{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:50:08Z","timestamp":1785797408970,"version":"3.56.0"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T00:00:00Z","timestamp":1591142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000691","name":"Academy of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>There is limited literature on the appropriateness of viral load (VL) monitoring and management of detectable VL in public health settings in rural South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed data captured in the electronic patient register from HIV\u2010positive patients \u2265\u00a015\u00a0years old initiating antiretroviral therapy (ART) in 17 public sector clinics in rural KwaZulu\u2010Natal, during 2010\u20132016. We estimated the completion rate for VL monitoring at 6, 12, and 24\u00a0months. We described the cascade of care for those with any VL measurement \u2265\u00a01000 HIV\u20101 RNA copies\/mL after \u2265\u00a020\u00a0weeks on ART, including the following proportions: (1) repeat VL within 6\u00a0months; (2) re\u2010suppressed; (3) switched to second\u2010line regimen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 29\u00a0384 individuals who initiated ART during the period [69% female, median age 31\u00a0years (interquartile range 25\u201339)]. Of those in care at 6, 12, and 24\u00a0months, 40.7% (9861\/24\u00a0199), 34% (7765\/22\u00a0807), and 25.5% (4334\/16\u00a0965) had a VL test at each recommended time\u2010point, respectively. The VL results were documented at all recommended time\u2010points for 12% (2730\/22\u00a0807) and 6.2% (1054\/16\u00a0965) of ART\u2010treated patients for 12 and 24\u00a0months, respectively. Only 391 (18.3%) of 2135 individuals with VL \u2265\u00a01000 copies\/mL on first\u2010line ART had a repeat VL documenting re\u2010suppression or were appropriately changed to second\u2010line with persistent failure. Completion of the treatment failure cascade occurred a median of 338\u00a0days after failure was detected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found suboptimal VL monitoring and poor responses to virologic failure in public\u2010sector ART clinics in rural South Arica. Implications include increased likelihood of morbidity and transmission of drug\u2010resistant HIV.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12877","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T03:34:37Z","timestamp":1591241677000},"page":"457-462","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Clinical outcomes after first\u2010line HIV treatment failure in South Africa: the next cascade of care"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2045-1717","authenticated-orcid":false,"given":"CC","family":"Iwuji","sequence":"first","affiliation":[{"name":"Department of Global Health and Infection Brighton and Sussex Medical School Brighton UK"},{"name":"Africa Health Research Institute KwaZulu-Natal South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Shahmanesh","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute KwaZulu-Natal South Africa"},{"name":"Research Department of Infection &amp; Population Health University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Koole","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute KwaZulu-Natal South Africa"},{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Herbst","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute KwaZulu-Natal South Africa"},{"name":"SAPRIN South African Medical Research Council Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Pillay","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute KwaZulu-Natal South Africa"},{"name":"Division of Infection and Immunity University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MJ","family":"Siedner","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute KwaZulu-Natal South Africa"},{"name":"Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1849-6625","authenticated-orcid":false,"given":"K","family":"Baisley","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute KwaZulu-Natal South Africa"},{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the H\u2010DREAM Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,3]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"UNAIDS.90\u201090\u201090. An ambitious treatment target to help end the AIDS epidemic.2014. Available athttp:\/\/www.unaids.org\/en\/resources\/documents\/2014\/90\u201090\u201090(accessed 14 March 2017)."},{"key":"e_1_2_7_3_1","unstructured":"World Health Organisation.Consolidated guidelines on the use of Antiretrpviral drugs for treating and preventing HIV infections. Recommendations for a public health approach 2013. Available athttp:\/\/apps.who.int\/iris\/bitstream\/10665\/85321\/1\/9789241505727_eng.pdf(accessed 22 September 2013)."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(15)00536-8"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2015.0225"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy881"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dym211"},{"key":"e_1_2_7_8_1","unstructured":"Department of Health RoSA.The South African antiretroviral treatment guidelines 2010.2010. 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