Rapid point-of-care CD4 testing at mobile HIV testing sites to increase linkage to care: an evaluation of a pilot program in South Africa.
BACKGROUND
A mobile HIV counseling and testing (HCT) program around Johannesburg piloted the integration of point-of-care (POC) CD4 testing, using the Pima analyzer, to improve linkages to HIV care. We report results from this pilot program for patients testing positive (n = 508) from May to October 2010.


METHODS
We analyzed 3 primary outcomes: assignment to testing group (offered POC CD4 or not), successful follow-up (by telephone), and completed the referral visit for HIV care within 8 weeks after HIV testing if successfully followed up. Proportions for each outcome were calculated, and relative risks were estimated using a modified Poisson approach.


RESULTS
Three hundred eleven patients were offered the POC CD4 test, and 197 patients were not offered the test. No differences in patient characteristics were observed between the 2 groups. Approximately 62.7% of patients were successfully followed up 8 weeks after HIV testing, with no differences observed between testing groups. Among those followed up, 54.4% reported completing their referral visit. Patients offered the POC CD4 test were more likely to complete the referral visit for further HIV care (relative risk 1.25, 95% confidence interval: 1.00 to 1.57).


CONCLUSIONS
In this mobile HCT setting, patients offered POC CD4 testing as part of the HCT services were more likely to visit a referral clinic after testing, suggesting that rapid CD4 testing technology may improve linkage to HIV care. Future research can evaluate options for adjusting HCT services if POC CD4 testing was included permanently and the cost-effectiveness of the POC CD4 testing compared with other approaches for improving linkage of care.
Department of International Health, Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA 02118, USA. blarson@bu.edu
Bruce A
BA
Larson
Kathryn
K
Schnippel
Buyiswa
B
Ndibongo
Thembisile
T
Xulu
Alana
A
Brennan
Lawrence
L
Long
Matthew P
MP
Fox
Sydney
S
Rosen
D000328:Adult; D018791:CD4 Lymphocyte Count / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008952:Mobile Health Units; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D019095:Point-of-Care Systems; D013019:South Africa