RAPID, POINT-OF-CARE CD4 TESTING AT MOBILE AND FIXED HIV TESTING SITES: DOES IT INCREASE LINKAGE TO HIV CARE?

By  Dr. Bruce Larson   Kathryn Schnippel  Buyiswa Ndibongo  Alana Brennan  Thembi Xulu  Dr. Lawrence Long  Dr. Matthew Fox  Professor Ian Sanne  Professor Sydney Rosen  |  | 

Effective care and treatment for HIV/AIDS requires the integration of all stages of disease management, which include: (1) HIV testing; (2) referral of those who test HIV-positive to a clinic for assessment; (3) assessment of the patient with CD4 test to determine eligibility for antiretroviral therapy (ART) or pre-ART care; (4) patient enrolment and retention in pre-ART care if not immediately eligible for ART; (5) patient initiation of ART as soon as eligible; and (6) maintenance of long-term ART adherence.

Steps 2 and 3—referral of HIV-positive patients to a clinic and completion of an assessment for pre-ART care or ART—have been particulary difficult to achieve in South Africa, even when testing, assessment, care, and treatment are all provided at the same site. Published data and reports on South Africa’s national HIV counseling and testing (HCT) campaign suggest that most people who test HIVpositive, whether at fixed HCT sites located in clinics or at mobile or community-based, stand-alone HCT sites, do not complete referral appointments for CD4 testing. Among five studies from South Africa included in a recent literature review, a median of 53% of patients failed to return to a clinic for their CD4 count results, leaving them unaware of what care they should be receiving (see
http://www.plosmedicine.org/article/info:doi/10.1371/j
ournal.pmed.1001056).

One solution proposed for the failure of many HCT clients to return for their CD4 test results is to integrate rapid, point-of-care testing (POCT) technologies into HCT service sites. These technologies allow blood samples to be processed immediately, at the location where the HIV test is performed, so that an HCT client can receive CD4 count results on the same visit as the HIV test. In 2010, two different POCT technologies were piloted in Gauteng Province by Right to Care, a South African nongovernmental organization, with support from the U.S. Agency for International Development. The interventions’ effect on the likelihood of patients returning for further care was evaluated. This policy brief summarizes the results of the two pilot projects.

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