Linkage to HIV Care and Antiretroviral Therapy in Cape Town, South Africa

BACKGROUND: Antiretroviral therapy (ART) has been scaled-up rapidly in Africa. Programme reports typically focus on loss to follow-up and mortality among patients receiving ART. However, little is known about linkage and retention in care of individuals prior to starting ART. METHODOLOGY: Data on adult residents from a periurban community in Cape Town were collected at a primary care clinic and hospital. HIV testing registers, CD4 count results provided by the National Health Laboratory System and ART registers were linked. A random sample (n = 885) was drawn from adults testing HIV positive through antenatal care, sexual transmitted disease and voluntary testing and counseling services between January 2004 and March 2009. All adults (n = 103) testing HIV positive through TB services during the same time period were also included in the study. Linkage to HIV care was defined as attending for a CD4 count measurement within 6 months of HIV diagnosis. Linkage to ART care was defined as initiating ART within 6 months of HIV diagnosis in individuals with a CD4 count ≤200 cells/µl taken within 6 months of HIV diagnosis. FINDINGS: Only 62.6% of individuals attended for a CD4 count measurement within 6 months of testing HIV positive. Individuals testing through sexually transmitted infection services had the best (84.1%) and individuals testing on their own initiative (53.5%) the worst linkage to HIV care. One third of individuals with timely CD4 counts were eligible for ART and 66.7% of those were successfully linked to ART care. Linkage to ART care was highest among antenatal care clients. Among individuals not yet eligible for ART only 46.3% had a repeat CD4 count. Linkage to HIV care improved in patients tested in more recent calendar period. CONCLUSION: Linkage to HIV and ART care was low in this poor peri-urban community despite free services available within close proximity. More efforts are needed to link VCT scale-up to subsequent care

Factors associated with linkage to HIV care (attending for a CD4 count measurement within 6 months of HIV diagnosis) stratified by service.

<p>ANC = antenatal care, STI = sexual transmitted infections, TB = tuberculosis, VCT = voluntary counseling and testing.</p><p>NA = not applicaple.</p

Number (%) of individuals who tested for HIV and who were found to be positive stratified by type of clinical service.

<p>All HIV testing records available for the period from January 2004 until March 2009 from adult patients were included in this analysis.</p><p>ANC = antenatal care, STI = sexual transmitted infections, TB = tuberculosis, VCT = voluntary counseling and testing.</p

Factors associated with having a CD4 count ≤200 cells/µl within 6 months of HIV diagnosis.

<p>ANC = antenatal care, STI = sexual transmitted infections, TB = tuberculosis, VCT = voluntary counseling and testing.</p

Percentage of individuals linking to HIV care (as defined by attending for a CD4 cell count measurement), distribution of CD4 count measurements, percentage of patients subsequently initiating ART and percentage of clients non-eligible for ART returning for a repeat CD4 count.

<p>ANC = antenatal care, STI = sexual transmitted infections, TB = tuberculosis, VCT = voluntary counseling and testing.</p