Immediate Blood Draw for CD4+ Cell Count Is Associated with Linkage to Care in Durban, South Africa: Findings from Pathways to Engagement in HIV Care
Identifieur interne : 002918 ( Pmc/Curation ); précédent : 002917; suivant : 002919Immediate Blood Draw for CD4+ Cell Count Is Associated with Linkage to Care in Durban, South Africa: Findings from Pathways to Engagement in HIV Care
Auteurs : Susie Hoffman [États-Unis] ; Theresa M. Exner [États-Unis] ; Naomi Lince-Deroche [Afrique du Sud] ; Cheng-Shiun Leu [États-Unis] ; Jessica L. Phillip [Afrique du Sud] ; Elizabeth A. Kelvin [États-Unis] ; Anisha D. Gandhi [États-Unis] ; Bruce Levin [États-Unis] ; Dinesh Singh [Afrique du Sud] ; Joanne E. Mantell [États-Unis] ; Kelly Blanchard [États-Unis] ; Gita Ramjee [Afrique du Sud]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Timely linkage to care by newly-diagnosed HIV+ individuals remains a significant challenge to achieving UNAIDS 90-90-90 goals. Current World Health Organization (WHO) guidelines recommend initiating anti-retroviral treatment (ART) regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. We evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study.
Individuals (N = 2773) were interviewed prior to HIV counseling and testing at three public sector primary care clinics in the greater Durban area; 785 were newly-diagnosed and eligible for the cohort study; 459 (58.5%) joined and were followed for eight months with three structured assessments. Linkage to care, defined as returning to clinic for CD4+ count results, and day-of-diagnosis blood draw were self-reported.
Overall, 72.5% did not have a day-of-diagnosis CD4+ count blood draw, and 19.2% of these never returned. Compared with a day-of-diagnosis blood draw, the adjusted hazard ratio of linkage (AHRlinkage) associated with not having day-of-diagnosis blood draw was 0.66 (95%CI: 0.51, 0.85). By 4 months, 54.8% of those without day-of-diagnosis blood draw vs. 75.2% with one were linked to care (chi-squared
Newly-diagnosed HIV+ individuals who did not undergo CD4+ count blood draw on the day they were diagnosed—regardless of the reason for deferring—had delayed linkage to care relative to those with same-day blood draw. To enhance prompt linkage to care even when test and treat protocols are implemented, all diagnostic testing required before ART initiation should be performed on the same day as HIV testing/diagnosis. This may require modifying clinic procedures to enable overnight blood storage if same-day draws cannot be performed, and providing additional counseling to encourage newly-diagnosed individuals to complete day-of-diagnosis testing. Tracking HIV+ individuals via clinic registries should commence immediately from diagnosis to reduce these early losses to care.
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DOI: 10.1371/journal.pone.0162085
PubMed: 27706150
PubMed Central: 5051894
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Gandhi</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Levin, Bruce" sort="Levin, Bruce" uniqKey="Levin B" first="Bruce" last="Levin">Bruce Levin</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Singh, Dinesh" sort="Singh, Dinesh" uniqKey="Singh D" first="Dinesh" last="Singh">Dinesh Singh</name><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>South African Medical Research Council, HIV Prevention Research Unit, Durban</wicri:regionArea></affiliation></author><author><name sortKey="Mantell, Joanne E" sort="Mantell, Joanne E" uniqKey="Mantell J" first="Joanne E." last="Mantell">Joanne E. 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Exner</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Lince Deroche, Naomi" sort="Lince Deroche, Naomi" uniqKey="Lince Deroche N" first="Naomi" last="Lince-Deroche">Naomi Lince-Deroche</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Ibis Reproductive Health, Johannesburg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Ibis Reproductive Health, Johannesburg</wicri:regionArea></affiliation></author><author><name sortKey="Leu, Cheng Shiun" sort="Leu, Cheng Shiun" uniqKey="Leu C" first="Cheng-Shiun" last="Leu">Cheng-Shiun Leu</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Phillip, Jessica L" sort="Phillip, Jessica L" uniqKey="Phillip J" first="Jessica L." last="Phillip">Jessica L. Phillip</name><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>South African Medical Research Council, HIV Prevention Research Unit, Durban</wicri:regionArea></affiliation></author><author><name sortKey="Kelvin, Elizabeth A" sort="Kelvin, Elizabeth A" uniqKey="Kelvin E" first="Elizabeth A." last="Kelvin">Elizabeth A. Kelvin</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Gandhi, Anisha D" sort="Gandhi, Anisha D" uniqKey="Gandhi A" first="Anisha D." last="Gandhi">Anisha D. Gandhi</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Levin, Bruce" sort="Levin, Bruce" uniqKey="Levin B" first="Bruce" last="Levin">Bruce Levin</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Singh, Dinesh" sort="Singh, Dinesh" uniqKey="Singh D" first="Dinesh" last="Singh">Dinesh Singh</name><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>South African Medical Research Council, HIV Prevention Research Unit, Durban</wicri:regionArea></affiliation></author><author><name sortKey="Mantell, Joanne E" sort="Mantell, Joanne E" uniqKey="Mantell J" first="Joanne E." last="Mantell">Joanne E. Mantell</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York</wicri:regionArea></affiliation></author><author><name sortKey="Blanchard, Kelly" sort="Blanchard, Kelly" uniqKey="Blanchard K" first="Kelly" last="Blanchard">Kelly Blanchard</name><affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>Ibis Reproductive Health, Cambridge, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Ibis Reproductive Health, Cambridge, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Ramjee, Gita" sort="Ramjee, Gita" uniqKey="Ramjee G" first="Gita" last="Ramjee">Gita Ramjee</name><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>South African Medical Research Council, HIV Prevention Research Unit, Durban</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Timely linkage to care by newly-diagnosed HIV+ individuals remains a significant challenge to achieving UNAIDS 90-90-90 goals. Current World Health Organization (WHO) guidelines recommend initiating anti-retroviral treatment (ART) regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. We evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study.</p></sec><sec id="sec002"><title>Methods</title><p>Individuals (N = 2773) were interviewed prior to HIV counseling and testing at three public sector primary care clinics in the greater Durban area; 785 were newly-diagnosed and eligible for the cohort study; 459 (58.5%) joined and were followed for eight months with three structured assessments. Linkage to care, defined as returning to clinic for CD4+ count results, and day-of-diagnosis blood draw were self-reported.</p></sec><sec id="sec003"><title>Results</title><p>Overall, 72.5% did not have a day-of-diagnosis CD4+ count blood draw, and 19.2% of these never returned. Compared with a day-of-diagnosis blood draw, the adjusted hazard ratio of linkage (AHR<sub>linkage</sub>) associated with not having day-of-diagnosis blood draw was 0.66 (95%CI: 0.51, 0.85). By 4 months, 54.8% of those without day-of-diagnosis blood draw vs. 75.2% with one were linked to care (chi-squared <italic>p</italic> = 0.004). Of those who deferred blood draw, 48.3% cited clinic-related and 51.7% cited personal reasons. AHR<sub>linkage</sub> was 0.60 (95%CI: 0.44, 0.82) for clinic-related and 0.53 (95%CI: 0.38, 0.75) for personal reasons relative to having day-of-diagnosis blood draw.</p></sec><sec id="sec004"><title>Conclusions</title><p>Newly-diagnosed HIV+ individuals who did not undergo CD4+ count blood draw on the day they were diagnosed—regardless of the reason for deferring—had delayed linkage to care relative to those with same-day blood draw. To enhance prompt linkage to care even when test and treat protocols are implemented, all diagnostic testing required before ART initiation should be performed on the same day as HIV testing/diagnosis. This may require modifying clinic procedures to enable overnight blood storage if same-day draws cannot be performed, and providing additional counseling to encourage newly-diagnosed individuals to complete day-of-diagnosis testing. Tracking HIV+ individuals via clinic registries should commence immediately from diagnosis to reduce these early losses to care.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Drain, Pk" uniqKey="Drain P">PK Drain</name></author><author><name sortKey="Losina, E" uniqKey="Losina E">E Losina</name></author><author><name sortKey="Parker, G" uniqKey="Parker G">G Parker</name></author><author><name sortKey="Giddy, J" uniqKey="Giddy J">J Giddy</name></author><author><name sortKey="Ross, D" uniqKey="Ross D">D Ross</name></author><author><name sortKey="Katz, Jn" uniqKey="Katz J">JN Katz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hoffman, S" uniqKey="Hoffman S">S Hoffman</name></author><author><name sortKey="Wu, Y" uniqKey="Wu Y">Y Wu</name></author><author><name sortKey="Lahuerta, M" uniqKey="Lahuerta M">M 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27706150</article-id><article-id pub-id-type="pmc">5051894</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0162085</article-id><article-id pub-id-type="publisher-id">PONE-D-16-03683</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Physiology</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Physiology</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Hematology</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and health sciences</subject><subj-group><subject>Diagnostic medicine</subject><subj-group><subject>HIV diagnosis and management</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Research and Analysis Methods</subject><subj-group><subject>Research Design</subject><subj-group><subject>Cohort Studies</subject></subj-group></subj-group></subj-group><subj-group 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Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and life sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>RNA viruses</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Medical Microbiology</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Pathogens</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Vaccination and Immunization</subject><subj-group><subject>Antiviral Therapy</subject><subj-group><subject>Antiretroviral Therapy</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Vaccination and Immunization</subject><subj-group><subject>Antiviral Therapy</subject><subj-group><subject>Antiretroviral Therapy</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Preventive Medicine</subject><subj-group><subject>Vaccination and Immunization</subject><subj-group><subject>Antiviral Therapy</subject><subj-group><subject>Antiretroviral Therapy</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and places</subject><subj-group><subject>Geographical locations</subject><subj-group><subject>Africa</subject><subj-group><subject>South Africa</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Sociology</subject><subj-group><subject>Education</subject><subj-group><subject>Schools</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Primary Care</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Immediate Blood Draw for CD4+ Cell Count Is Associated with Linkage to Care in Durban, South Africa: Findings from <italic>Pathways to Engagement in HIV Care</italic></article-title><alt-title alt-title-type="running-head">Same-Day CD4+ Count Blood Draw and Linkage to Care</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hoffman</surname><given-names>Susie</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Exner</surname><given-names>Theresa M.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Lince-Deroche</surname><given-names>Naomi</given-names></name><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="author-notes" rid="currentaff001"><sup>¤a</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Leu</surname><given-names>Cheng-Shiun</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Phillip</surname><given-names>Jessica L.</given-names></name><xref ref-type="aff" rid="aff005"><sup>5</sup></xref><xref ref-type="author-notes" rid="currentaff002"><sup>¤b</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Kelvin</surname><given-names>Elizabeth A.</given-names></name><xref ref-type="aff" rid="aff006"><sup>6</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Gandhi</surname><given-names>Anisha D.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Levin</surname><given-names>Bruce</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Singh</surname><given-names>Dinesh</given-names></name><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mantell</surname><given-names>Joanne E.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Blanchard</surname><given-names>Kelly</given-names></name><xref ref-type="aff" rid="aff007"><sup>7</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ramjee</surname><given-names>Gita</given-names></name><xref ref-type="aff" rid="aff005"><sup>5</sup></xref><xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Ibis Reproductive Health, Johannesburg, South Africa</addr-line></aff><aff id="aff004"><label>4</label><addr-line>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America</addr-line></aff><aff id="aff005"><label>5</label><addr-line>South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa</addr-line></aff><aff id="aff006"><label>6</label><addr-line>Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America</addr-line></aff><aff id="aff007"><label>7</label><addr-line>Ibis Reproductive Health, Cambridge, Massachusetts, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Andrei</surname><given-names>Graciela</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Katholieke Universiteit Leuven Rega Institute for Medical Research, BELGIUM</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold> SH TME EAK JEM KB GR.</p></list-item><list-item><p><bold>Data curation:</bold> NL-D EAK TME ADG KB.</p></list-item><list-item><p><bold>Formal analysis:</bold> C-SL EAK ADG SH TME.</p></list-item><list-item><p><bold>Funding acquisition:</bold> SH TME JEM KB GR.</p></list-item><list-item><p><bold>Investigation:</bold> NL-D JLP DS.</p></list-item><list-item><p><bold>Methodology:</bold> SH TME KB GR BL C-SL.</p></list-item><list-item><p><bold>Project administration:</bold> SH NL-D JLP EAK DS KB GR.</p></list-item><list-item><p><bold>Resources:</bold> GR.</p></list-item><list-item><p><bold>Supervision:</bold> SH KB GR.</p></list-item><list-item><p><bold>Validation:</bold> NL-D EAK.</p></list-item><list-item><p><bold>Writing – original draft:</bold> SH.</p></list-item><list-item><p><bold>Writing – review & editing:</bold> ADG NL-D TME C-SL JLP EAK BL DS JEM KB GR.</p></list-item></list></p></fn><fn fn-type="current-aff" id="currentaff001"><label>¤a</label><p>Current address: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</p></fn><fn fn-type="current-aff" id="currentaff002"><label>¤b</label><p>Current address: Health Systems Trust, Midrand, South Africa</p></fn><fn fn-type="other" id="econtrib001"><p>‡ These authors also contributed equally to this work.</p></fn><corresp id="cor001">* E-mail: <email>sh51@cumc.columbia.edu</email></corresp></author-notes><pub-date pub-type="epub"><day>5</day><month>10</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>11</volume><issue>10</issue><elocation-id>e0162085</elocation-id><history><date date-type="received"><day>26</day><month>1</month><year>2016</year></date><date date-type="accepted"><day>17</day><month>8</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Hoffman et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Hoffman et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pone.0162085.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>Timely linkage to care by newly-diagnosed HIV+ individuals remains a significant challenge to achieving UNAIDS 90-90-90 goals. Current World Health Organization (WHO) guidelines recommend initiating anti-retroviral treatment (ART) regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. We evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study.</p></sec><sec id="sec002"><title>Methods</title><p>Individuals (N = 2773) were interviewed prior to HIV counseling and testing at three public sector primary care clinics in the greater Durban area; 785 were newly-diagnosed and eligible for the cohort study; 459 (58.5%) joined and were followed for eight months with three structured assessments. Linkage to care, defined as returning to clinic for CD4+ count results, and day-of-diagnosis blood draw were self-reported.</p></sec><sec id="sec003"><title>Results</title><p>Overall, 72.5% did not have a day-of-diagnosis CD4+ count blood draw, and 19.2% of these never returned. Compared with a day-of-diagnosis blood draw, the adjusted hazard ratio of linkage (AHR<sub>linkage</sub>) associated with not having day-of-diagnosis blood draw was 0.66 (95%CI: 0.51, 0.85). By 4 months, 54.8% of those without day-of-diagnosis blood draw vs. 75.2% with one were linked to care (chi-squared <italic>p</italic> = 0.004). Of those who deferred blood draw, 48.3% cited clinic-related and 51.7% cited personal reasons. AHR<sub>linkage</sub> was 0.60 (95%CI: 0.44, 0.82) for clinic-related and 0.53 (95%CI: 0.38, 0.75) for personal reasons relative to having day-of-diagnosis blood draw.</p></sec><sec id="sec004"><title>Conclusions</title><p>Newly-diagnosed HIV+ individuals who did not undergo CD4+ count blood draw on the day they were diagnosed—regardless of the reason for deferring—had delayed linkage to care relative to those with same-day blood draw. To enhance prompt linkage to care even when test and treat protocols are implemented, all diagnostic testing required before ART initiation should be performed on the same day as HIV testing/diagnosis. This may require modifying clinic procedures to enable overnight blood storage if same-day draws cannot be performed, and providing additional counseling to encourage newly-diagnosed individuals to complete day-of-diagnosis testing. Tracking HIV+ individuals via clinic registries should commence immediately from diagnosis to reduce these early losses to care.</p></sec></abstract><funding-group><award-group id="award001"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000025</institution-id><institution>National Institute of Mental Health</institution></institution-wrap></funding-source><award-id>R01 MH83561</award-id><principal-award-recipient><name><surname>Hoffman</surname><given-names>Susie</given-names></name></principal-award-recipient></award-group><award-group id="award002"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000025</institution-id><institution>National Institute of Mental Health</institution></institution-wrap></funding-source><award-id>R01 MH083561-03S1</award-id><principal-award-recipient><name><surname>Hoffman</surname><given-names>Susie</given-names></name></principal-award-recipient></award-group><award-group id="award003"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000025</institution-id><institution>National Institute of Mental Health</institution></institution-wrap></funding-source><award-id>T32 MH19139</award-id><principal-award-recipient><name><surname>Gandhi</surname><given-names>Anisha D.</given-names></name></principal-award-recipient></award-group><award-group id="award004"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100000025</institution-id><institution>National Institute of Mental Health</institution></institution-wrap></funding-source><award-id>P30-MH43520</award-id></award-group><funding-statement>This research was supported by the National Institute of Mental Health (R01 MH83561 and R01 MH083561-03S1; Principal Investigator: Susie Hoffman, DrPH), and by a center grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University [P30-MH43520; Principal Investigators: Anke A. Ehrhardt (1987–2013)/Robert H. Remien, Ph.D. (2013–2018)]. Dr. Gandhi was supported by a training grant from the National Institute of Mental Health (T32 MH19139, Behavioral Sciences Research in HIV Infection; Principal Investigator: Theo Sandfort, Ph.D.). Additional support was provided by the South African Medical Research Council HIV Prevention Research Unit (MRC HPRU). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the MRC HPRU.</funding-statement></funding-group><counts><fig-count count="3"></fig-count><table-count count="3"></table-count><page-count count="16"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the paper and its Supporting Information files.</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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