Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review

Eugene Ruzagira, Kathy Baisley, Anatoli Kamali, Samuel Biraro, Heiner Grosskurth, Alison Wringe, Connie Celum, Ruanne V. Barnabas, Heidi van Rooyen, Becky L. Genberg, Paula Braitstein, Samson Ndege, Gertrude Nakigozi, Lucy A. Parker, Niklaus D. Labhardt, Reshma Naik, Stan Becker, Christopher J. Hoffmann, Collins C. Iwuji, Joseph Larmarange & 1 others

Research output: Contribution to journalReview article

Abstract

Background: Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. Methods: Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. Results: A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8–9.8%] to 99.1% (95% CI, 96.9–99.9%). Linkage was generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1–21.8) to 77.8% (95% CI, 40.0–97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36–57.9%) to 94.9% (95% CI, 91.3–97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. Conclusion: Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials.

Original languageEnglish (US)
Pages (from-to)807-821
Number of pages15
JournalTropical Medicine and International Health
Volume22
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Africa South of the Sahara
Home Care Services
Counseling
HIV
Confidence Intervals
Trimethoprim-Sulfamethoxazole Combination
Referral and Consultation
CD4 Lymphocyte Count
Ambulatory Care
HIV Infections
Randomized Controlled Trials

Keywords

  • HIV/AIDS
  • home-based HIV counselling and testing
  • linkage to care
  • Uganda

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Ruzagira, E., Baisley, K., Kamali, A., Biraro, S., Grosskurth, H., Wringe, A., ... the Working Group on Linkage to HIV Care (2017). Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review. Tropical Medicine and International Health, 22(7), 807-821. DOI: 10.1111/tmi.12888

Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa : a systematic review. / Ruzagira, Eugene; Baisley, Kathy; Kamali, Anatoli; Biraro, Samuel; Grosskurth, Heiner; Wringe, Alison; Celum, Connie; Barnabas, Ruanne V.; van Rooyen, Heidi; Genberg, Becky L.; Braitstein, Paula; Ndege, Samson; Nakigozi, Gertrude; Parker, Lucy A.; Labhardt, Niklaus D.; Naik, Reshma; Becker, Stan; Hoffmann, Christopher J.; Iwuji, Collins C.; Larmarange, Joseph; the Working Group on Linkage to HIV Care.

In: Tropical Medicine and International Health, Vol. 22, No. 7, 01.07.2017, p. 807-821.

Research output: Contribution to journalReview article

Ruzagira, E, Baisley, K, Kamali, A, Biraro, S, Grosskurth, H, Wringe, A, Celum, C, Barnabas, RV, van Rooyen, H, Genberg, BL, Braitstein, P, Ndege, S, Nakigozi, G, Parker, LA, Labhardt, ND, Naik, R, Becker, S, Hoffmann, CJ, Iwuji, CC, Larmarange, J & the Working Group on Linkage to HIV Care 2017, 'Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review' Tropical Medicine and International Health, vol 22, no. 7, pp. 807-821. DOI: 10.1111/tmi.12888
Ruzagira E, Baisley K, Kamali A, Biraro S, Grosskurth H, Wringe A et al. Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review. Tropical Medicine and International Health. 2017 Jul 1;22(7):807-821. Available from, DOI: 10.1111/tmi.12888

Ruzagira, Eugene; Baisley, Kathy; Kamali, Anatoli; Biraro, Samuel; Grosskurth, Heiner; Wringe, Alison; Celum, Connie; Barnabas, Ruanne V.; van Rooyen, Heidi; Genberg, Becky L.; Braitstein, Paula; Ndege, Samson; Nakigozi, Gertrude; Parker, Lucy A.; Labhardt, Niklaus D.; Naik, Reshma; Becker, Stan; Hoffmann, Christopher J.; Iwuji, Collins C.; Larmarange, Joseph; the Working Group on Linkage to HIV Care / Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa : a systematic review.

In: Tropical Medicine and International Health, Vol. 22, No. 7, 01.07.2017, p. 807-821.

Research output: Contribution to journalReview article

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abstract = "Background: Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. Methods: Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. Results: A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8–9.8%] to 99.1% (95% CI, 96.9–99.9%). Linkage was generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1–21.8) to 77.8% (95% CI, 40.0–97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36–57.9%) to 94.9% (95% CI, 91.3–97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. Conclusion: Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials.",
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year = "2017",
month = "7",
doi = "10.1111/tmi.12888",
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TY - JOUR

T1 - Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa

T2 - Tropical Medicine and International Health

AU - Ruzagira,Eugene

AU - Baisley,Kathy

AU - Kamali,Anatoli

AU - Biraro,Samuel

AU - Grosskurth,Heiner

AU - Wringe,Alison

AU - Celum,Connie

AU - Barnabas,Ruanne V.

AU - van Rooyen,Heidi

AU - Genberg,Becky L.

AU - Braitstein,Paula

AU - Ndege,Samson

AU - Nakigozi,Gertrude

AU - Parker,Lucy A.

AU - Labhardt,Niklaus D.

AU - Naik,Reshma

AU - Becker,Stan

AU - Hoffmann,Christopher J.

AU - Iwuji,Collins C.

AU - Larmarange,Joseph

AU - the Working Group on Linkage to HIV Care

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background: Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. Methods: Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. Results: A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8–9.8%] to 99.1% (95% CI, 96.9–99.9%). Linkage was generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1–21.8) to 77.8% (95% CI, 40.0–97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36–57.9%) to 94.9% (95% CI, 91.3–97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. Conclusion: Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials.

AB - Background: Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. Methods: Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. Results: A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8–9.8%] to 99.1% (95% CI, 96.9–99.9%). Linkage was generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1–21.8) to 77.8% (95% CI, 40.0–97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36–57.9%) to 94.9% (95% CI, 91.3–97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. Conclusion: Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials.

KW - HIV/AIDS

KW - home-based HIV counselling and testing

KW - linkage to care

KW - Uganda

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DO - 10.1111/tmi.12888

M3 - Review article

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