A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa
| dc.contributor.author | Leon, Natalie | |
| dc.contributor.author | Mathews, Catherine | |
| dc.contributor.author | Lewin, Simon | |
| dc.contributor.author | Osler, Meg | |
| dc.contributor.author | Boulle, Andrew | |
| dc.contributor.author | Lombard, Carl | |
| dc.date.accessioned | 2015-07-30T04:01:30Z | |
| dc.date.available | 2015-07-30T04:01:30Z | |
| dc.date.issued | 2014-08-18 | |
| dc.date.updated | 2015-01-15T17:58:39Z | |
| dc.description.abstract | Abstract Background We examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care. Methods In a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms. Results There was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007). Conclusion The PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies. Trial registration Current Controlled Trials ISRCTN93692532 | |
| dc.identifier.apacitation | Leon, N., Mathews, C., Lewin, S., Osler, M., Boulle, A., & Lombard, C. (2014). A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/13614 | en_ZA |
| dc.identifier.chicagocitation | Leon, Natalie, Catherine Mathews, Simon Lewin, Meg Osler, Andrew Boulle, and Carl Lombard "A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa." <i>BMC Health Services Research</i> (2014) http://hdl.handle.net/11427/13614 | en_ZA |
| dc.identifier.citation | Leon, N., Mathews, C., Lewin, S., Osler, M., Boulle, A., & Lombard, C. (2014). A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa. BMC health services research, 14(1), 350. | |
| dc.identifier.ris | TY - Journal Article AU - Leon, Natalie AU - Mathews, Catherine AU - Lewin, Simon AU - Osler, Meg AU - Boulle, Andrew AU - Lombard, Carl AB - Abstract Background We examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care. Methods In a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms. Results There was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007). Conclusion The PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies. Trial registration Current Controlled Trials ISRCTN93692532 DA - 2014-08-18 DB - OpenUCT DO - 10.1186/1472-6963-14-350 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa TI - A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa UR - http://hdl.handle.net/11427/13614 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/13614 | |
| dc.identifier.uri | http://dx.doi.org/10.1186/1472-6963-14-350 | |
| dc.identifier.vancouvercitation | Leon N, Mathews C, Lewin S, Osler M, Boulle A, Lombard C. A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa. BMC Health Services Research. 2014; http://hdl.handle.net/11427/13614. | en_ZA |
| dc.language.rfc3066 | en | |
| dc.publisher.department | Department of Public Health and Family Medicine | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights | This is an Open Access article distributed under the terms of the Creative Commons Attribution License | * |
| dc.rights.holder | Leon et al.; licensee BioMed Central Ltd. | |
| dc.rights.uri | http://creativecommons.org/licenses/by/2.0 | * |
| dc.source | BMC Health Services Research | en_ZA |
| dc.source.uri | http://www.biomedcentral.com/bmchealthservres/ | |
| dc.subject.other | Routine HIV screening | en_ZA |
| dc.subject.other | Linkage to HIV care | en_ZA |
| dc.subject.other | Sexually transmitted infections | en_ZA |
| dc.subject.other | Controlled trial | en_ZA |
| dc.title | A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa | |
| dc.type | Journal Article | en_ZA |
| uct.type.filetype | ||
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |