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Point-of-care CD4 counts improve linkage to HIV care in Kenya
Keith Alcorn, 2017-06-06 11:50:00

Carrying out a point-of-care CD4 count immediately after a person was diagnosed with HIV by home-based testing doubled the rate of linkage to HIV care, a randomised study in Kenya has shown. The results were published on 31 May in The Lancet HIV.

In an accompanying Comment article Rosanna Peeling of the London School of Hygiene and Tropical Medicine and Nathan Ford of the World Health Organization’s HIV/AIDS department say that despite the push towards treatment for all regardless of CD4 count, measuring the CD4 cell count remains valuable for prioritising people for treatment and encouraging rapid linkage to care and initiation of treatment.

Late presentation for HIV care – typically after developing symptoms of advanced HIV disease or when at high risk of opportunistic infections – remains common in sub-Saharan Africa and other resource-limited settings. Although late presentation for care is declining in some countries, findings published last week by the US Centers for Disease Control and Prevention (CDC) show that even in the best-performing countries, around one in five people entered HIV care in 2014 or 2015 when their CD4 cell counts had already fallen below 100 cells/mm3.

Although recently-surveyed countries with comprehensive data on people who start HIV treatment report substantial improvements since 2010, just over a third of people started treatment when already at high risk of opportunistic infections, their most recent data show. National data for Mozambique show that 37% of people starting antiretroviral treatment had CD4 cell counts below 200 in 2014. In Haiti 34% of people starting antiretroviral treatment had CD4 cell counts below 200 in 2015.

A large study carried out in South Africa has shown that delays in linkage to care pose the biggest barrier to achieving the UNAIDS 90-90-90 targets for antiretroviral treatment initiation and viral suppression. The study found that less than half the people diagnosed with HIV in a rural district of KwaZulu-Natal had linked to care within eight years of diagnosis.