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

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...

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Autores principales: Rentsch, Christopher T., Wringe, Alison, Machemba, Richard, Michael, Denna, Urassa, Mark, Todd, Jim, Reniers, Georges, Zaba, Basia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334504/
https://www.ncbi.nlm.nih.gov/pubmed/30282113
http://dx.doi.org/10.1111/tmi.13153
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author Rentsch, Christopher T.
Wringe, Alison
Machemba, Richard
Michael, Denna
Urassa, Mark
Todd, Jim
Reniers, Georges
Zaba, Basia
author_facet Rentsch, Christopher T.
Wringe, Alison
Machemba, Richard
Michael, Denna
Urassa, Mark
Todd, Jim
Reniers, Georges
Zaba, Basia
author_sort Rentsch, Christopher T.
collection PubMed
description 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/mm(3) 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.
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spelling pubmed-63345042019-01-23 Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017 Rentsch, Christopher T. Wringe, Alison Machemba, Richard Michael, Denna Urassa, Mark Todd, Jim Reniers, Georges Zaba, Basia Trop Med Int Health Original Research Papers 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/mm(3) 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. John Wiley and Sons Inc. 2018-10-24 2018-12 /pmc/articles/PMC6334504/ /pubmed/30282113 http://dx.doi.org/10.1111/tmi.13153 Text en © 2018 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research Papers
Rentsch, Christopher T.
Wringe, Alison
Machemba, Richard
Michael, Denna
Urassa, Mark
Todd, Jim
Reniers, Georges
Zaba, Basia
Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017
title Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017
title_full Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017
title_fullStr Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017
title_full_unstemmed Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017
title_short Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017
title_sort linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with hiv in tanzania, 2014–2017
topic Original Research Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334504/
https://www.ncbi.nlm.nih.gov/pubmed/30282113
http://dx.doi.org/10.1111/tmi.13153
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