Page 421 - HIVMED_v21_i1.indb

Page 2 of 8 Original Research

However, routine monitoring of HIV treatment programmes TABLE 1: Facilities in the Western Cape rendering antiretroviral therapy services
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does not report RiC and treatment outcomes for adolescents (N = 256). Rural Metro Total
Facility type
(10–19 years); they report only for children (0–14 years) and Clinic (including satellite clinics) 138 26 164
adults (15 years and older). In this way, adolescent problems Mobile clinics 8 0 8
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with RiC and treatment outcomes remain undetected in the Community day centre 17 29 46
monitoring of HIV programmes. It is argued that because of Community health centre 0 9 9
the general adherence problems faced by adolescents District hospital 4 6 10
globally, specific analysis is needed to report outcomes for TB hospitals 4 2 6
this age group at a health-systems level. Regional hospitals 0 4 4
8
Correctional centres 8 1 9
Objectives Total 179 77 256
TB, tuberculosis.
This article reports on the RiC of ALWH aged 10–19 years
who were newly initiated on ART in public health facilities in are designated as paediatric or adult. Adolescent-specific
the Western Cape Metropole, SA, in 2013, and the risk factors ART services are not yet part of standard care being offered at
associated with remaining in care at 4, 12 and 24 months all ART facilities. Those that do are limited to services
post-initiation on ART.
initiated and/or supported by tertiary hospitals or non-profit
Methods organisations.
Design Data source

We conducted a retrospective cohort analysis of adolescents Two data sources were used for this analysis: the Three
aged 10–19 years, who were initiated on ART in 2013 in the Interlinked Electronic Registers.Net (TIER.Net), an electronic
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Western Cape Metropole. ART database developed by the University of Cape Town’s
Centre for Infectious Disease Epidemiology and Research,
Study context and patients’ folders accessed at the treating facilities. Tier.Net
is used operationally in the public health facilities of SA to
The Western Cape’s ART programme has been in existence monitor baseline clinical care and client outcomes over time.
for over 10 years. The 2013 version of the ART guidelines It is also the platform on which HIV tests are electronically
was updated in 2016, and had consolidated adult, captured in the public sector. 15
adolescent, paediatric and prevention of mother-to-child
transmission of HIV guidelines. In the province of We first visited the Tier.net platform to obtain data on all
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the Western Cape, most adults and children access ART those who met the inclusion criteria. With the use of our data-
services at primary healthcare facilities, such as clinics, capturing form, we searched for the relevant information
community day centres and community health centres. At from the Tier.net platform. Where information was missing,
the end of June 2017, this province had 237 285 patients on we accessed the patient’s folder to confirm the availability of
ART, of whom 229 171 were aged ≥ 15 years and 8114 were the required information.
aged < 15 years. The Cape Town Metropole accounts for
74.3% (167 833) of the total number of ART patients in the
Western Cape, that is 162 092 aged ≥ 15 years and 5741 Study participants
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aged < 15 years. Antiretroviral therapy services are Data were found for 332 ALWH newly registered on ART
rendered at the various Western Cape facilities, as outlined from 29 facilities across the Western Cape Metropole and
in Table 1. 13 extracted from the provincial Tier.net register. Only 220
participants were included in the final analysis. Of the 112
However, services rendered at these facilities vary. Some excluded, for 68, folders could not be found in spite of making
provide only adult ART services. Others offer both adult and numerous attempts to trace these documents at the various
paediatric support. Some facilities offer ART daily, whilst facilities. Furthermore, 28 patients were incorrectly captured
others provide ART only on certain days of the week. Human as new patients when they had been transferred in from other
resource capacity also varies. Not all facilities have resident facilities; 4 patients were not adolescents, and their birth
medical officers or clinical nurse practitioners. Hence, the dates had been incorrectly captured; and 12 patients had
need for outreach support arises. The capacity to care for been incorrectly captured as having initiated ART in 2013.
adults in the Western Cape has improved with the
implementation of the nurse-initiated management of Main outcome measures and analysis
antiretroviral treatment (NIMART) programme, whereby
nurses are trained and receive structured mentorship and We extracted data on sociodemographic characteristics
accreditation to initiate first-line ART. A challenge in the rural (age, sex, source of income, type of dwelling, disclosure to
areas is the irregular access to competent and skilled clinicians significant other and reported alcohol or other drug use) and
to manage paediatric patients and complicated adult and clinical characteristics (CD4 count, WHO stage, pregnancy
adolescent patients. As previously stated, most ART services and ART regimen).

http://www.sajhivmed.org.za 413 Open Access