Strategies to Accelerate HIV Care and Antiretroviral Therapy Initiation after HIV Diagnosis: A Randomized Trial

Christopher J. Hoffmann, Tonderai Mabuto, Sibuse Ginindza, Katherine L. Fielding, Griffths Kubeka, David W. Dowdy, Gavin J. Churchyard, Salome Charalambous

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Determine the effectiveness of strategies to increase linkage to care after testing HIV positive at mobile HIV testing in South Africa. Design: Unmasked randomized controlled trial. Methods: Recruitment of adults testing HIV positive and not currently in HIV care occurred at 7 mobile HIV counseling and testing units in urban, periurban, and rural South Africa with those consenting randomized 1:1:1:1 into 1 of 4 arms. Three strategies were compared with standard of care (SOC): point-of-care CD4 count testing (POC CD4), POC CD4 plus longitudinal strengths-based counseling (care facilitation; CF), and POC CD4 plus transport reimbursement (transport). Participants were followed up telephonically and through clinic records and analyzed with an intention-to-treat analysis. Results: From March 2013 to October 2014, 2558 participants were enrolled, of whom 160 were excluded postrandomization. Compared with the SOC arm where 298 (50%) reported having entered care, linkage to care was 319 (52%) for POC CD4, hazard ratio (HR) 1.0 [95% confidence interval (CI): 0.89 to 1.2, P = 0.6]; 331 (55%) for CF, HR: 1.1 (95% CI: 0.84 to 1.3, P = 0.2); and 291 (49%) for transport, HR 0.97 (95% CI: 0.83 to 1.1, P = 0.7). Linkage to care verified with clinical records that occurred for 172 (29%) in the SOC arm; 187 (31%) in the POC CD4 arm, HR: 1.0 (95% CI: 0.86 to 1.3, P = 0.6); 225 (38%) in the CF arm, HR: 1.4 (95% CI: 1.1 to 1.7, P = 0.001); and 180 (31%) in the transport arm, HR: 1.1 (95% CI: 0.88 to 1.3, P = 0.5). Conclusions: CF improved verified linkage to care from 29% to 38%.

Original languageEnglish (US)
Pages (from-to)540-547
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume75
Issue number5
DOIs
StatePublished - Aug 15 2017

Keywords

  • Africa
  • HIV
  • counseling
  • linkage to care
  • randomized trial
  • transportation

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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