last appointment | |||||
≤ 1 year | 354 (50.2) | Reference | __ | Reference | __ |
1–2 years | 269 (38.2) | 0.36 (0.28, 0.46) | < 0.001 | 0.63 (0.49, 0.80) | < 0.001 |
> 2 years | 82 (11.6) | 0.10 (0.06, 0.17) | < 0.001 | 0.33 (0.16, 0.65) | 0.001 |