Linkage to HIV Care After Home-Based HIV Counselling and Testing in Sub-Saharan Africa: A Systematic Review

June 2017 - Combination Prevention

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Ruzagira, E., Baisley, K., Kamali, A., et al. Tropical Medicine & International Health (April 2017), e-publication ahead of print, doi:10.1111/tmi.12888.

Home-based HIV counseling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), supporting 90-90-90 objectives. However, data on linkage to HIV care after HBHCT are scarce. This systematic review examined linkage to care after HBHCT in SSA—specifically, initiation of cotrimoxazole (CTX) prophylaxis and antiretroviral therapy (ART). The authors identified 14 eligible studies from six countries. HIV-positive clients were referred for care in all studies; nine studies described specific strategies for facilitating linkage. Time intervals for ascertaining linkage ranged from one week to 12 months post-HBHCT. Linkage rates varied widely (from 8.2% to 99.1%), and were generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Of the 14 studies, 5 included data on CTX prophylaxis and 12 on ART initiation. CTX uptake among those eligible ranged from 0 to 100 percent. ART initiation also varied: among those eligible, the proportion starting ART ranged from 14.3 percent to 94.9 percent. The authors concluded that few studies from SSA have investigated linkage to care among adults newly diagnosed with HIV through HBHCT. They called for randomized controlled trials to confirm the effectiveness of linkage strategies.

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