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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31822e0c4c
Epidemiology and Prevention

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*,§

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Abstract

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.

© 2011 Lippincott Williams & Wilkins, Inc.

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