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Intern. AIDS Soc."],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>\n<jats:styled-content style=\"fixed-case\">Abstract<\/jats:styled-content>\n<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Policies for Universal Test &amp; Treat (UTT) and same\u2010day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled three cohorts of newly diagnosed HIV\u2010infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre\u2010UTT, N\u00a0=\u00a0144), May\u2010September 2017 (UTT, N\u00a0=\u00a0178) and October\u2010December 2017 (SDI, N\u00a0=\u00a088). A baseline survey was administered immediately after HIV diagnosis after which follow\u2010up using clinical records (paper charts, electronic health records and laboratory data) ensued for 12\u00a0months. The primary outcome was patient loss to follow\u2010up (being &gt;90\u00a0days late for the last scheduled appointment) at 12\u00a0months post\u2010HIV diagnosis. We modelled attrition across HIV policy periods with Cox proportional hazard regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 410 of 580 screened HIV\u2010positive patients were enrolled. Overall, attrition at 12\u00a0months was 30% lower in the UTT guideline period (38.2%) compared to pre\u2010UTT (47.2%, aHR 0.7, 95% CI: 0.5 to 1.0). However, the total attrition was similar between the SDI (47.7%) and pre\u2010UTT cohorts (aHR 1.0, 95% CI: 0.7 to 1.5). Older age at HIV diagnosis (aHR 0.5 for \u226540 vs. 25 to 29\u00a0years, 95% CI: 0.3 to 0.8) and being in a non\u2010marital relationship (aHR 0.5 vs. being single, 95% CI: 0.3 to 0.8) protected against LTFU at 12\u00a0months, whereas LTFU rates increased with longer travel time to the diagnosing clinic (aHR 1.8 for \u226530\u00a0minutes vs. \u226415\u00a0minutes, 95% CI: 1.1 to 3.1). In analyses adjusted for the time\u2010varying ART initiation status, compared to the pre\u2010ART period of care, the hazard of on\u2010ART LTFU was 90% higher among participants diagnosed under the SDI policy compared to pre\u2010UTT (aHR 1.9, 95% CI: 1.1 to 2.9).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall, nearly two\u2010fifths of HIV positive patients are likely to disengage from care by 12\u00a0months after HIV diagnosis under the new SDI policy. Furthermore, the increase in on\u2010ART patient attrition after the introduction of the SDI policy is cause for concern. Further research is needed to determine the best way for rapidly initiating patients on ART and also reducing long\u2010term attrition from care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25652","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T22:19:12Z","timestamp":1613859552000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Attrition in HIV care following HIV diagnosis: a comparison of the pre\u2010UTT and UTT eras in South Africa"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2664-7342","authenticated-orcid":false,"given":"Dorina","family":"Onoya","sequence":"first","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2744-5208","authenticated-orcid":false,"given":"Cheryl","family":"Hendrickson","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1856-6358","authenticated-orcid":false,"given":"Tembeka","family":"Sineke","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhairi","family":"Maskew","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4986-4988","authenticated-orcid":false,"given":"Lawrence","family":"Long","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"Department of Global Health Boston University School of Public Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5112-8536","authenticated-orcid":false,"given":"Jacob","family":"Bor","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"Department of Global Health Boston University School of Public Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9887-0634","authenticated-orcid":false,"given":"Matthew P.","family":"Fox","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"Department of Global Health Boston University School of Public Health Boston MA USA"},{"name":"Department of Epidemiology Boston University School of Public Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,18]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"National Department of Health of South Africa (SA\u2010NDoH).National Department of Health 2018\/2019 Annual report South Africa.2019. 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