{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:51:49Z","timestamp":1792291909720,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2017,7,21]],"date-time":"2017-07-21T00:00:00Z","timestamp":1500595200000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Introduction<\/jats:bold>: Increasingly, there is a need for health authority scale up of successfully piloted differentiated models of antiretroviral therapy (ART) delivery. However, there is a paucity of evidence on system\u2010wide outcomes after scale\u2010up. In the Cape Town health district, stable adult patients were referred to adherence clubs (ACs) \u2013 a group model of ART delivery with five visits per year. By the end of March 2015, over 32,000 ART patients were in an AC. We describe patient outcomes of a representative sample of AC patients during this scale\u2010up.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: Patients enrolled in an AC at non\u2010research supported sites between 2011 and 2014 were eligible for analysis. We sampled 10% of ACs (<jats:italic>n<\/jats:italic> = 100) in quintets proportional to the number of ACs at each facility, linking each patient to city\u2010wide laboratory and service access data to validate retention and virologic outcomes. We digitized registers and used competing risks regression and cross\u2010sectional methods to estimate outcomes: mortality, transfers, loss to follow\u2010up (LTFU) and viral load suppression (\u2264400 copies\/mL). Predictors of LTFU and viral rebound were assessed using Cox proportional hazards models.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: Of the 3216 adults contributing 4019 person years of follow\u2010up (89% in an AC, median 1.1 years), 70% were women. Retention was 95.2% (95% CI, 94.0\u201096.4) at 12 months and 89.3% (95% CI, 87.1\u201091.4) at 24 months after AC enrolment. In the 13 months prior to analysis closure, 88.1% of patients had viral load assessments and of those, viral loads \u2264400 copies\/mL were found in 97.2% (95% CI, 96.5\u201097.8) of patients. Risk of LTFU was higher in younger patients and in patients accessing ART from facilities with larger ART cohorts. Risk of viral rebound was higher in younger patients, those that had been on ART for longer and patients that had never sent a buddy to collect their medication.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>: This is the first analysis reporting patient outcomes after health authorities scaled\u2010up a differentiated care model across a high burden district. The findings provide substantial reassurance that stable patients on long\u2010term ART can safely be offered care options, which are more convenient to patients and less burdensome to services.<\/jats:p>","DOI":"10.7448\/ias.20.5.21649","type":"journal-article","created":{"date-parts":[[2017,7,15]],"date-time":"2017-07-15T09:21:06Z","timestamp":1500110466000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":89,"title":["High rates of retention and viral suppression in the scale\u2010up of antiretroviral therapy adherence clubs in Cape Town, South Africa"],"prefix":"10.1002","volume":"20","author":[{"given":"Priscilla Ruvimbo","family":"Tsondai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne Susan","family":"Wilkinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Grimsrud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Precious Thembekile","family":"Mdlalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica","family":"Ullauri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Boulle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,21]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"AIDS by the numbers: ending the AIDS epidemic by 2030 as part of the sustainable development goals","author":"UNAIDS","year":"2016"},{"key":"e_1_2_8_3_1","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed","author":"World Health Organization","year":"2016"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.7196\/sajhivmed.924"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0056088"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12699"},{"key":"e_1_2_8_7_1","volume-title":"Census 2011 statistical release \u2013 P0301.4","author":"Statistics South Africa","year":"2012"},{"key":"e_1_2_8_8_1","volume-title":"The 2013 national antenatal sentinel HIV prevalence survey South Africa","author":"National Department of Health","year":"2013"},{"key":"e_1_2_8_9_1","unstructured":"M\u00e9decins sans Fronti\u00e8res [Internet].ART adherence clubs: club report and toolkit. 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