Why are They Leaving?… Factors Associated With Attrition After Testing Among Young South Africans Recently Diagnosed With HIV: An Observational Study.

Abstract

Purpose: Young people in South Africa face unique challenges in initiating HIV treatment. There has been limited research on sociobehavioral factors influencing attrition from care among recently diagnosed adolescents and young adults (AYA).

Methods: We enrolled 100 AYA who recently tested positive for HIV between April 2018 and October 2019 at two community testing sites in Cape Town. We administered a sociobehavioral survey within 2 weeks of diagnosis and 6 months of follow-up and used electronic health records to confirm linkage to care, antiretroviral therapy (ART) initiation, and viral load suppression within 1 year of diagnosis. We used descriptive statistics to explore the general relationships between clinical and sociobehavioral factors.

Results: Seven participants were excluded from the analysis because they had evidence of ART initiation. Among 93 eligible participants, the majority were not linked to care (n = 82) and over 80% reported food insecurity and HIV diagnosis disclosure concerns. Of those who linked to care (n = 11), 10 initiated ART and 6 achieved viral suppression within 1 year. AYA who initiated ART were more likely to live with a parent/relative (10 of 10 vs. 57 of 83) and were more likely to have disclosed their status to household members (7 of 10 vs. 25 of 83) than noninitiators. Mean baseline scale scores for anticipated and enacted stigma were higher among ART noninitiators compared to ART initiators, with mean differences of 0.4 and 0.5, respectively.

Discussion: In a sample of recently diagnosed AYA in South Africa, the majority showed no evidence of entering care within a year. All of the participants who initiated ART reported living with a relative and were more likely to disclose their HIV status than noninitiators. Further research is needed to develop effective intervention strategies to address barriers to care for AYA with HIV in South Africa.