Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers

Abstract

IntroductionAccess to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda.MethodsData were obtained from routine clinic registers from eight health facilities in Rwanda on patients who were diagnosed with HIV at the antenatal care, voluntary counselling-and-testing, outpatient or tuberculosis departments between March and May 2009. The proportion of patients enrolled into HIV care and treatment was calculated as the number of HIV infected patients registered in ART clinics for follow-up care and treatment within 90 days of HIV diagnosis divided by the total number of persons diagnosed with HIV in the study period.ResultsOut of 482 patients diagnosed with HIV in the study period, 339 (70%) were females, and the median age was 29 years (interquartile range [IQR] 24–37). 201 (42%) enrolled into care and treatment within 90 days of HIV diagnosis. The median time between testing and enrolment was six days (IQR 2–14). Enrolment in care and treatment was not significantly associated with age, sex, or department of testing, but was associated with study site. None of those enrolled were in WHO stage 4. The median CD4 cell count among adult patients was 387 cells/mm3 (IQR: 242–533 cells/mm3); 81 of 170 adult patients (48%) were eligible to start ART (CD4 count<350 cells/mm3 or WHO stage 4). Among those eligible, 45 (56%) started treatment within 90 days of HIV diagnosis.ConclusionLess than 50% of diagnosed HIV patients from eight Rwandan health facilities had enrolled into care and treatment within 90 days of diagnosis. Improving linkage to care and treatment after HIV diagnosis is needed to harness the full potential of ART.

Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities

“…Under PITC a previous HIV diagnosis and enrolment in care might not be communicated to the HCW. Different research by our group (Kayigamba et al, 2012(Kayigamba et al, , 2014 found that before the introduction of PITC the most common reason for testing was the desire to know one's HIV status, while afterwards this was because one was offered a test. Some patients reported an HIV-negative test after their initial positive test when they were tested at a different facility.…”

“…The current study was part of a cluster non-randomized controlled trial that investigated the HIV testing uptake and acceptability of introducing a PITC intervention in OPDs of Rwandan HFs (Kayigamba et al, 2012(Kayigamba et al, , 2014. Eight Rwandan HFs were purposefully selected for this trial, ensuring inclusion of urban and rural HFs and sufficient numbers of attendees.…”

“…Data from VCT departments were included in order to examine whether linkage-to-HIV-care among out-patients differed from VCT patients and to detect seasonal effects. Due to low numbers of HIV cases in the two control HFs, these could not serve as control sites for the purpose of the current study and were therefore excluded (Kayigamba et al, 2012). Characteristics of the HFs included in this study are described in Table S1.…”

“…Information from patients diagnosed with HIV was abstracted from VCT, OPD, and laboratory registers of six Rwandan HFs during three-month periods before (March-May 2009) and after (December 2009-February 2010) the introduction of PITC in the OPDs of these HFs. Data collection and hospital routine have been described in detail before (Kayigamba et al, 2012).…”

Mitigating intimate partner violence to promote safe linkage to care for South African women who test HIV positive during mobile counseling and testing.

“…This program also has empirical support for its use among South Africans (Van Zyl et al, 2015). While offering HCT through the mobile medium has assisted with testing uptake, most individuals living with HIV remain without needed medical care because they delay linkage to care (Lawn et al, 2006;Losina et al, 2010;Bassett et al, 2010;Kayigamba, Bakker, Fikse, Mugisha, & Asiimwe, 2012 As the most basic explanation, the health belief model demonstrates that individuals will act to avoid poor health. Individuals must first perceive themselves to be at risk and then discern the possibility for risk high enough that action should be taken to avoid harm.…”