Providing immediate CD4 count results at HIV testing improves ART initiation

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 58; no. 3; p. e54
• Main Authors: Faal, Mamsallah, Naidoo, Nicolette, Glencross, Deborah K, Venter, Willem D F, Osih, Regina
• Format: Journal Article
• Language: English
• Published: United States 01.11.2011
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - immunology; Humans; Male; South Africa; Time Factors; South Africa
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0b013e3182303921

In South Africa, CD4 count results are typically available within a week of testing. However, 35%-55% of newly diagnosed HIV-positive patients do not return for their CD4 results and therefore, do not access further care. We evaluated the impact of a CD4 count result and patient written information provided immediately after diagnosis on retention in care. HIV-infected subjects were randomized to 3 arms; receipt of a CD4 result at time of HIV diagnosis, receipt of written information, and standard of care (CD4 collection after 1 week) or standard of care alone. The outcome of interest was enrollment for further care within 1 month for pre-antiretroviral therapy (ART) care or within 3 months for ART initiation. Secondary outcome was time taken from diagnosis to each stage of care pathway. Independent predictors of retention were assessed with multivariate analysis. Three hundred forty-four patients recruited, of which 64.5% were females with a median age of 30 years (interquartile range: 27-35). Subjects were similar in age, gender, CD4 count, education, and employment status. Providing CD4 results at HIV diagnosis increases the likelihood of reporting for ART initiation (risk ratio = 2.1; 95% confidence interval = 1.39 to 3.17) compared with standard of care. Written information only reduced the time to presentation for pre-ART care although increasing age was associated with retention. There was 49% attrition in the standard of care arms. Receipt of a CD4 count at the time of HIV testing increases ART initiation rates. Point-of-care diagnostics can be used to improve retention, but losses to pre-ART care remain high.