Linkage to HIV care after discharge from an academic hospital in Johannesburg, South Africa

Degree Project Thesis, Programme in Medicine. TITLE: Linkage to HIV care after discharge from an academic hospital in Johannesburg, South Africa. Abstract Background: Over the past decade the development and large-scale distribution of antiretroviral treatment has posed a shift in the challenges of the global HIV epidemic. Today, one of the biggest issues in the battle against HIV is to retain eligible patients in lifelong care. Most studies conducted in the area focus on linkage to care after arrival to a HIV clinic, while very few studies have been conducted on linkage to care after hospital discharge. Aim: To assess the proportion of HIV positive, treatment naive patients that link to HIV care and treatment at a primary health care facility after discharge from Helen Joseph Hospital, Johannesburg, South Africa, and to identify risk factors for failed linkage to care. Method: Outcome was determined by review of clinic files and by telephone interviews with patients. Patients were categorized as linked to care (no time cut-off), failed linkage to care, lost to follow-up or deceased. Results: Among 62 included patients, 69.4% were found to link to HIV care after discharge, while only one (1.6%) reported failed linkage to care. Mortality and lost to follow-up in the group were both 14.5%. Median time between hospital discharge and first visit to a clinic for HIV care was 21 days (IQR 13-31.5). A possible correlation between having TB at discharge and better linkage to HIV care was observed. Conclusions: Considering the moderate level of linkage to care and the high mortality found in the study, it is recommended that procedures to ensure counselling and a proper referral for this group of severely ill patients are implemented at Helen Joseph Hospital. If routine follow up of HIV patients is to be conducted in the future, there is a need for a computerized system at the hospital that can be used in the referral and follow-up proces