Providing immediate CD4 count results at HIV testing improves ART initiation.

Area of Science:

• Public Health
• Infectious Diseases
• Clinical Medicine

Background:

• High rates (35-55%) of newly diagnosed HIV-positive patients in South Africa do not return for CD4 count results, hindering access to care.
• Delayed access to CD4 results and subsequent care pathways contribute to significant patient attrition.
• Evaluating interventions to improve patient retention in HIV care is crucial for effective treatment outcomes.

Purpose of the Study:

• To assess the impact of immediate CD4 count results and written information on patient retention in HIV care.
• To determine if providing CD4 results at diagnosis improves linkage to pre-antiretroviral therapy (ART) and ART initiation.
• To identify factors influencing patient retention in the HIV care cascade.

Main Methods:

• Randomized controlled trial with three arms: immediate CD4 results, written information, and standard of care.
• Study included 344 HIV-infected subjects in South Africa.
• Outcomes measured were enrollment for pre-ART care within 1 month and ART initiation within 3 months, with secondary analysis of time to care stages.

Main Results:

• Immediate CD4 count results at diagnosis increased the likelihood of ART initiation by 2.1 times compared to standard care.
• Written information alone reduced time to pre-ART care but did not significantly impact ART initiation.
• The standard of care arm experienced 49% attrition, highlighting significant losses in the care pathway.

Conclusions:

• Providing CD4 count results at the time of HIV diagnosis is an effective strategy to increase ART initiation rates.
• Point-of-care diagnostics show promise for improving patient retention in HIV care.
• Despite improvements, substantial losses to pre-ART care remain a challenge that requires further intervention.