Linkage to HIV Care and Antiretroviral Therapy in Cape Town, South Africa

Abstract

BackgroundAntiretroviral therapy (ART) has been scaled-up rapidly in Africa. Programme reports typically focus on loss to follow-up and mortality among patients receiving ART. However, little is known about linkage and retention in care of individuals prior to starting ART.MethodologyData on adult residents from a periurban community in Cape Town were collected at a primary care clinic and hospital. HIV testing registers, CD4 count results provided by the National Health Laboratory System and ART registers were linked. A random sample (n = 885) was drawn from adults testing HIV positive through antenatal care, sexual transmitted disease and voluntary testing and counseling services between January 2004 and March 2009. All adults (n = 103) testing HIV positive through TB services during the same time period were also included in the study. Linkage to HIV care was defined as attending for a CD4 count measurement within 6 months of HIV diagnosis. Linkage to ART care was defined as initiating ART within 6 months of HIV diagnosis in individuals with a CD4 count ≤200 cells/µl taken within 6 months of HIV diagnosis.FindingsOnly 62.6% of individuals attended for a CD4 count measurement within 6 months of testing HIV positive. Individuals testing through sexually transmitted infection services had the best (84.1%) and individuals testing on their own initiative (53.5%) the worst linkage to HIV care. One third of individuals with timely CD4 counts were eligible for ART and 66.7% of those were successfully linked to ART care. Linkage to ART care was highest among antenatal care clients. Among individuals not yet eligible for ART only 46.3% had a repeat CD4 count. Linkage to HIV care improved in patients tested in more recent calendar period.ConclusionLinkage to HIV and ART care was low in this poor peri-urban community despite free services available within close proximity. More efforts are needed to link VCT scale-up to subsequent care.

Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi

“…Adolescents may be undiagnosed in part because they have been infected for a shorter time [20,32]. The lower probability of linkage once diagnosed, which was also found in other studies, highlights the need of specific interventions targeting youth and adolescents [26,[34][35][36]. This study was based on a large and representative population sample.…”

“…A total of 1213 (98.4%) of the 1233 HIV-positive individuals had complete information and were included in the analysis; 68.2% were women, 70% were married and 72.8% had attended primary school as highest level of schooling. Median age was 37 years [IQR [31][32][33][34][35][36][37][38][39][40][41][42][43][44] (Table 1).…”

Behavioral and Biomedical Combination Strategies for HIV Prevention

“…The past decade has seen a rapid global scale-up of HCT (WHO 2009;Kranzer et al 2010). HCT uptake is associated with a range of sociodemographic factors and identifying characteristics of individuals who have never been tested is important to develop services targeted at first-time testers and thus to achieve universal access to HCT (Khumalo-Sakutukwa et al 2008;Helleringer et al 2009).…”

Effect of cotrimoxazole on mortality in HIV-infected adults on antiretroviral therapy: a systematic review and meta-analysis

“…45 Unfortunately, at present over 50% of HIV-infected individuals are lost to care between diagnosis and the start of ART. [46][47][48][49] Giving free cotrimoxazole can help increase the retention rate, 50 provide an opportunity to assess an individual's adherence to treatment before the start of ART 51 and improve survival in those not on ART. 52 Efforts to reduce early mortality in HIV-infected individuals and to increase retention rates in treatment programmes could be assisted by implementing intensified tuberculosis case-finding at every health-care visit and by providing free isoniazid to those with tuberculosis who do not have a cough, night sweats, weight loss or fever.…”