Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province
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...
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South African Medical Association
2023-12-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/810 |
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| author | J Chiliza R Laing F G Feeley A T Brennan |
| author_facet | J Chiliza R Laing F G Feeley A T Brennan |
| author_sort | J Chiliza |
| collection | DOAJ |
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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.
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| format | Article |
| id | doaj-art-d28f63efabc841bf8c5fd8a4fbfd658e |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-d28f63efabc841bf8c5fd8a4fbfd658e2025-02-10T12:26:33ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352023-12-01114110.7196/SAMJ.2024.v114i1.810Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape ProvinceJ Chiliza0R Laing1F G Feeley2A T Brennan3Department of Global Health, School of Public Health, Boston University, USADepartment of Global Health, School of Public Health, Boston University, USA; School of Public Health, University of the Western Cape, Cape Town, South AfricaDepartment of Global Health, School of Public Health, Boston University, USADepartment of Global Health, School of Public Health, Boston University, USA; Department of Epidemiology, School of Public Health, Boston University, USA; Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 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. https://samajournals.co.za/index.php/samj/article/view/810PEPFARHIVretentionSouth Africa |
| spellingShingle | J Chiliza R Laing F G Feeley A T Brennan Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province South African Medical Journal PEPFAR HIV retention South Africa |
| title | Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province |
| title_full | Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province |
| title_fullStr | Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province |
| title_full_unstemmed | Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province |
| title_short | Evaluation of the impact of PEPFAR transition on retention in care in South Africa’s Western Cape Province |
| title_sort | evaluation of the impact of pepfar transition on retention in care in south africa s western cape province |
| topic | PEPFAR HIV retention South Africa |
| url | https://samajournals.co.za/index.php/samj/article/view/810 |
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