Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Larson, Bruce A.; Brennan, Alana T.; McNamara, Lynne; Long, Lawrence; Rosen, Sydney; Sanne, Ian; Fox, Matthew P.

doi:10.2471/blt.09.068981

Cited by 60 publications

(49 citation statements)

References 16 publications

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“…Linkage was reported for ten home 14,15,29,34,41–43,65,72,132 , six mobile 72,91,92,94,133–135 , two campaign 76,77 , eight facility VCT 56,81,84,91,92,123,126,136 and five facility PITC studies 60,84,87,111,126 . Home and campaign interventions achieved a high proportion of individuals linked (95%, 95% CI = 87–98%) when paired with facilitated linkage to care strategies (for example lay-counsellor follow up to encourage clinic visit); interventions without facilitated linkage achieved lower proportions of HIV positive individuals visiting a clinic (26%, 95% CI = 18–36%) (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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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

View full text Add to dashboard Cite

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“…Delaying entry to care has been associated with lower CD4 cell counts (Mugglin et al, 2012;Patten et al, 2013) and subsequently hastened mortality (Kayigamba, Bakker, Fikse, Mugisha, & Asiimwe, 2012;Larson et al, 2010); yet mobile testing has been shown to detect HIV at earlier stages of the disease cycle, as evidenced by higher CD4 counts (Bassett, Govindassamy, et al, 2014). Our mobile HCT study appears to Figure 2.…”

Section: Discussionmentioning

confidence: 68%

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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“…It is apparent that there is a substantial loss of patient follow-up between HIV testing and ART initiation. 13 This may be prevented by making CD4 cell count results immediately available after HIV testing through point-of-care testing facilities. 14−16 This concept has been supported by a meta-analysis study, in which 15 sub-Saharan studies were reviewed and it was concluded that point-of-care CD4 testing increased patient retention in care, which may result in an upscale of ART.…”

Section: Discussionmentioning

confidence: 99%

The use of readily available biomarkers to predict CD4 cell counts in HIV-infected individuals

Moolla

Reddy³

et al. 2015

South African Family Practice

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Background:The use of readily available biochemical investigations to predict the CD4 cell count in HIV-infected patients may provide clinicians with insight regarding disease severity at first contact. The aims of the study were to determine the relationship of calculated globulin and white cell count (WCC) with CD4 cell count. Methods: Data were collected prospectively from ambulatory HIV-infected, anti-retro viral therapy (ART) naive patients at the HIV clinic of King Edward Hospital, Durban, between 2010 and 2012. Results: The mean age of the participants was 39 ± 9.53 years and 70% were female. Median calculated globulin and WCC was 49 g/l and 4.74 × 10 9 cells/l respectively, whilst the CD4 cell count was 244 cells/mm 3 . A significant positive correlation was demonstrated between CD4 cell count and WCC (r = 0.25, p < 0.001). WCC and albumin were identified as potential surrogate markers for CD4 count ≤ 200 cells/mm 3 . Combination of WCC with either albumin or globulin predicts a CD4 count of less than 200 cells/ mm 3 with moderate accuracy. Conclusion:The use of combined biomarkers may influence initiation of Pneumocystis jiroveci pneumonia prophylaxis in resource-limited settings. Further evaluation is warranted to assess the role of these markers in disease progression and ART.

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Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Cited by 60 publications

References 16 publications

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

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

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

The use of readily available biomarkers to predict CD4 cell counts in HIV-infected individuals

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