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Linkage to HIV Care From a Mobile Testing Unit in South Africa by Different CD4 Count Strata

Govindasamy, Darshini BSc (BioMedSc), Hons*,†; van Schaik, Nienke MBChB*; Kranzer, Katharina MBBS, MRCP(UK), MSc*,‡; Wood, Robin BSc, BM, MMed, FCP(SA)*,§; Mathews, Catherine PhD; Bekker, Linda-Gail MBChB, FCP(SA), PhD*,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2011 - Volume 58 - Issue 3 - p 344–352
doi: 10.1097/QAI.0b013e31822e0c4c
Epidemiology and Prevention

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 per microliter and 30% of individuals with CD4 counts >350 cells per microliter were sampled. Linkage to care was assessed during April to June 2010 in those who 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 per microliter, 66.7% in individuals with CD4 counts 201–350 cells per microliter, and 36.4% in those with CD4 counts >350 cells per microliter. A lower CD4 count, disclosure, symptoms of tuberculosis, and unemployment increased the likelihood of linking to care.

Conclusion Linkage to care was best among those eligible for antiretroviral therapy. Interventions designed at improving linkage among employed individuals are urgently warranted.

*Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine

School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

§Department of Medicine

Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town; and Health Systems Research Unit, Medical Research Council, Cape Town, South Africa

The authors have no conflicts of interest to disclose.

The project described was supported in part by R01 AI058736 from the National Institute of Allergy and Infectious Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIAID or the NIH.

Correspondence to: Darshini Govindasamy, BSc BioMedSc, (Hons), Institute of Infectious Disease and Molecular Medicine, Anzio Road, Observatory, Cape Town, Western Cape 7925, South Africa (e-mail:

Received March 9, 2011

Accepted July 15, 2011

© 2011 Lippincott Williams & Wilkins, Inc.