Background The linkage and barriers of linkage to facility-based HIV care from a mobile HIV testing unit have not previously been described. Methods A stratified random sample (N=192) was drawn of all eligible, newly-diagnosed HIV-infected individuals with a laboratory CD4 count result on a mobile unit between August 2008 and December 2009. All individuals with CD4 counts ≤ 350 cells/μl and 30% of individuals with CD4 counts > 350 cells/μl were sampled. Linkage to care was assessed during April to June 2010 in those that received their CD4 count result. A participant who accessed HIV care at least once after testing was regarded as having linked to care. Binomial regression models were used to identify clinical and socio-demographic factors associated with receiving a CD4 count result and linking to care. Results Forty-three (27%) individuals did not receive their CD4 count result. A lower CD4 count, being female and the availability of a phone number increased the likelihood of receiving this result. Follow-up was attempted in the remaining 145 individuals. Ten refused to participate and contact was unsuccessful in 42.4%. Linkage was 100% in patients with CD4 counts ≤ 200 cells/μl, 66.7% in individuals with CD4 counts of 201-350 cells/μl and 36.4% in those with CD4 counts > 350 cells/μl. A lower CD4 count, disclosure, presence of TB symptoms and unemployment increased the likelihood of linking to care. Conclusion Linkage to care was best among those eligible for ART. Interventions designed at improving linkage among employed individuals are urgently warranted.

Background In Southern Africa, men access HIV counseling and testing (HCT) services less than women. Innovative strategies are needed to increase uptake of testing among men. This study assessed the effectiveness of incentivized mobile HCT in reaching unemployed men in Cape Town, South Africa. Methods A retrospective analysis of HCT data collected between August 2008 and August 2010 from adult men accessing clinic-based stationary and non-incentivized and incentivized mobile services. Data from these three services were analyzed using descriptive statistics and log-binomial regression models. Results A total of 9416 first time testers were included in the analysis: 708 were clinic-based, 4985 were non-incentivized and 3723 incentivized mobile service testers. A higher HIV prevalence was observed among men accessing incentivized mobile testing 16.6% (617/3723) compared to those attending non-incentivized mobile 5.5% (277/4985)] and clinic-based services 10.2% (72/708)]. Among men testing at the mobile service, greater proportions of men receiving incentives were self-reported first-time testers (60.1% vs. 42.0%) and had advanced disease (14.9% vs. 7.5%) compared to men testing at non-incentivized mobile services. Furthermore, compared to the non-incentivized mobile service, the incentivized service was associated with a 3-fold greater yield of newly diagnosed HIV infections. This strong association persisted in analyses adjusted for age and first-time versus repeat testing (RR 2.33 95% CI 2.03–2.57]; p<0.001). Conclusions These findings suggest that incentivized mobile testing services may reach more previously untested men and significantly increase detection of HIV infection in men.

BackgroundHIV counseling and testing may serve as an entry point for non-communicable disease screening.ObjectivesTo determine the yield of newly-diagnosed HIV, tuberculosis (TB) symptoms, diabetes and hypertension, and to assess CD4 count testing, linkage to care as well as correlates of linkage and barriers to care from a mobile testing unit.MethodsA mobile unit provided screening for HIV, TB symptoms, diabetes and hypertension in Cape Town, South Africa between March 2010 and September 2011. The yield of newly-diagnosed cases of these conditions was measured and clients were followed-up between January and November 2011 to assess linkage. Linkage to care was defined as accessing care within one, three or six months post-HIV diagnosis (dependent on CD4 count) and one month post-diagnosis for other conditions. Clinical and socio-demographic correlates of linkage to care were evaluated using Poisson regression and barriers to care were determined.ResultsOf 9,806 clients screened, the yield of new diagnoses was: HIV (5.5%), TB suspects (10.1%), diabetes (0.8%) and hypertension (58.1%). Linkage to care for HIV-infected clients, TB suspects, diabetics and hypertensives was: 51.3%, 56.7%, 74.1% and 50.0%. Only disclosure of HIV-positive status to family members or partners (RR=2.6, 95% CI: 1.04-6.3, p=0.04) was independently associated with linkage to HIV care. The main barrier to care reported by all groups was lack of time to access a clinic.ConclusionScreening for HIV, TB symptoms and hypertension at mobile units in South Africa has a high yield but inadequate linkage. After-hours and weekend clinics may overcome a major barrier to accessing care.

Katharina Kranzer and colleagues investigate the operational characteristics of an active tuberculosis case-finding service linked to a mobile HIV testing unit that operates in underserviced areas in Cape Town, South Africa.