High HIV Testing Uptake and Linkage to Care in a Novel Program of Home-Based HIV Counseling and Testing With Facilitated Referral in KwaZulu-Natal, South Africa

September 2013 - Combination Prevention

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van Rooyen, H., Barnabas, R.V., Baeten, J.M., et al., Journal of Acquired Immune Deficiency Syndromes (September 2013), Vol. 64 No. 1

The authors assessed an innovative model of home-based counseling and testing (HBCT), HBCT Plus –included point-of-care (POC) CD4 testing and referrals to HIV care in rural KwaZulu-Natal, to determine if the model achieved high testing coverage; reached persons unaware of their HIV status; and reduced infectiousness and barriers to accessing HIV care through antiretroviral therapy (ART) adherence. HBCT Plus achieved high uptake of HIV testing and increased knowledge of HIV status; POC CD4 testing, referral, and follow-up from lay counselors attained nearly 100 percent linkage to HIV care and ART initiation. From March 2011 to March 2012, 671 participants were tested; of these, 201 were HIV-positive, and 73 (36 percent) newly identified as positive.  The number of participants reporting ever visiting a HIV clinic increased from 116 (57 percent) to 196 (96 percent) at baseline and six-month follow-up, respectively. At follow-up, there was a significant reduction in the mean HIV viral load, and an increase in the proportion with a viral load <1000 copies per milliliter among those ART-eligible. The model could be combined with other effective mobile testing strategies; and while it is promising, its impact and cost-effectiveness should be assessed in remote areas with greater distances to referral clinics to inform national HIV programs.

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