Determinants of Time from HIV Infection to Linkage-to-Care in Rural KwaZulu-Natal, South Africa

May 2017 - Combination Prevention

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Maheu-Giroux, M., Tanser, F., Boily, M.C., et al. AIDS (April 2017), 31(7):1017–1024, doi:10.1097/QAD.0000000000001435.

Traditionally, the time of linkage to care has been defined using HIV diagnosis as the starting point. The authors of this study estimated the time elapsing between HIV infection and linkage to care, and sought to identify factors that determined this time. They used longitudinal HIV serosurvey data from a large population-based HIV incidence cohort in KwaZulu-Natal, South Africa (2004–2013) to estimate time of HIV infection; they then linked these data to patient records from a public-sector HIV treatment and care program to determine time from infection to linkage. They also examined various factors (sex, age, education, food security, economic status, and others) in terms on their effect on the time to linkage. They found an average lapse of 4.9 years for half (50%) of HIV seroconverters to be linked to care. For all cohort members who were linked to care, the median CD4 cell count at linkage was 350 cells/μl. Women comprised 76.9 percent of seroconverters; but men and participants below age 30 were found to have the slowest rates of linkage to care. The authors concluded that the average time from HIV infection to linkage to care is long and must be reduced to ensure the effectiveness of HIV treatment-as-prevention policies. They said that targeted interventions for men and young individuals have the largest potential to improve linkage rates.

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