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IAS 2013: Linkage to Care Following Home-based HIV Testing

Here's an interesting presentation from the 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Malaysia.

The study was done in South Africa - a very high prevalence area from HIV. Before you say that South Africa is different from the industrialized world, take a look at the results. I suspect there are some similarities in challenges/ opportunities.

The basis for the study involved a community-based HIV testing program that was linked to medical care.

Being linked in to HIV treatment and primary care services – is an important part of staying well with HIV. How HIV care is delivered varies significantly from region to region in South Africa, according to the authors. However, perceptions of the benefits of care and limitations in local healthcare systems are important factors as well. 

The study was done in rural South Africa and looked at the reasons why people diagnosed through a home-based HIV counseling and testing service (HBHCT) stay or are lost from care following an HIV diagnosis.

The study found that younger age, not believing HIV test results, and believing that antiretroviral drugs make you sick, were all associated with people being less likely to be linked to healthcare services. Living in a household with more than two adults, having difficulty finding time to seek medical care, and drinking alcohol were all also linked to not accessing care.

On the other hand, people who believed that they would be able to get the drugs and other supplies they needed at their local health facility, and those who experienced more than three symptoms of depression after their HIV diagnosis were more likely to access and stay in contact with care services.

The researchers suggested that community-based health services and flexible opening hours at healthcare facilities would help people access and stay in care. Increasing awareness of newer antiretrovirals – that are more convenient and better tolderated than the previous most commonly used drugs – could also help.

South Africa sounds similar in many ways to downtown Rochester NY, New York City, Central London, Amsterdam, or Zagreb, Croatia. The point of the article is that an HIV diagnosis is just the beginning of the journey for many people - and it takes time and effort to connect people to their first medical appointment, connect with them to engage them in care, and keep them there.

Reference: Naik R, et al. Factors associated with patient linkage to care following home-based HIV counseling and testing: a prospective cohort study in rural South Africa. Presented July 1, 2013 at IAS 2013 in Kuala Lumpur, Malaysia. Abstract MOAD0101.

Source: Reporting from Kuala Lumpur for the PRN News: Bill Valenti, MD