Abstract
BackgroundMobile HIV testing services (HTS) are effective at reaching undiagnosed people living with HIV. However, linkage to HIV care from mobile HTS is often poor, ranging from 10 to 60%. Point-of-care (POC) CD4 testing has shown to increase retention in health facilities, but little evidence exists about their use in mobile HTS. This study assessed the feasibility of POC CD4 test implementation and investigated linkage to HIV care among clients accepting a POC test at community-based mobile HTS.MethodsThis retrospective study used routinely collected data from clients who utilized community-based mobile HTS in the City of Cape Town Metropolitan district, South Africa between December 2014 and September 2016. A POC CD4 test was offered to all clients with an HIV positive diagnosis during this period, and a CD4 cell count was provided to clients accepting a POC CD4 test. Random effects logistic regression was used to assess factors associated with POC CD4 test uptake and self-reported linkage to care among clients accepting a POC test. Models were adjusted for sex, age, previous HIV test done, tuberculosis status and year of HIV diagnosis.ResultsOne thousand three hundred twenty-five of Thirty-nine thousand seven hundred ninety clients utilizing mobile HTS tested HIV positive (3%). 51% (679/1325) accepted a POC test. The age group with the highest proportion accepting a POC test was 50+ years (60%). Females were less likely to accept a POC test than males (odds ratio = 0.7, 95%CI = 0.6–0.8). Median CD4 count was 429 cells/μl (interquartile range = 290–584). Among 679 clients who accepted a POC CD4 test, 491 (72%) linked to HIV care. CD4 cell count was not associated with linkage to care.ConclusionOur findings suggest that mobile HTS can identify early HIV infection, and show that a high proportion of clients with a POC test result linked to care. Future research should assess factors associated with POC test acceptance and assess the impact of POC CD4 testing in comparison to alternative strategies to engage HIV positive people in care.
Highlights
Mobile human immunodeficiency virus (HIV) testing services (HTS) are effective at reaching undiagnosed people living with HIV
Statistical analysis Our study aims were to (i) describe characteristics of HIV positive clients diagnosed at mobile HIV testing services (HTS), (ii) assess the uptake of POC CD4 testing, (iii) quantify CD4 cell count to get an indication of disease progression among clients targeted by mobile HTS, and (iv) investigate the relationship between CD4 cell count and linkage to HIV care among clients accepting a POC CD4 test
Identifying effective approaches to engage HIV positive people in care is essential to optimise the benefits of free antiretroviral therapy (ART) for all HIV positive people
Summary
Mobile HIV testing services (HTS) are effective at reaching undiagnosed people living with HIV. Detection of HIV-infection and prompt receipt of antiretroviral therapy (ART) post diagnosis can optimize individual health benefit and prevent onward transmission [2,3,4,5,6]. These benefits are supported by strong evidence, they pose challenges for timely linkage to care, especially in high-burden, resource-constrained settings. In September 2016, South Africa implemented a universal test and treat policy, enabling free ART access for all HIV positive people regardless of CD4 count [9, 10]. In 2018, ART coverage remained at 62% among people living with HIV in South Africa [1]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
