Barcelona 2013
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| Abstract #521 - Health Care Provision | ||||
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Session: 33.3: Health Care Provision (Parallel) on Tuesday @ 14.30-16.00 in Teatre Chaired by Araceli Rousaud, Sheana Bull Authors: Presenting Author: Ms Rachel Kelders - AIDS Healthcare Foundation, Netherlands |
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| Additional Authors: Sra. Rosa de Dios, Sra. Lourdes Mestres, Sra. Alicia Lluva, | ||||
| Aim: Studies have shown that there is a substantial loss of clients along the HIV care path, or cascade of care. This results in long delays in ART initiation and increased morbidity and mortality. A robust cascade of care management framework is necessary to have effective care and treatment programs. This study examines the cascade of care in a multi-site Test & Treat program in Masaka, Uganda from January 2012 to March 2013. | ||||
| Method / Issue: In 2010 the AIDS Healthcare Foundation in collaboration with district health bodies and non-governmental organizations began the Test & Treat project. Village health teams visit villages in the Greater Masaka District to mobilize communities and conduct HIV testing. The project utilizes fixed site, door-to-door and mobile HIV testing. Clients found to be HIV positive are referred for HIV care and treatment at 14 sites and since July 2012 immediate blood draw for CD4 testing in the field is offered. Village health teams track clients to minimize loss to follow up. | ||||
| Results / Comments: During the study period 208,454 people were tested for HIV. 101,309 (48.6%) of clients tested were first time testers; 10,877 (5.2%) people tested HIV positive of which 38.9% were male and 61.1% were female; 9,651 (88.7%) of positive testers were 15-49 years old. Of those who tested HIV positive 89.7% were referred to care and treatment, 43.2% enrolled in care and treatment and 15.1% were initiated on ART. During the first quarter of 2012 22.9% of clients testing positive had a baseline CD4 test conducted, after providing CD4 testing in the field this increased to 71.8% in the first quarter of 2013. Enrollment rates increased from 40.8% during the first quarter of 2012 to 58.1% in the first quarter of 2013. Of the 4,698 clients enrolled 2,387 (50.8%) were eligible for ART and 1,645 (68.9%) have initiated treatment. | ||||
| Discussion: Community mobilization and door-to-door testing is an effective way to reach people who have not previously tested for HIV, particularly for children, couples and persons who live in rural areas and do not have access to health services. Given that many clients did not enroll in care and treatment after testing HIV positive an effective linkage component is essential for managing clients in the early stage of the care pathway. Data suggest that clients who receive a CD4 test in the field may be more likely to enroll in care and treatment. | ||||
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