High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa.

Publication Type:

Journal Article


Journal of acquired immune deficiency syndromes (1999) (2013)


2013, June 2013, Vaccine and Infectious Disease Division


OBJECTIVE:: Home-based counseling and testing (HBCT) has demonstrated high HIV testing uptake in Africa. We piloted expanded HBCT-Plus, with point-of-care CD4 count testing and follow-up visits, as a strategy to increase linkage to HIV care and antiretroviral therapy (ART) uptake. METHODS:: We conducted universal, adult HBCT-Plus among contiguous households in rural KwaZulu-Natal, South Africa; HIV-infected individuals received point-of-care CD4 testing which was compared to CD4 results by flow cytometry, counseling and referral to care. Follow-up visits at months 1, 3 and 6 evaluated linkage to care and ART uptake. Plasma viral load was measured at baseline and month 6. RESULTS:: 671 adults were tested for HIV (91% coverage) and 201 (30%) were HIV-infected. Median CD4 count was 435 cells/μL by point-of-care testing. There was high agreement between the point-of-care and flow cytometry CD4 test results; the mean difference was 16 cells/μL (CI: -1 to 32 cells/μL). By month 3, 86% of those eligible (CD4 ≤200 cells/μL) had initiated ART. Among 196 HIV-infected participants, mean viral load decreased by 0.31 log10 copies/mL (p=0.009) between baseline and month 6 and among those eligible for ART, mean PVL decreased by 2.46 log10 copies/mL (p=<0.001). CONCLUSIONS:: HBCT-Plus pilot achieved approximately 90% uptake of HIV testing, linkage to care and ART initiation, thus providing clinical and public health benefits, as demonstrated by a significantly decreased mean viral load. These data indicate a significant impact of HBCT-Plus on knowledge of HIV serostatus, linkage to HIV care, uptake of ART, adherence and reduced HIV infectiousness.