TitleSame-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough
AuthorsBruce A. Larson, Kathryn Schnippel, Alana Brennan, Lawrence Long, Thembi Xulu, Thapelo Maotoe, Sydney Rosen, Ian Sanne, and Matthew P. Fox
PublicationAIDS Research and Treatment. 2013 Jun; 2013:1-7.
AbstractWe evaluated whether a pilot program providing point-of-care (POC), but not rapid, CD4 testing (BD FACSCount) immediately after testing HIV-positive improved retention in care. Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period) to patients testing positive during January 2008–February 2009 (baseline period). The outcome for those with a ≤ 250 cells/mm3 when testing HIV-positive was initiating ART < 16 weeks after HIV testing. Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines). ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer. Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.
Related ProjectsEconomics and Epidemiology of HIV/AIDS, Tuberculosis, and Non-Communicable Diseases in Africa and Asia