Abstract
BackgroundRoutine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country.MethodsWe analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR’s) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model.ResultsOf 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33–1.68), women (ARR: 1.24, 95% CI: 1.11–1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12–1.45).ConclusionsIn this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis.
Highlights
Routine screening for HIV infection can lead to earlier detection and treatment compared to screening only those experiencing symptoms of infection [1]
The cohort comprises adults who presented for HIV testing at the outpatient departments of two South African hospitals between November 2006 and August 2010
We present adjusted relative risks (ARR’s) and confidence intervals (CI)’s for these characteristics from a model predicting prior testing that includes participant gender, age group, reason for HIV testing, awareness of friends or family members with HIV infection, and knowledge of HIV and enrollment site
Summary
Routine screening for HIV infection can lead to earlier detection and treatment compared to screening only those experiencing symptoms of infection [1]. Because treatment lowers viral load and infectivity, a further benefit of early detection is reduced transmission of the virus [4]. WHO guidelines recommend routine screening for HIV in high prevalence areas. In South Africa, national prevalence was 17% among those 15 to 49 years old in 2008, but was as high as to 26% in KwaZulu Natal (KZN) Province [5]. Young women are the most affected group, with prevalence of 33% among 25 to 29 year old females [5]. Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country
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