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Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa

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  • Jacob Bor
  • Matthew P Fox
  • Sydney Rosen
  • Atheendar Venkataramani
  • Frank Tanser
  • Deenan Pillay
  • Till Bärnighausen

Abstract

Background: Loss to follow-up is high among HIV patients not yet receiving antiretroviral therapy (ART). Clinical trials have demonstrated the clinical efficacy of early ART; however, these trials may miss an important real-world consequence of providing ART at diagnosis: its impact on retention in care. Methods and findings: We examined the effect of immediate (versus deferred) ART on retention in care using a regression discontinuity design. The analysis included all patients (N = 11,306) entering clinical HIV care with a first CD4 count between 12 August 2011 and 31 December 2012 in a public-sector HIV care and treatment program in rural South Africa. Patients were assigned to immediate versus deferred ART eligibility, as determined by a CD4 count

Suggested Citation

  • Jacob Bor & Matthew P Fox & Sydney Rosen & Atheendar Venkataramani & Frank Tanser & Deenan Pillay & Till Bärnighausen, 2017. "Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa," PLOS Medicine, Public Library of Science, vol. 14(11), pages 1-20, November.
    • Handle: RePEc:plo:pmed00:1002463
    DOI: 10.1371/journal.pmed.1002463
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    Cited by:

    1. Mhairi Maskew & Alana T Brennan & Matthew P Fox & Lungisile Vezi & Willem D F Venter & Peter Ehrenkranz & Sydney Rosen, 2020. "A clinical algorithm for same-day HIV treatment initiation in settings with high TB symptom prevalence in South Africa: The SLATE II individually randomized clinical trial," PLOS Medicine, Public Library of Science, vol. 17(8), pages 1-20, August.
    2. Mariam O. Adeleke & Gianluca Baio & Aidan G. O'Keeffe, 2022. "Regression discontinuity designs for time‐to‐event outcomes: An approach using accelerated failure time models," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 185(3), pages 1216-1246, July.
    3. Matias D. Cattaneo & Luke Keele & Rocio Titiunik, 2023. "A Guide to Regression Discontinuity Designs in Medical Applications," Papers 2302.07413, arXiv.org, revised May 2023.
    4. Ahmed, Shahira & Autrey, Jessica & Katz, Ingrid T. & Fox, Matthew P. & Rosen, Sydney & Onoya, Dorina & Bärnighausen, Till & Mayer, Kenneth H. & Bor, Jacob, 2018. "Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 213(C), pages 72-84.
    5. Jacob Bor & Anna Gage & Dorina Onoya & Mhairi Maskew & Yorghos Tripodis & Matthew P Fox & Adrian Puren & Sergio Carmona & Koleka Mlisana & William MacLeod, 2021. "Variation in HIV care and treatment outcomes by facility in South Africa, 2011–2015: A cohort study," PLOS Medicine, Public Library of Science, vol. 18(3), pages 1-18, March.
    6. Dean Eckles & Nikolaos Ignatiadis & Stefan Wager & Han Wu, 2020. "Noise-Induced Randomization in Regression Discontinuity Designs," Papers 2004.09458, arXiv.org, revised Nov 2023.

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