With the South African guidelines changing in 2015 to offer antiretroviral treatment for patients having a CD4 count ≤500, there is concern that there will be a reshuffling of the clinical losses in care.
All of us in HIV/AIDS clinical research hope to see a decrease in the mortality rate across the spectrum of care, from testing to maintenance in care. However, with higher CD4 counts, patients’ perceptions of their health might shift their decision making to delay treatment initiation and buffer any gains that could have been made in mortality. Correlated to this, patients may be less willing to adhere and be more likely to drop out of care. More concerning, these newly qualified patients may also be at increased risk of cycling in/out of care – a phenomena where patients move between clinics and are not in care for many months at a time.
Katz, IT, Essien T, Marinda E, Gray G, Bangsberg D, Martinson N, DeBruyn G. Antiretroviral refusal among newly diagnosed HIV-infected adults in Soweto, South Africa. AIDS. 2011 Nov 13;25(17):2177-81. PMCID: PMC3272300
Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, Tsai AC. Impact of HIV-related stigma and serostatus disclosure on HIV treatment adherence: systematic review, meta-synthesis, and conceptual framework. Journal of the International AIDS Society. 2013, 16(Suppl 2):18640. PMCID: PMC3833107
Katz IT, Dietrich J, Tshabalala G, Essien T, Rough K, Wright AA, Bangsberg DR, Gray G, Ware NC. Understanding treatment refusal among adults presenting for HIV-testing in Soweto, South Africa: A Qualitative Study. AIDS Behav. 2015 Apr;19(4):704-14. doi: 10.1007/s10461-014-0920-y.
Dominick A. Leone: Who is and is not in HIV care?
Losses in HIV Care