Patient enrolment into HIV care and treatment within 90 days of HIV diagnosis in eight Rwandan health facilities: a review of facility-based registers

• Published in: PloS one Vol. 7; no. 5; p. e36792
• Main Authors: Kayigamba, Felix R, Bakker, Mirjam I, Fikse, Hadassa, Mugisha, Veronicah, Asiimwe, Anita, Schim van der Loeff, Maarten F
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.05.2012; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Adults; AIDS; Ambulatory Care; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biomedical research; CD4 antigen; CD4 Lymphocyte Count; Child; Child, Preschool; Clinical outcomes; Clinics; Cohort analysis; Diagnosis; Drug therapy; Female; Females; Health aspects; Health care facilities; Health Facilities; Health services; Health Services Accessibility; Highly active antiretroviral therapy; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - immunology; HIV patients; Human immunodeficiency virus; Humans; Infant; Low income groups; Male; Medical diagnosis; Medical research; Medical tests; Medicine; Middle Aged; Mortality; National Health Programs; Patients; Public health; Rwanda; Sexually transmitted diseases; STD; Time Factors; Tuberculosis; Young Adult; Rwanda; Uganda; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0036792

Access to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda. Data were obtained from routine clinic registers from eight health facilities in Rwanda on patients who were diagnosed with HIV at the antenatal care, voluntary counselling-and-testing, outpatient or tuberculosis departments between March and May 2009. The proportion of patients enrolled into HIV care and treatment was calculated as the number of HIV infected patients registered in ART clinics for follow-up care and treatment within 90 days of HIV diagnosis divided by the total number of persons diagnosed with HIV in the study period. Out of 482 patients diagnosed with HIV in the study period, 339 (70%) were females, and the median age was 29 years (interquartile range [IQR] 24-37). 201 (42%) enrolled into care and treatment within 90 days of HIV diagnosis. The median time between testing and enrolment was six days (IQR 2-14). Enrolment in care and treatment was not significantly associated with age, sex, or department of testing, but was associated with study site. None of those enrolled were in WHO stage 4. The median CD4 cell count among adult patients was 387 cells/mm(3) (IQR: 242-533 cells/mm(3)); 81 of 170 adult patients (48%) were eligible to start ART (CD4 count<350 cells/mm(3) or WHO stage 4). Among those eligible, 45 (56%) started treatment within 90 days of HIV diagnosis. Less than 50% of diagnosed HIV patients from eight Rwandan health facilities had enrolled into care and treatment within 90 days of diagnosis. Improving linkage to care and treatment after HIV diagnosis is needed to harness the full potential of ART.