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Open Access Research article

A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa

Natalie Leon1*, Catherine Mathews12, Simon Lewin13, Meg Osler4, Andrew Boulle45 and Carl Lombard6

Author Affiliations

1 Health Systems Research Unit (HSRU), Medical Research Council of South Africa (MRC), P.O. Box 19070, Tygerberg, 7507 Cape Town, Western Cape Province, Republic of South Africa

2 School of Public Health and Family Medicine, University of Cape Town (UCT), Cape Town, Western Cape Province, Republic of South Africa

3 Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway

4 Centre for Infectious Disease Epidemiology and Research (CIDER), UCT, Cape Town, Western Cape Province, Republic of South Africa

5 Provincial Government of the Western Cape (PGWC), Cape Town, Western Cape Province, Republic of South Africa

6 Biostatistics Unit, MRC, Cape Town, Western Cape Province, Republic of South Africa

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BMC Health Services Research 2014, 14:350  doi:10.1186/1472-6963-14-350

Published: 18 August 2014

Abstract

Background

We examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care.

Methods

In a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms.

Results

There was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007).

Conclusion

The PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies.

Trial registration

Current Controlled Trials ISRCTN93692532

Keywords:
Routine HIV screening; Linkage to HIV care; Sexually transmitted infections; Controlled trial; South Africa