title: Linkage to HIV care from a mobile testing unit in South Africa by different CD4 count strata.
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.
  
  
  CONCLUSIONS
  Linkage to care was best among those eligible for antiretroviral therapy. Interventions designed at improving linkage among employed individuals are urgently warranted.
authors.affiliation: Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. gdarsh@gmail.com
authors.forename: Darshini
authors.initials: D
authors.lastname: Govindasamy
authors.forename: Nienke
authors.initials: N
authors.lastname: van Schaik
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Catherine
authors.initials: C
authors.lastname: Mathews
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D006302:Health Services Research / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008952:Mobile Health Units; D013019:South Africa