Linkage to HIV, TB and Non-Communicable Disease Care from a Mobile Testing Unit in Cape Town, South Africa
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Auteurs : Darshini Govindasamy [Afrique du Sud] ; Katharina Kranzer [Afrique du Sud, Royaume-Uni] ; Nienke Van Schaik [Afrique du Sud] ; Farzad Noubary [États-Unis] ; Robin Wood [Afrique du Sud] ; Rochelle P. Walensky [États-Unis] ; Kenneth A. Freedberg [États-Unis] ; Ingrid V. Bassett [États-Unis] ; Linda-Gail Bekker [Afrique du Sud]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Abstract
HIV counseling and testing may serve as an entry point for non-communicable disease screening.
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.
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.
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,
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.
Url:
DOI: 10.1371/journal.pone.0080017
PubMed: 24236170
PubMed Central: 3827432
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wicri:level="1"><nlm:aff id="aff1"><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London</wicri:regionArea></affiliation></author><author><name sortKey="Van Schaik, Nienke" sort="Van Schaik, Nienke" uniqKey="Van Schaik N" first="Nienke" last="Van Schaik">Nienke Van Schaik</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation></author><author><name sortKey="Noubary, Farzad" sort="Noubary, Farzad" uniqKey="Noubary F" first="Farzad" last="Noubary">Farzad Noubary</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice 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Cape Town, South Africa </title><author><name sortKey="Govindasamy, Darshini" sort="Govindasamy, Darshini" uniqKey="Govindasamy D" first="Darshini" last="Govindasamy">Darshini Govindasamy</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation></author><author><name sortKey="Kranzer, Katharina" sort="Kranzer, Katharina" uniqKey="Kranzer K" first="Katharina" last="Kranzer">Katharina Kranzer</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London</wicri:regionArea></affiliation></author><author><name sortKey="Van Schaik, Nienke" sort="Van Schaik, Nienke" uniqKey="Van Schaik N" first="Nienke" last="Van Schaik">Nienke Van Schaik</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation></author><author><name sortKey="Noubary, Farzad" sort="Noubary, Farzad" uniqKey="Noubary F" first="Farzad" last="Noubary">Farzad Noubary</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"> The<addr-line>Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation></author><author><name sortKey="Walensky, Rochelle P" sort="Walensky, Rochelle P" uniqKey="Walensky R" first="Rochelle P." last="Walensky">Rochelle P. Walensky</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff9"><addr-line>Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A." last="Freedberg">Kenneth A. Freedberg</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff9"><addr-line>Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff10"><addr-line>Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V." last="Bassett">Ingrid V. Bassett</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff9"><addr-line>Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts</wicri:regionArea></affiliation></author><author><name sortKey="Bekker, Linda Gail" sort="Bekker, Linda Gail" uniqKey="Bekker L" first="Linda-Gail" last="Bekker">Linda-Gail Bekker</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec sec-type="headed"><title>Background</title><p>HIV counseling and testing may serve as an entry point for non-communicable disease screening.</p></sec><sec sec-type="headed"><title>Objectives</title><p>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.</p></sec><sec sec-type="headed"><title>Methods</title><p>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.</p></sec><sec sec-type="headed"><title>Results</title><p>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, <italic>p</italic>=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.</p></sec><sec sec-type="headed"><title>Conclusion</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Dalal, S" uniqKey="Dalal S">S Dalal</name></author><author><name sortKey="Beunza, Jj" uniqKey="Beunza J">JJ Beunza</name></author><author><name sortKey="Volmink, J" uniqKey="Volmink J">J Volmink</name></author><author><name sortKey="Adebamowo, C" uniqKey="Adebamowo C">C Adebamowo</name></author><author><name sortKey="Bajunirwe, F" uniqKey="Bajunirwe F">F Bajunirwe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hendriks, Me" uniqKey="Hendriks M">ME Hendriks</name></author><author><name sortKey="Wit, Fw" uniqKey="Wit F">FW Wit</name></author><author><name sortKey="Roos, Mt" uniqKey="Roos M">MT Roos</name></author><author><name sortKey="Brewster, Lm" uniqKey="Brewster L">LM Brewster</name></author><author><name 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Kranzer</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<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, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24236170</article-id><article-id pub-id-type="pmc">3827432</article-id><article-id pub-id-type="publisher-id">PONE-D-13-23672</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0080017</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Linkage to HIV, TB and Non-Communicable Disease Care from a Mobile Testing Unit in Cape Town, South Africa </article-title><alt-title alt-title-type="running-head">Linkage to Care from a Mobile Testing Unit</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Govindasamy</surname><given-names>Darshini</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kranzer</surname><given-names>Katharina</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>van Schaik</surname><given-names>Nienke</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Noubary</surname><given-names>Farzad</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="aff" rid="aff4"><sup>4</sup></xref><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wood</surname><given-names>Robin</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Walensky</surname><given-names>Rochelle P.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="aff" rid="aff7"><sup>7</sup></xref><xref ref-type="aff" rid="aff8"><sup>8</sup></xref><xref ref-type="aff" rid="aff9"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Freedberg</surname><given-names>Kenneth A.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="aff" rid="aff7"><sup>7</sup></xref><xref ref-type="aff" rid="aff9"><sup>9</sup></xref><xref ref-type="aff" rid="aff10"><sup>10</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bassett</surname><given-names>Ingrid V.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="aff" rid="aff7"><sup>7</sup></xref><xref ref-type="aff" rid="aff9"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bekker</surname><given-names>Linda-Gail</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></aff><aff id="aff4"><label>4</label> The<addr-line>Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, United States of America</addr-line></aff><aff id="aff6"><label>6</label><addr-line>Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</addr-line></aff><aff id="aff7"><label>7</label><addr-line>Divisions of General Medicine and Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></aff><aff id="aff8"><label>8</label><addr-line>Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America</addr-line></aff><aff id="aff9"><label>9</label><addr-line>Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America</addr-line></aff><aff id="aff10"><label>10</label><addr-line>Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Pett</surname><given-names>Sarah</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of New South Wales, Australia</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>gdarsh@gmail.com</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>Co-author Dr Katharina Kranzer is a PLoS ONE Editorial Board member. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: DG NVS KK LGB IVB RPW KF. Performed the experiments: DG NVS. Analyzed the data: DG KK FN. Contributed reagents/materials/analysis tools: DG KK IVB LGB NVS. Wrote the manuscript: DG. Provided input on all drafts of the manuscript: NVS KK FN RW RPW KF IB LGB.. </p></fn></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>13</day><month>11</month><year>2013</year></pub-date><volume>8</volume><issue>11</issue><elocation-id>e80017</elocation-id><history><date date-type="received"><day>7</day><month>6</month><year>2013</year></date><date date-type="accepted"><day>27</day><month>9</month><year>2013</year></date></history><permissions><copyright-year>2013</copyright-year><copyright-holder>Govindasamy et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/3.0/"><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/3.0/">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><abstract><sec sec-type="headed"><title>Background</title><p>HIV counseling and testing may serve as an entry point for non-communicable disease screening.</p></sec><sec sec-type="headed"><title>Objectives</title><p>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.</p></sec><sec sec-type="headed"><title>Methods</title><p>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.</p></sec><sec sec-type="headed"><title>Results</title><p>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, <italic>p</italic>=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.</p></sec><sec sec-type="headed"><title>Conclusion</title><p>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.</p></sec></abstract><funding-group><funding-statement>This work was supported in part by: the National Institute of Allergy and Infectious Disease: 3R01AI058736, K24 AI062476; the Harvard University Center for AIDS Research P30 AI060354; the National Institute of Mental Health: R01 MH090326, R01 MH073445, the Presidents Emergency Plan for AIDS Relief (PEPFAR); and the Claflin Distinguished Scholar Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The mobile testing unit is partially funded by PEPFAR through the Anova Health Institute and the United States Agency for International Development program and received further funding through the Agence Française de Développement. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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