Linkage to HIV, TB and non-communicable disease care from a mobile testing unit in Cape Town, South Africa.
BACKGROUND
HIV counseling and testing may serve as an entry point for non-communicable disease screening.


OBJECTIVE
To determine the yield of newly-diagnosed HIV, tuberculosis (TB) symptoms, diabetes and hypertension, and to assess CD4 count testing, linkage to care as well as correlates of linkage and barriers to care from a mobile testing unit.


METHODS
A mobile unit provided screening for HIV, TB symptoms, diabetes and hypertension in Cape Town, South Africa between March 2010 and September 2011. The yield of newly-diagnosed cases of these conditions was measured and clients were followed-up between January and November 2011 to assess linkage. Linkage to care was defined as accessing care within one, three or six months post-HIV diagnosis (dependent on CD4 count) and one month post-diagnosis for other conditions. Clinical and socio-demographic correlates of linkage to care were evaluated using Poisson regression and barriers to care were determined.


RESULTS
Of 9,806 clients screened, the yield of new diagnoses was: HIV (5.5%), TB suspects (10.1%), diabetes (0.8%) and hypertension (58.1%). Linkage to care for HIV-infected clients, TB suspects, diabetics and hypertensives was: 51.3%, 56.7%, 74.1% and 50.0%. Only disclosure of HIV-positive status to family members or partners (RR=2.6, 95% CI: 1.04-6.3, p=0.04) was independently associated with linkage to HIV care. The main barrier to care reported by all groups was lack of time to access a clinic.


CONCLUSIONS
Screening for HIV, TB symptoms and hypertension at mobile units in South Africa has a high yield but inadequate linkage. After-hours and weekend clinics may overcome a major barrier to accessing care.
Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Darshini
D
Govindasamy
Katharina
K
Kranzer
Nienke
N
van Schaik
Farzad
F
Noubary
Robin
R
Wood
Rochelle P
RP
Walensky
Kenneth A
KA
Freedberg
Ingrid V
IV
Bassett
Linda-Gail
LG
Bekker
D000328:Adult; D000554:Ambulatory Care Facilities; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003376:Counseling; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D013019:South Africa; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult