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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Linkage to HIV care and antiretroviral therapy in Cape Town, South Africa
PLoS ONE, Volume 5, No. 11, Article e13801, Year 2010
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Description
Background: Antiretroviral therapy (ART) has been scaled-up rapidly in Africa. Programme reports typically focus on loss to follow-up and mortality among patients receiving ART. However, little is known about linkage and retention in care of individuals prior to starting ART. Methodology: Data on adult residents from a periurban community in Cape Town were collected at a primary care clinic and hospital. HIV testing registers, CD4 count results provided by the National Health Laboratory System and ART registers were linked. A random sample (n = 885) was drawn from adults testing HIV positive through antenatal care, sexual transmitted disease and voluntary testing and counseling services between January 2004 and March 2009. All adults (n = 103) testing HIV positive through TB services during the same time period were also included in the study. Linkage to HIV care was defined as attending for a CD4 count measurement within 6 months of HIV diagnosis. Linkage to ART care was defined as initiating ART within 6 months of HIV diagnosis in individuals with a CD4 count ≤200 cells/ml taken within 6 months of HIV diagnosis. Findings: Only 62.6% of individuals attended for a CD4 count measurement within 6 months of testing HIV positive. Individuals testing through sexually transmitted infection services had the best (84.1%) and individuals testing on their own initiative (53.5%) the worst linkage to HIV care. One third of individuals with timely CD4 counts were eligible for ART and 66.7% of those were successfully linked to ART care. Linkage to ART care was highest among antenatal care clients. Among individuals not yet eligible for ART only 46.3% had a repeat CD4 count. Linkage to HIV care improved in patients tested in more recent calendar period. Conclusion: Linkage to HIV and ART care was low in this poor peri-urban community despite free services available within close proximity. More efforts are needed to link VCT scale-up to subsequent care. © 2010 Kranzer et al.
Authors & Co-Authors
Kranzer, Katharina A.
Unknown Affiliation
Zeinecker, Jennifer
Unknown Affiliation
Ginsberg, Philip
Unknown Affiliation
Orrell, Catherine J.
Unknown Affiliation
Kalawe, Nosindiso N.
Unknown Affiliation
Lawn, Stephen D.
Unknown Affiliation
Bekker, Linda-Gail Gail
Unknown Affiliation
Wood, Robin Y.
Unknown Affiliation
Statistics
Citations: 160
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0013801
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
South Africa