title: Impact of systematic HIV testing on case finding and retention in care at a primary care clinic in South Africa.
abstract: OBJECTIVE
  Systematic, opt-out HIV counselling and testing (HCT) may diagnose individuals at lower levels of immunodeficiency but may impact loss to follow-up (LTFU) if healthier people are less motivated to engage and remain in HIV care. We explored LTFU and patient clinical outcomes under two different HIV testing strategies.
  
  
  METHODS
  We compared patient characteristics and retention in care between adults newly diagnosed with HIV by either voluntary counselling and testing (VCT) plus targeted provider-initiated counselling and testing (PITC) or systematic HCT at a primary care clinic in Johannesburg, South Africa.
  
  
  RESULTS
  One thousand one hundred and forty-four adults were newly diagnosed by VCT/PITC and 1124 by systematic HCT. Two-thirds of diagnoses were in women. Median CD4 count at HIV diagnosis (251 vs. 264 cells/μl, P = 0.19) and proportion of individuals eligible for antiretroviral therapy (ART) (67.2% vs. 66.7%, P = 0.80) did not differ by HCT strategy. Within 1 year of HIV diagnosis, half were LTFU: 50.5% under VCT/PITC and 49.6% under systematic HCT (P = 0.64). The overall hazard of LTFU was not affected by testing policy (aHR 0.98, 95%CI: 0.87-1.10). Independent of HCT strategy, males, younger adults and those ineligible for ART were at higher risk of LTFU.
  
  
  CONCLUSIONS
  Implementation of systematic HCT did not increase baseline CD4 count. Overall retention in the first year after HIV diagnosis was low (37.9%), especially among those ineligible for ART, but did not differ by testing strategy. Expansion of HIV testing should coincide with effective strategies to increase retention in care, especially among those not yet eligible for ART at initial diagnosis.
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Clouse
authors.forename: Colleen F
authors.initials: CF
authors.lastname: Hanrahan
authors.forename: Jean
authors.initials: J
authors.lastname: Bassett
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D000328:Adult; D000367:Age Factors; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D015995:Prevalence; D011320:Primary Health Care; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV counselling and testing; HIV/AIDS; VIH/SIDA; aconsejamiento y prueba voluntarios (APV); asesoramiento y prueba iniciado por el proveedor (APIP); conseil et dépistage (CD) du VIH; conseil et dépistage du VIH à l'initiative du prestataire (CDIP); conseil et dépistage volontaire (CDV); loss to follow-up; perte au suivi; provider-initiated HIV counselling and testing; pérdida durante el seguimiento (PDS); retención en cuidados; retention in care; rétention dans les soins; voluntary counselling and testing