Providing immediate CD4 count results at HIV testing improves ART initiation

  • Faal M
  • Naidoo N
  • Glencross D
 et al. 
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Abstract

Background: In South Africa, CD4 count results are typically available within a week of testing. However, 35%–55% of newly diagnosed HIV-positive patients do not return for their CD4 results and therefore, do not access further care.12 We evaluated the impact of a CD4 count result and patient written information provided immediately after diagnosis on retention in care. Methods: HIV-infected subjects were randomized to 3 arms; receipt of a CD4 result at time of HIV diagnosis, receipt of written information, and standard of care (CD4 collection after 1 week) or standard of care alone. The outcome of interest was enrollment for further care within 1 month for pre-antiretroviral therapy (ART) care or within 3 months for ART initiation. Secondary outcome was time taken from diagnosis to each stage of care pathway. Independent predictors of retention were assessed with multivariate analysis. Results: Three hundred forty-four patients recruited, of which 64.5% were females with a median age of 30 years (interquartile range: 27–35). Subjects were similar in age, gender, CD4 count, education, and employment status. Providing CD4 results at HIV diagnosis increases the likelihood of reporting for ART initiation (risk ratio = 2.1; 95% confidence interval = 1.39 to 3.17) compared with standard of care. Written information only reduced the time to presentation for pre-ART care although increasing age was associ- ated with retention. There was 49% attrition in the standard of care arms. Received for publication March 15, 2011; accepted July 28, 2011. From the *Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; †Department of Molecular Medicine and Hematology, University of Witwatersrand, Johannesburg, South Africa; and ‡National Laboratory Health Service, Johannesburg, South Africa. Funding for the study was made available through the President’s Emergency Plan for AIDS relief. The results of this article were presented in part at the XVIII International AIDS conference (poster presentation, July 20, 2010). M.F. was involved in the implementation of the study, data analysis, and interpretation, writing, and editing of the article. N.N. was involved in the conceptualization and implementation of the study and data analysis and editing of the article. D.K.G. was involved in implementing and coordinating on-site and laboratory CD4 testing and editing the article. W.D.F.V was involved in study design and editing of the article. R.O. conceptualized the study, supervised implementation, and assisted with data analysis, writing, and editing the article. Conclusions: Receipt of a CD4 count at the time of HIV testing increases ART initiation rates. Point-of-care diagnostics can be used to improve retention, but losses to pre-ART care remain high.

Author-supplied keywords

  • CD4 monitoring
  • loss to initiation
  • point-of-care CD4
  • point-of-care diagnostics
  • pre-ART loss to care
  • retention in care

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Authors

  • Mamsallah Faal

  • Nicolette Naidoo

  • Deborah K. Glencross

  • Willem D.F. Venter

  • Regina Osih

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