title: Linkage to care following community-based mobile HIV testing compared with clinic-based testing in Umlazi Township, Durban, South Africa.
abstract: OBJECTIVE
  The aim of the study was to assess HIV prevalence, disease stage and linkage to HIV care following diagnosis at a mobile HIV testing unit, compared with results for clinic-based testing, in a Durban township.
  
  
  METHODS
  This was a prospective cohort study. We enrolled adults presenting for HIV testing at a community-based mobile testing unit (mobile testers) and at an HIV clinic (clinic testers) serving the same area. Testers diagnosed with HIV infection, regardless of testing site, were offered immediate CD4 testing and instructed to retrieve results at the clinic. We assessed rates of linkage to care, defined as CD4 result retrieval within 90 days of HIV diagnosis and/or completion of antiretroviral therapy (ART) literacy training, for mobile vs. clinic testers.
  
  
  RESULTS
  From July to November 2011, 6957 subjects were HIV tested (4703 mobile and 2254 clinic); 55% were female. Mobile testers had a lower HIV prevalence than clinic testers (10% vs. 36%, respectively), were younger (median 23 vs. 27 years, respectively) and were more likely to live >5 km or >30 min from the clinic (64% vs. 40%, respectively; all P < 0.001). Mobile testers were less likely to undergo CD4 testing (33% vs. 83%, respectively) but more likely to have higher CD4 counts [median (interquartile range) 416 (287-587) cells/μL vs. 285 (136-482) cells/μL, respectively] than clinic testers (both P < 0.001). Of those who tested HIV positive, 10% of mobile testers linked to care, vs. 72% of clinic testers (P < 0.001).
  
  
  CONCLUSIONS
  Mobile HIV testing reaches people who are younger, who are more geographically remote, and who have earlier disease compared with clinic-based testing. Fewer mobile testers underwent CD4 testing and linked to HIV care. Enhancing linkage efforts may improve the impact of mobile testing for those with early HIV disease.
authors.affiliation: Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Center for AIDS Research, Harvard University, Boston, MA, USA.
authors.forename: I V
authors.initials: IV
authors.lastname: Bassett
authors.forename: S
authors.initials: S
authors.lastname: Regan
authors.forename: P
authors.initials: P
authors.lastname: Luthuli
authors.forename: H
authors.initials: H
authors.lastname: Mbonambi
authors.forename: B
authors.initials: B
authors.lastname: Bearnot
authors.forename: A
authors.initials: A
authors.lastname: Pendleton
authors.forename: M
authors.initials: M
authors.lastname: Robine
authors.forename: D
authors.initials: D
authors.lastname: Mukuvisi
authors.forename: H
authors.initials: H
authors.lastname: Thulare
authors.forename: R P
authors.initials: RP
authors.lastname: Walensky
authors.forename: K A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: E
authors.initials: E
authors.lastname: Losina
authors.forename: B
authors.initials: B
authors.lastname: Mhlongo
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008952:Mobile Health Units; D010353:Patient Education as Topic; D015995:Prevalence; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV/AIDS; South Africa; linkage to care; mobile HIV testing