Linkage to HIV care and survival following inpatient HIV counseling and testing.
Linkage to HIV care and survival in sub-Saharan Africa is not well documented. In 2004 we conducted a randomized trial among medical inpatients in Mulago Hospital to assess the impact of HIV counseling and testing (HCT) on linkage to care and survival. Participants were randomized to inpatient HCT (intervention) or outpatient HCT 1 week post-discharge (control); inpatient HCT was not available at Mulago during the study. Among 590 eligible patients, 85% (500) agreed to participate; 98.8% (248) in the intervention arm received HCT compared to 68.7% (171) in the control arm. Within 6 months, 62.2% (92) of surviving HIV-infected participants received HIV care; 15.0% (20) received antiretroviral medications (ARVs). Overall mortality among HIV-infected participants was 34.6% (72). HCT had significant impact on linkage to care among surviving participants. Referral for HCT was a missed opportunity for diagnosis. There is need for earlier diagnosis and linkage to HIV care among inpatients.
Wanyenze
Rhoda K
RK
Makerere University School of Public Health, Kampala, Uganda. rwanyenze@hotmail.com
Hahn
Judith A
JA
Liechty
Cheryl A
CA
Ragland
Kathie
K
Ronald
Allan
A
Mayanja-Kizza
Harriet
H
Coates
Thomas
T
Kamya
Moses R
MR
Bangsberg
David R
DR
D015492:AIDS Serodiagnosis; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006297:Health Services Accessibility; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents