Dr. Elizabeth Kelvin, a professor at CUNY School of Public Health and colleagues examined the timely linkage to care of newly-diagnosed HIV+ individuals in South Africa. The findings were published in the journal PLoS One.
Current World Health Organization guidelines recommend initiating anti-retroviral treatment regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. The research team evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study.
Individuals (N = 2773) were interviewed prior to HIV counseling and testing at three public sector primary care clinics in the greater Durban area; 785 were newly-diagnosed and eligible for the cohort study; 459 (58.5%) joined and were followed for eight months with three structured assessments. Linkage to care, defined as returning to clinic for CD4+ count results, and day-of-diagnosis blood draw were self-reported.
Overall, 72.5 percent did not have a day-of-diagnosis CD4+ count blood draw, and 19.2 percent of these never returned. Compared with a day-of-diagnosis blood draw, the adjusted hazard ratio of linkage associated with not having day-of-diagnosis blood draw was 0.66. By 4 months, 54.8 percent of those without day-of-diagnosis blood draw vs. 75.2percent with one were linked to care. Of those who deferred blood draw, 48.3percent cited clinic-related and 51.7percent cited personal reasons.
Newly-diagnosed HIV+ individuals who did not undergo CD4+ count blood draw on the day they were diagnosed, regardless of the reason for deferring, had delayed linkage to care relative to those with same-day blood draw. The research team concluded that to enhance prompt linkage to care even when test and treat protocols are implemented, all diagnostic testing required before anti-retroviral treatment initiation should be performed on the same day as HIV testing/diagnosis. They noted that to implement this may require modifying clinic procedures to enable overnight blood storage if same-day draws cannot be performed, and providing additional counseling to encourage newly-diagnosed individuals to complete day-of-diagnosis testing.