Linkage to HIV care after home‐based HIV counselling and testing in sub‐Saharan Africa: a systematic review

• Published in: Tropical medicine & international health 2017-07, Vol.22 (7), p.807-821
• Main Authors: Ruzagira, Eugene, Baisley, Kathy, Kamali, Anatoli, Biraro, Samuel, Grosskurth, Heiner, Wringe, Alison, Celum, Connie, Barnabas, Ruanne V., Rooyen, Heidi, Genberg, Becky L., Braitstein, Paula, Ndege, Samson, Nakigozi, Gertrude, Parker, Lucy A., Labhardt, Niklaus D., Naik, Reshma, Becker, Stan, Hoffmann, Christopher J., Iwuji, Collins C., Larmarange, Joseph
• Format: Article
• Language: English
• Subjects: aconsejamiento y prueba del VIH en el hogar; Adults; Africa South of the Sahara; Anti-Bacterial Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Augmentation; Bias; CD4 antigen; Confidence intervals; conseil et dépistage du VIH à domicile; Cotrimoxazole; Counseling; Counseling - methods; Disease prophylaxis; Heterogeneity; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV/AIDS; Home Care Services; Home health care; home‐based HIV counselling and testing; Human health and pathology; Human immunodeficiency virus; Humans; Infections; Infectious diseases; liaison avec les soins; Life Sciences; linkage to care; Ouganda; Prophylaxis; Randomization; Reviews; Risk; Santé publique et épidémiologie; Studies; Sub Saharan Africa studies; Testing; Transport; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Uganda; Uptake; VIH/SIDA; vinculación a la atención sanitaria
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12888

Background Home‐based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub‐Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. Methods Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. Results A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point‐of‐care CD4 count testing, follow‐up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post‐HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8–9.8%] to 99.1% (95% CI, 96.9–99.9%). Linkage was generally lower (80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1–21.8) to 77.8% (95% CI, 40.0–97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36–57.9%) to 94.9% (95% CI, 91.3–97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. Conclusion Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials. Contexte Le conseil et dépistage du VIH à domicile (CDVD) peut augmenter l'adoption du dépistage du VIH en Afrique subsaharienne (ASS), mais les données sur la liaison avec les soins du VIH