Outcomes from the implementation of a counselling model supporting rapid antiretroviral treatment initiation in a primary healthcare clinic in Khayelitsha, South Africa

Abstract

Background: Lengthy antiretroviral treatment (ART) preparation contributes to high lossesto care between communicating ART eligibility and initiating ART. To address this shortfall, Médecins Sans Frontières implemented a revised approach to ART initiation counsellingpreparation (integrated for TB co-infected patients), shifting the emphasis frompre-initiation sessions to addressing common barriers to adherence and strengthening postinitiationsupport in a primary healthcare facility in Khayelitsha, South Africa. Methods: An observational cohort study was conducted using routinely collected data forall ART-eligible patients attending their first counselling session between 23 July 2012 and 30April 2013 to assess losses to care prior to and post ART initiation. Viral load completion andsuppression rates of those retained on ART were also calculated. Results: Overall, 449 patients enrolled in the study, of whom 3.6% did not return to the facilityto initiate ART. Of those who were initiated, 96.7% were retained at their first ART refill visitand 85.9% were retained 6 months post ART initiation. Of those retained, 80.2% had a viralload taken within 6 months of initiating ART, with 95.4% achieving viral load suppression. Conclusions: Adapting counselling to enable rapid ART initiation is feasible and has thepotential to reduce losses to care prior to ART initiation without increasing short-term lossesthereafter or compromising patient adherence.

Keywords

• Counselling, HIV/AIDS, patient adherence, antiretroviral therapy, motivational interviewing, lost to follow-up, viral load, South Africa