Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis
Objectives For persons living with HIV (PLWH) in long-term care, clinic transfers are common and influence sustained engagement in HIV care, as they are associated with significant time out-of-care, low CD4 count, and unsuppressed viral load on re-entry. Despite the geospatial nature of clinic trans...
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BMJ Publishing Group
2021-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/12/e055712.full |
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| author | Christopher J Colvin Mark N Lurie Ana Lucia Espinosa Dice Angela M Bengtson Kevin M Mwenda |
| author_facet | Christopher J Colvin Mark N Lurie Ana Lucia Espinosa Dice Angela M Bengtson Kevin M Mwenda |
| author_sort | Christopher J Colvin |
| collection | DOAJ |
| description | Objectives For persons living with HIV (PLWH) in long-term care, clinic transfers are common and influence sustained engagement in HIV care, as they are associated with significant time out-of-care, low CD4 count, and unsuppressed viral load on re-entry. Despite the geospatial nature of clinic transfers, there exist limited data on the geospatial trends of clinic transfers to guide intervention development. In this study, we investigate the geospatial characteristics and trends of clinic transfers among PLWH on antiretroviral therapy (ART) in the Western Cape Province of South Africa.Design Retrospective spatial analysis.Setting PLWH who initiated ART treatment between 2012 and 2016 in South Africa’s Western Cape Province were followed from ART initiation to their last visit prior to 2017. Deidentified electronic medical records from all public clinical, pharmacy, and laboratory visits in the Western Cape were linked across space and time using a unique patient identifier number.Participants 4176 ART initiators in South Africa (68% women).Methods We defined a clinic transfer as any switch between health facilities that occurred on different days and measured the distance between facilities using geodesic distance. We constructed network flow maps to evaluate geospatial trends in clinic transfers over time, both for individuals’ first transfer and overall.Results Two-thirds of ART initiators transferred health facilities at least once during follow-up. Median distance between all clinic transfer origins and destinations among participants was 8.6 km. Participant transfers were heavily clustered around Cape Town. There was a positive association between time on ART and clinic transfer distance, both among participants’ first transfers and overall.Conclusion This study is among the first to examine geospatial trends in clinic transfers over time among PLWH. Our results make clear that clinic transfers are common and can cluster in urban areas, necessitating better integrated health information systems and HIV care. |
| format | Article |
| id | doaj-art-575618bac3b14124927dbf8fe68decfb |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-575618bac3b14124927dbf8fe68decfb2025-08-20T01:54:38ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-055712Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysisChristopher J Colvin0Mark N Lurie1Ana Lucia Espinosa Dice2Angela M Bengtson3Kevin M Mwenda4Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Observatory, Western Cape, South Africa3 Brown University, School of Public Health, International Health Institute, Providence, Rhode Island, USADepartment of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USADepartment of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA2 Spatial Structures in the Social Sciences (S4), Population Studies and Training Center (PSTC), Brown University, Providence, Rhode Island, USAObjectives For persons living with HIV (PLWH) in long-term care, clinic transfers are common and influence sustained engagement in HIV care, as they are associated with significant time out-of-care, low CD4 count, and unsuppressed viral load on re-entry. Despite the geospatial nature of clinic transfers, there exist limited data on the geospatial trends of clinic transfers to guide intervention development. In this study, we investigate the geospatial characteristics and trends of clinic transfers among PLWH on antiretroviral therapy (ART) in the Western Cape Province of South Africa.Design Retrospective spatial analysis.Setting PLWH who initiated ART treatment between 2012 and 2016 in South Africa’s Western Cape Province were followed from ART initiation to their last visit prior to 2017. Deidentified electronic medical records from all public clinical, pharmacy, and laboratory visits in the Western Cape were linked across space and time using a unique patient identifier number.Participants 4176 ART initiators in South Africa (68% women).Methods We defined a clinic transfer as any switch between health facilities that occurred on different days and measured the distance between facilities using geodesic distance. We constructed network flow maps to evaluate geospatial trends in clinic transfers over time, both for individuals’ first transfer and overall.Results Two-thirds of ART initiators transferred health facilities at least once during follow-up. Median distance between all clinic transfer origins and destinations among participants was 8.6 km. Participant transfers were heavily clustered around Cape Town. There was a positive association between time on ART and clinic transfer distance, both among participants’ first transfers and overall.Conclusion This study is among the first to examine geospatial trends in clinic transfers over time among PLWH. Our results make clear that clinic transfers are common and can cluster in urban areas, necessitating better integrated health information systems and HIV care.https://bmjopen.bmj.com/content/11/12/e055712.full |
| spellingShingle | Christopher J Colvin Mark N Lurie Ana Lucia Espinosa Dice Angela M Bengtson Kevin M Mwenda Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis BMJ Open |
| title | Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis |
| title_full | Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis |
| title_fullStr | Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis |
| title_full_unstemmed | Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis |
| title_short | Quantifying clinic transfers among people living with HIV in the Western Cape, South Africa: a retrospective spatial analysis |
| title_sort | quantifying clinic transfers among people living with hiv in the western cape south africa a retrospective spatial analysis |
| url | https://bmjopen.bmj.com/content/11/12/e055712.full |
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