Incentivized recruitment of a population sample to a mobile HIV testing service increases the yield of newly diagnosed cases, including those in need of antiretroviral therapy

Abstract

Objective The aim of the study was to compare the yields of newly diagnosed cases of HIV infection and advanced immunodeficiency between individuals attending a mobile HIV counselling and testing (HCT) service as participants in a population-based HIV seroprevalence survey and those accessing the same service as volunteers for routine testing. Methods The study was conducted in a peri-urban township within the Cape Metropolitan Region, South Africa. Survey participants (recruited testers) were randomly selected, visited at home and invited to attend the mobile HCT service. They received 70 South African Rand food vouchers for participating in the survey, but could choose to test anonymously. The yield of HIV diagnoses was compared with that detected in members of the community who voluntarily attended the same HIV testing facility prior to the survey and did not receive incentives (voluntary testers). Results A total of 1813 individuals were included in the analysis (936 recruited and 877 voluntary testers). The prevalence of newly diagnosed HIV infection was 10.9% [95% confidence interval (CI) 9.0–13.1%] among recruited testers and 5.0% (3.7–6.7%) among voluntary testers. The prevalence of severe immune deficiency (CD4 count ≤200 cells/μL) among recruited and voluntary testers was 17.8% (10.9–26.7%) and 4.6% (0.0–15.4%), respectively. Linkage to HIV care in recruited testers with CD4 counts ≤350 cells/μL was 78.8%. Conclusion Compared with routine voluntary HCT, selection and invitation in combination with incentives doubled the yield of newly diagnosed HIV infections and increased the yield almost fourfold of individuals needing antiretroviral therapy. This may be an important strategy to increase community-based HIV diagnosis and access to care.

Provision of Antiretroviral Therapy in South Africa: The Nuts and Bolts

“…As documented in other parts of the world, the South African 'treatment cascade', whereby individuals who test positive are linked to care, attain viral suppression and remain in care, is also associated with significant 'leakage' or loss of PLHIV at each stage in the process [51]. Innovative methods such as community-based follow up and cell phone messaging have been explored to enhance linkage to care [52][53][54]. As the treatment pool expands, more innovation in retaining and tracking individuals in care are required.…”

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

“…Numerous studies based their follow-up times on CD4 stratums (lower counts receiving fastest follow-up, etc.). For example, Krazner et al (2012) reported a linkage rate of 78% among mobile HCT testers near Cape Town, but linkage follow-up occurred at 4 and 12 weeks respective to CD4 cell stratum, and there was a much smaller sample size. Govindassamy et al (2013) also tracked linkage rates by CD4 stratum, finding in the Western Cape, South Africa, that at one month only 37% of individuals had linked to care.…”

Factor Influencing HIV Care Continuum among People Living with HIV in Western Kenya

“…Previously loss of patients along the HIV care continuum has been demonstrated [5] but less is known about the predictors of the uptake of the HIV care continuum among PLWHA in regions with high HIV burden. In this study a majority of the patients were linked to HIV care verbally or were given referral form to the next step of care with a few being escorted to the HIV care and treatment clinics.…”

“…Therefore, effective HIV treatment and prevention programs requires that HIV counseling and testing (HTC) services and linkages of patients to HIV care and support to reduce HIV associated morbidity and mortality [4], especially in sub-Saharan Africa where 1.5 million cases of new HIV infection occur annually [5,6]. However, in this region only a third of adults have tested for HIV and even among those who have tested positive only a few are on ART [4,7].…”