title: High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa.
abstract: OBJECTIVE
  For antiretroviral therapy (ART) to have a population-level HIV prevention impact, high levels of HIV testing and effective linkages to HIV care among HIV-infected persons are required.
  
  
  METHODS
  We piloted home-based counseling and testing (HBCT) with point-of-care CD4 count testing and follow-up visits to facilitate linkage of HIV-infected persons to local HIV clinics and uptake of ART in rural KwaZulu-Natal, South Africa. Lay counselor follow-up visits at months one, three and six evaluated the primary outcome of linkage to care. Plasma viral load was measured at baseline and month six.
  
  
  RESULTS
  671 adults were tested for HIV (91% coverage) and 201 (30%) were HIV-infected, of which 73 (36%) were new diagnoses. By month three, 90% of HIV-infected persons not on ART at baseline had visited an HIV clinic and 80% of those eligible for ART at baseline by South African guidelines (CD4≤200 cells/μL at the time of the study) had initiated ART. Among HIV-infected participants who were eligible for ART at baseline, mean viral load decreased by 3.23 log10 copies/mL (p<0.001) and the proportion with viral load suppression increased from 20% to 80% between baseline and month six.
  
  
  CONCLUSIONS
  In this pilot of HBCT and linkages to care in KwaZulu-Natal, 91% of adults were tested for HIV. Linkage to care was ∼90% both among newly-identified HIV-infected persons as well as known HIVinfected persons who were not engaged in care. Among those eligible for ART, a high proportion initiated ART and achieved viral suppression, indicating high adherence and reduced infectiousness.
authors.affiliation: Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa. hvanrooyen@hsrc.ac.za
authors.forename: Heidi
authors.initials: H
authors.lastname: van Rooyen
authors.forename: Ruanne V
authors.initials: RV
authors.lastname: Barnabas
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Zipho
authors.initials: Z
authors.lastname: Phakathi
authors.forename: Philip
authors.initials: P
authors.lastname: Joseph
authors.forename: Meighan
authors.initials: M
authors.lastname: Krows
authors.forename: Ting
authors.initials: T
authors.lastname: Hong
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Murnane
authors.forename: James
authors.initials: J
authors.lastname: Hughes
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003376:Counseling / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D019095:Point-of-Care Systems; D015995:Prevalence; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents