Rapid point-of-care CD4 testing at mobile units and linkage to HIV care : an evaluation of community-based mobile HIV testing services in South Africa
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Mobile HIV testing services (HTS) are effective at reaching undiagnosed people living with HIV.
However, linkage to HIV care from mobile HTS is often poor, ranging from 10 to 60%. Point-of-care (POC) CD4
testing has shown to increase retention in health facilities, but little evidence exists about their use in mobile HTS.
This study assessed the feasibility of POC CD4 test implementation and investigated linkage to HIV care among
clients accepting a POC test at community-based mobile HTS.
Methods: This retrospective study used routinely collected data from clients who utilized community-based mobile
HTS in the City of Cape Town Metropolitan district, South Africa between December 2014 and September 2016. A
POC CD4 test was offered to all clients with an HIV positive diagnosis during this period, and a CD4 cell count was
provided to clients accepting a POC CD4 test. Random effects logistic regression was used to assess factors
associated with POC CD4 test uptake and self-reported linkage to care among clients accepting a POC test. Models
were adjusted for sex, age, previous HIV test done, tuberculosis status and year of HIV diagnosis.
Results: One thousand three hundred twenty-five of Thirty-nine thousand seven hundred ninety clients utilizing
mobile HTS tested HIV positive (3%). 51% (679/1325) accepted a POC test. The age group with the highest
proportion accepting a POC test was 50+ years (60%). Females were less likely to accept a POC test than males
(odds ratio = 0.7, 95%CI = 0.6–0.8). Median CD4 count was 429 cells/μl (interquartile range = 290–584). Among 679
clients who accepted a POC CD4 test, 491 (72%) linked to HIV care. CD4 cell count was not associated with linkage
to care.
Conclusion: Our findings suggest that mobile HTS can identify early HIV infection, and show that a high proportion
of clients with a POC test result linked to care. Future research should assess factors associated with POC test
acceptance and assess the impact of POC CD4 testing in comparison to alternative strategies to engage HIV
positive people in care.
Description
CITATION: Sloot, R., et al. 2020. Rapid point-of-care CD4 testing at mobile units and linkage to HIV care : an evaluation of community-based mobile HIV testing services in South Africa. BMC Public Health, 20:528, doi:10.1186/s12889-020-08643-3.
The original publication is available at https://bmcpublichealth.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at https://bmcpublichealth.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
HIV (Viruses) -- Testing -- South Africa, Mobile health services -- South Africa, Point-of-care testing -- South Africa, CD4 antigen -- Testing -- South Africa, HIV-positive persons -- Services for -- South Africa, HIV-positive persons -- Medical care -- South Africa
Citation
Sloot, R., et al. 2020. Rapid point-of-care CD4 testing at mobile units and linkage to HIV care : an evaluation of community-based mobile HIV testing services in South Africa. BMC Public Health, 20:528, doi:10.1186/s12889-020-08643-3