Limited linkage to care following mobile screening for HIV, TB and non-communicable diseases

Linkage to HIV, TB and Non-Communicable Disease Care from a Mobile Testing Unit in Cape Town, South Africa.

Govindasamy D, Kranzer K, van Schaik N, Noubary F, Wood R, Walensky RP, Freedberg KA, Bassett IV, Bekker LG. PLoS One. 2013 Nov 13;8(11):e80017. doi: 10.1371/journal.pone.0080017.

Background: HIV counseling and testing may serve as an entry point for non-communicable disease screening.

Objectives: To determine the yield of newly-diagnosed HIV, tuberculosis (TB) symptoms, diabetes and hypertension, and to assess CD4 count testing, linkage to care as well as correlates of linkage and barriers to care from a mobile testing unit.

Methods: A mobile unit provided screening for HIV, TB symptoms, diabetes and hypertension in Cape Town, South Africa between March 2010 and September 2011. The yield of newly-diagnosed cases of these conditions was measured and clients were followed-up between January and November 2011 to assess linkage. Linkage to care was defined as accessing care within one, three or six months post-HIV diagnosis (dependent on CD4 count) and one month post-diagnosis for other conditions. Clinical and socio-demographic correlates of linkage to care were evaluated using Poisson regression and barriers to care were determined.

Results: Of 9 806 clients screened, the yield of new diagnoses was: HIV (5.5%), TB suspects (10.1%), diabetes (0.8%) and hypertension (58.1%). Linkage to care for HIV-infected clients, TB suspects, diabetics and hypertensives was: 51.3%, 56.7%, 74.1% and 50.0%. Only disclosure of HIV-positive status to family members or partners (RR=2.6, 95% CI: 1.04-6.3, p=0.04) was independently associated with linkage to HIV care. The main barrier to care reported by all groups was lack of time to access a clinic.

Conclusion: Screening for HIV, TB symptoms and hypertension at mobile units in South Africa has a high yield but inadequate linkage. After-hours and weekend clinics may overcome a major barrier to accessing care.

Abstract  Full-text [free] access

Editor’s notes: This study reported that a mobile testing unit in South African township could simultaneously identify a high yield of new HIV diagnoses as well as patients with TB symptoms, diabetes and hypertension. However, linkage to care was inadequate and limited by difficulties accessing clinic services.

Avoid TB deaths
Africa
South Africa
  • share