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Observational Study
. 2018 Dec;23(12):1384-1393.
doi: 10.1111/tmi.13153. Epub 2018 Oct 24.

Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014-2017

Affiliations
Observational Study

Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014-2017

Christopher T Rentsch et al. Trop Med Int Health. 2018 Dec.

Abstract

Objective: To measure linkage to care and antiretroviral therapy (ART) initiation among newly diagnosed individuals with HIV in a rural Tanzanian community.

Methods: We included all new HIV diagnoses of adults made between 2014 and 2017 during community- or facility-based HIV testing and counselling (HTC) in a rural ward in northwest Tanzania. Community-based HTC included population-level HIV serological testing (sero-survey), and facility-based HTC included a stationary, voluntary HTC clinic (VCT) and an antenatal clinic (ANC) offering provider-initiated HTC (ANC-PITC). Cox regression models were used to compare linkage to care rates by testing modality and identify associated factors. Among those in care, we compared initial CD4 cell counts and ART initiation rates by testing modality.

Results: A total of 411 adults were newly diagnosed, of whom 10% (27/265 sero-survey), 18% (3/14 facility-based ANC-PITC) and 53% (68/129 facility-based VCT) linked to care within 90 days. Individuals diagnosed using facility-based VCT were seven times (95% CI: 4.5-11.0) more likely to link to care than those diagnosed in the sero-survey. We found no difference in linkage rates between those diagnosed using facility-based ANC-PITC and sero-survey (P = 0.26). Among individuals in care, 63% of those in the sero-survey had an initial CD4 count >350 cells/mm3 vs. 29% of those using facility-based VCT (P = 0.02). The proportion who initiated ART within 1 year of linkage to care was similar for both groups (94% sero-survey vs. 85% facility-based VCT; P = 0.16).

Conclusions: Community-based sero-surveys are important for earlier diagnosis of HIV-positive individuals; however, interventions are essential to facilitate linkage to care.

Objectif: Mesurer le lien entre les soins et l'initiation au traitement antirétroviral (ART) chez les personnes nouvellement diagnostiquées avec le VIH dans une communauté rurale tanzanienne.

Méthodes: Nous avons inclus tous les nouveaux cas d'adultes diagnostiqués avec le VIH entre 2014 et 2017 lors de conseils et de dépistage (CD) du VIH en milieu communautaire ou en établissement dans un quartier rural du nord‐ouest de la Tanzanie. Le CD communautaire comprenait un dépistage sérologique du VIH au niveau de la population (séro‐surveillance) et le CD en établissement comprenait une clinique de conseil et dépistage stationnaire volontaire (CDV) et un CD à l'initiative du prestataire offrant une clinique prénatale (ANC‐CDIS). Les modèles de régression de Cox ont été utilisés pour comparer les taux de ralliement aux soins en testant la modalité pour identifier les facteurs associés. Parmi les personnes en soins, nous avons comparé la numération initiale des CD4 et les taux d'initiation à l'ART par la modalité de test.

Résultats: Un total de 411 adultes ont été nouvellement diagnostiqués, dont 10% (27/265) dans la séro‐ surveillance, 18% (3/14) dans l'ANC‐CDIS basée en établissement et 53% (68/129) dans le CDV en établissement ont été ralliés aux soins dans les 90 jours. Les personnes diagnostiquées à l'aide CDV en établissement étaient sept fois (IC95%: 4,5‐11,0) plus susceptibles d’être ralliées vers les soins que celles diagnostiquées dans la séro‐surveillance. Nous n'avons trouvé aucune différence dans les taux de ralliement entre celles diagnostiquées via l'ANC‐CDIS en établissement et via la séro‐surveillance (p = 0,26). Chez les personnes en soins, 63% de celles de la séro‐surveillance avaient une numération initiale des CD4 > 350 cellules/mm3 vs 29% de celles utilisant le CDV en établissement (p = 0,02). La proportion qui a initié l'ART dans l'année du ralliement aux soins était similaire pour les deux groupes (94% séro‐surveillances contre 85% CDV en établissement; p = 0,16).

Conclusions: Les séro‐surveillances communautaires sont importantes pour un diagnostic plus précoce des personnes VIH positives. Cependant, les interventions sont essentielles pour faciliter le lien avec les soins.

Keywords: Afrique subsaharienne; HIV; HIV testing; VIH; lien vers les soins; linkage to care; longitudinal studies; population surveillance; sub-Saharan Africa; surveillance de la population; test du VIH; études longitudinales.

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Figures

Figure 1
Figure 1
Location of sero‐survey clinics and Kisesa health centre in Kisesa, Tanzania. Sero‐survey – HIV serological surveillance survey; B6 – main road, paved. Notes: Kisesa health centre includes the HIV care and treatment centre (CTC), HIV testing and counselling clinic (HTC), and antenatal clinic (ANC); map courtesy of Jocelyn Poppinchalk. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Adjusted cumulative probability of registration for HIV care after first positive HIV diagnosis by testing modality in Kisesa, Tanzania between 2014 and 2017, n = 411. VCT – voluntary counselling and testing; facility‐based provider‐initiated counselling and testing had too few individuals for curve to be drawn; allowed for 90 days of follow‐up, no event >71 days; adjusted for sex, age, rurality of sub‐village (urban, peri‐urban, rural), whether the sub‐village had access to a paved road, and distance between household and Kisesa health centre.

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