Accueil > Conférences / Présentations > From home-based HIV testing to viral suppression : HIV care trajectories in (...)

LHRS 2018

From home-based HIV testing to viral suppression : HIV care trajectories in the context of Universal Test-and-Treat in rural South Africa

mercredi 6 juin 2018
Mis à jour le mercredi 6 juin 2018

Oral communication presented May 31 2018 at Life History Research Society Conference in Paris.


Delphine Perriat, Mamadou Hassimiou Diallo, François Dabis, Deenan Pillay, Joanna Orne-Gliemann, Joseph Larmarange for the ANRS 12249 TasP Study Group


Background : In order for people living with HIV to achieve an undetectable viral load, and thus live longer and healthier, they need access to a continuum of services. There are numerous reports of “leaks” at all steps of the HIV care cascade. We described the timing and sequencing of individual HIV care statuses from care referral to viral suppression, by identifying groups of individuals with similar trajectories and factors associated.

Sample : We used prospective individual-level longitudinal data from the ANRS 12249 TasP cluster-randomized trial, which investigated the impact of universal antiretroviral treatment (ART) on HIV incidence in rural South Africa (2012-2016). We included trial participants >16 years, identified HIV+, not in care at referral and followed-up for ≥18 months.

Method : The care status of all study participants was classified for each calendar day as : not in care, in care but not on ART, on ART but not virally suppressed, virally suppressed. We used state sequence data analysis to identify homogeneous care trajectories groups. A multinomial logistic regression was used to identify the profile of each group in terms of individual and cluster characteristics.

Results : 1,816 participants were included. Median age was 34 years [IQR 27-45], 74% were female. We identified four care trajectories groups : (i) participants who mostly did not enter care (55%), (ii) participants with inconstant care, visiting a clinic occasionally but leaving care thereafter (median time to exit care : 10 m. [5.2-13]) (12%), (iii) participants who took extensive time at each step of the care continuum (median time between referral and ART : 8.0 m. [6.4-9.7]) (12%) and (iv) participants who rapidly progressed towards continuous care (median time between referral and ART : 1.2 m. [0.6-2.7]) (21%). Participants younger than 50 years, newly diagnosed at referral, living further than a kilometre from a trial clinic, and living in a cluster were immediate ART was not offered, were more likely to present with incomplete, inconstant and slow care trajectories.

Conclusions : A longitudinal and person-specific approach to the study of HIV care patterns contributed to highlight the heterogeneity in care trajectories, in terms of speed and care utilization behaviours. Differentiated and personalised care and support should be scaled-up, especially between diagnosis and ART initiation, which constitutes the main bottleneck of HIV programs in this South African rural study area.

Keywords : State sequence data analysis, HIV care, South Africa


Perriat Delphine, Diallo Mamadou Hassimiou, Dabis François, Pillay Deenan, Orne-Gliemann Joanna, Larmarange Joseph et ANRS 12249 TasP Study Group (2018) « From home-based HIV testing to viral suppression : HIV care trajectories in the context of Universal Test-and-Treat in rural South Africa » (communication orale), présenté à Life History Research Society Conference, Paris.

Répondre à cet article

modération a priori

Attention, votre message n’apparaîtra qu’après avoir été relu et approuvé.

Qui êtes-vous ?

Pour afficher votre trombine avec votre message, enregistrez-la d’abord sur (gratuit et indolore) et n’oubliez pas d’indiquer votre adresse e-mail ici.

Ajoutez votre commentaire ici <{sinon{ul}} class="editer-groupe"> <{sinon{li}} class='editer saisie_texte obligatoire'>

Ce champ accepte les raccourcis SPIP {{gras}} {italique} -*liste [texte->url] <quote> <code> et le code HTML <q> <del> <ins>. Pour créer des paragraphes, laissez simplement des lignes vides.

<{sinon{li}} class="editer pleine_largeur editer_notification">
Ajouter un document <{sinon{ul}} class="editer-groupe"> <{sinon{li}} class='editer saisie_document_forum'>

Dans la même rubrique

1 / 9 »

Retour haut de page
Site réalisé avec SPIP | Plan du site | Contact | Crédits | Mentions Légales | Suivre la vie du site RSS 2.0
Habillage visuel © Larma par Joseph Larmarange sous Licence Creative Commons Attribution 2.5 License