title: Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough.
abstract: Background. We evaluated whether a pilot program providing point-of-care (POC), but not rapid, CD4 testing (BD FACSCount) immediately after testing HIV-positive improved retention in care. Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period) to patients testing positive during January 2008-February 2009 (baseline period). The outcome for those with a ≤250 cells/mm(3) when testing HIV-positive was initiating ART <16 weeks after HIV testing. Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines). ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer. Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.
authors: Boston University Center for Global Health and Development, Boston University, Boston, MA 02118, USA ; Department of International Health, Boston University School of Public Health, Boston University, Boston, MA 02118, USA.
authors: Bruce A
authors: BA
authors: Larson
authors: Kathryn
authors: K
authors: Schnippel
authors: Alana
authors: A
authors: Brennan
authors: Lawrence
authors: L
authors: Long
authors: Thembi
authors: T
authors: Xulu
authors: Thapelo
authors: T
authors: Maotoe
authors: Sydney
authors: S
authors: Rosen
authors: Ian
authors: I
authors: Sanne
authors: Matthew P
authors: MP
authors: Fox
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