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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Abbreviated HIV counselling and testing and enhanced referral to care in Uganda: A factorial randomised controlled trial
The Lancet Global Health, Volume 1, No. 3, Year 2013
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Description
Background: HIV counselling and testing and linkage to care are crucial for successful HIV prevention and treatment. Abbreviated counselling could save time; however, its effect on HIV risk is uncertain and methods to improve linkage to care have not been studied. Methods: We did this factorial randomised controlled study at Mulago Hospital, Uganda. Participants were randomly assigned to abbreviated or traditional HIV counselling and testing; HIV-infected patients were randomly assigned to enhanced linkage to care or standard linkage to care. All study personnel except counsellors and the data officer were masked to study group assignment. Participants had structured interviews, given once every 3 months. We compared sexual risk behaviour by counselling strategy with a 6·5% non-inferiority margin. We used Cox proportional hazards analyses to compare HIV outcomes by linkage to care over 1 year and tested for interaction by sex. This trial is registered with ClinicalTrials.gov (NCT00648232). Findings: We enrolled 3415 participants; 1707 assigned to abbreviated counselling versus 1708 assigned to traditional. Unprotected sex with an HIV discordant or status unknown partner was similar in each group (232/823 [27·9%] vs 251/890 [28·2%], difference -0·3%, one-sided 95% CI 3·2). Loss to follow-up was lower for traditional counselling than for abbreviated counselling (adjusted hazard ratio [HR] 0·61, 95% CI 0·44-0·83). 1003 HIV-positive participants were assigned to enhanced linkage (n=504) or standard linkage to care (n=499). Linkage to care did not have a significant effect on mortality or receipt of co-trimoxazole. Time to treatment in men with CD4 cell counts of 250 cells per μL or fewer was lower for enhanced linkage versus standard linkage (adjusted HR 0·60, 95% CI 0·41-0·87) and time to HIV care was decreased among women (0·80, 0·66-0·96). Interpretation: Abbreviated HIV counselling and testing did not adversely affect risk behaviour. Linkage to care interventions might decrease time to enrolment in HIV care and antiretroviral treatment and thus might affect secondary HIV transmission and improve treatment outcomes. Funding: US National Institute of Mental Health. © 2013 Wanyenze et al. Open Access article distributed under the terms of CC BY.
Authors & Co-Authors
Wanyenze, Rhoda Kitti
Uganda, Kampala
Makerere University School of Public Health
Kamya, Moses Robert K.
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Fatch, Robin S.
United States, San Francisco
Ucsf School of Medicine
Mayanja-Kizza, Harriet
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Baveewo, Steven
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Szekeres, Greg
United States, Los Angeles
David Geffen School of Medicine at Ucla
Bangsberg, David R.
United States, Boston
Massachusetts General Hospital
Coates, Thomas J.
United States, Los Angeles
David Geffen School of Medicine at Ucla
Hahn, Judith A.
United States, San Francisco
Ucsf School of Medicine
Statistics
Citations: 35
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1016/S2214-109X(13)70067-6
e-ISSN:
2214109X
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Mental Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Uganda
Participants Gender
Male
Female