CD4 Counts and Viral Loads of Newly Diagnosed HIV-Infected Individuals: Implications for Treatment as Prevention

Govender, Sarishen; Otwombe, Kennedy; Essien, Thandekile; Panchia, Ravindre; Bruyn, Guy de; Mohapi, Lerato; Gray, Glenda; Martinson, Neil

doi:10.1371/journal.pone.0090754

Cited by 25 publications

(18 citation statements)

References 16 publications

(18 reference statements)

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“…Gender differences in our study were consistent with several sources reporting on HCT (Govender et al, 2014;Govindassamy et al, 2013;May et al, 2010;Patten et al, 2013); most individuals referred to the call center were female (similar to Govindassamy et al, 2013), whom were more likely to link to care than males and had higher CD4 counts. Govindassamy et al (2013) reported a similar mean CD4 count (481) among women.…”

Section: Discussionsupporting

confidence: 90%

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Using a call center to encourage linkage to care following mobile HIV counseling and testing

2015

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Engaging newly diagnosed HIV+ individuals in treatment is a significant global challenge. As South Africa expands HIV counseling and testing (HCT) services, the growing numbers of people diagnosed with HIV will need innovative links to care approaches in order for treatment to be most effective. While definitions vary, we have defined "linkage to care" as connecting an HIV+ individual to medical care, so that CD4 cell test results are obtained and antiretroviral therapy (ART) eligibility assessed. The study is of HIV+ participants (n = 1096), from either Limpopo or Gauteng provinces from a "Links to Care" program. A two-pronged expanded HCT service was used, which included a community outreach approach to address HIV testing and a call center to encourage and track each patient's linkage to care post-HIV diagnosis. The majority of individuals (51%) were linked to care with a mean time to linkage of 31 days (with most individuals linked in less than 14 days). More females (54%) were linked to care than males (47%) and had higher CD4 cell counts than males; females had a mean CD4 cell count of 440, while males took longer to link to care and had a lower mean CD4 cell count of 331. Females of 23 years or younger had the lowest linkage rate of all females. Findings suggest that expanding HCT services to include innovative links to care approaches can improve linkage to care and subsequently impact HIV prevention.

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Section: Discussionsupporting

confidence: 90%

“…AIDS Care 923 have procured CD4 counts that were comparably high. Mugglin et al's (2012) meta-analysis found that among six studies median CD4 counts ranged between 154 and 274, and Govender et al (2014) found a median CD4 count of 364, both slightly lower than our median count of 370.…”

Section: Discussioncontrasting

confidence: 61%

Using a call center to encourage linkage to care following mobile HIV counseling and testing

2015

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“…Yield of HIV positive individuals (HIV positivity) was reported in 29 home studies 14,15,18,27,29–32,34,36,38,41–45,63,65,66,68,70–73,88,89 , one home with self-testing 11 , 12 mobile 10,13,68,72,92–95,97,98,103,107,114 , five campaign 46,47,76,77,120 , three workplace 79,80,121 , four key population 12,115,116,122 , four index partner 48–50,88 , 27 facility VCT 54–56,64,81,84,88,91–93,95,98,102,104–107,114,118–120,123–127 , and 17 facility PITC 56,57,59,60,81,83–88,99,110–113,126 studies. Community-based strategies for the general population had lower HIV positivity (6–11%) than facility HTC (18–20%), whereas targeted community HTC for key populations and sexual partners of index patients had the highest HIV yield (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The proportion of individuals with CD4 count of less than 350 cells μL −1 at HIV diagnosis was reported in 7 home 14,38,42,43,65,72,73 , 3 mobile 91,94,114 , 3 campaign 46,47,76 , 8 facility VCT 60,81,107,126,127,129–131 and 5 facility PITC studies 61,81,99,126,130 . Community-based strategies identified HIV-positive individuals at higher CD4 counts than facility HTC, with campaign having the lowest proportion with CD4 count less than 350 cells μL −1 (26%, 95% CI = 22–30%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

449

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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“…The different transition probabilities associated with different CD4 counts are primarily intended to distinguish the behaviour of people with <200 CD4 cells/lL (AIDS-stage infection) and also capture differences in mortality rates. We assume that people with AIDS-stage infection have a symptomatic testing rate above the standard testing rate for their population cohort, which gives us an estimated median CD4 count at diagnosis of 340 cells/lL in 2015, approximately on par with other studies [21,22]. We assume that treatment spots are first taken by those with lower CD4 counts, which give us a mean CD4 count at time of treatment initiation of 190 cells/ll, again comparable to other studies [21].…”

Section: Model Transitionsmentioning

confidence: 99%

The City of Johannesburg can end AIDS by 2030: modelling the impact of achieving the Fast‐Track targets and what it will take to get there

et al. 2018

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IntroductionIn 2014, city leaders from around the world endorsed the Paris Declaration on Fast‐Track Cities, pledging to achieve the 2020 and 2030 HIV targets championed by UNAIDS. The City of Johannesburg – one of South Africa's metropolitan municipalities and also a health district – has over 600,000 people living with HIV (PLHIV), more than any other city worldwide. We estimate what it would take in terms of programmatic targets and costs for the City of Johannesburg to meet the Fast‐Track targets, and demonstrate the impact that this would have.MethodsWe applied the Optima HIV epidemic and resource allocation model to demographic, epidemiological and behavioural data on 26 sub‐populations in Johannesburg. We used data on programme costs and coverage to produce baseline projections. We calculated how many people must be diagnosed, put onto treatment and maintained with viral suppression to achieve the 2020 and 2030 targets. We also estimated how treatment needs – and therefore fiscal commitments – could be reduced if the treatment targets are combined with primary HIV prevention interventions (voluntary medical male circumcision (VMMC), an expanded condom programme, and comprehensive packages for female sex workers (FSW) and young females).ResultsIf current programmatic coverage were maintained, Johannesburg could expect 303,000 new infections and 96,000 AIDS‐related deaths between 2017 and 2030 and 769,000 PLHIV by 2030. Achieving the Fast‐Track targets would require an additional 135,000 diagnoses and 232,000 people on treatment by 2020 (an increase in around 80% over 2016 treatment numbers), but would avert 176,000 infections and 56,500 deaths by 2030. Assuming stable ART unit costs, this would require ZAR 29 billion (USD 2.15 billion) in cumulative treatment investments over the 14 years to 2030. Plausible scale‐ups of other proven interventions (VMMC, condom distribution and FSW strategies) could yield additional reductions in new infections (between 4 and 15%), and in overall treatment investment needs. Scaling up VMMC in line with national targets is found to be cost‐effective in the medium term.ConclusionsThe scale‐up in testing and treatment programmes over this decade has been rapid, but these efforts must be doubled to reach 2020 targets. Strategic investments in proven interventions will help Johannesburg achieve the treatment targets and be on track to end AIDS by 2030.

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CD4 Counts and Viral Loads of Newly Diagnosed HIV-Infected Individuals: Implications for Treatment as Prevention

Cited by 25 publications

References 16 publications

Using a call center to encourage linkage to care following mobile HIV counseling and testing

Using a call center to encourage linkage to care following mobile HIV counseling and testing

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

The City of Johannesburg can end AIDS by 2030: modelling the impact of achieving the Fast‐Track targets and what it will take to get there

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