Wednesday, February 24, 2016

Enrollment in HIV Care Two Years after HIV Diagnosis in the Kingdom of Swaziland: An Evaluation of a National Program of New Linkage Procedures

To improve early enrollment in HIV care, the Swaziland Ministry of Health implemented new linkage procedures for persons HIV diagnosed during the Soka Uncobe male circumcision campaign (SOKA, 2011–2012) and the Swaziland HIV Incidence Measurement Survey (SHIMS, 2011). 

Abstraction of clinical records and telephone interviews of a retrospective cohort of HIV-diagnosed SOKA and SHIMS clients were conducted in 2013–2014 to evaluate compliance with new linkage procedures and enrollment in HIV care at 92 facilities throughout Swaziland. 

Of 1,105 clients evaluated, within 3, 12, and 24 months of diagnosis, an estimated 14.0%, 24.3%, and 37.0% enrolled in HIV care, respectively, after adjusting for lost to follow-up and non-response. Kaplan-Meier functions indicated lower enrollment probability among clients 14–24 (P = 0.0001) and 25–29 (P = 0.001) years of age compared with clients >35 years of age. At 69 facilities to which clients were referred for HIV care, compliance with new linkage procedures was low: referral forms were located for less than half (46.8%) of the clients, and few (9.6%) were recorded in the appointment register or called either before (0.3%) or after (4.9%) their appointment. Of over one thousand clients newly HIV diagnosed in Swaziland in 2011 and 2012, few received linkage services in accordance with national procedures and most had not enrolled in HIV care two years after their diagnosis. 

Our findings are a call to action to improve linkage services and early enrollment in HIV care in Swaziland.

Below:  Distribution of 69 HIV care facilities to which eligible SHIMS and SOKA clients were referred at HIV diagnosis, by class of facility

Full article at:

Duncan A. MacKellar, Daniel Williams, Jennifer Drummond, Simon Agolory, Andrew L. Baughman 
Division of Global HIV/AIDS, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Nosipho Storer, Harriet Nuwagaba-Biribonwoha, Ruben Sahabo 
ICAP at Columbia University, Mbabane, Swaziland

Velephi Okello, Charles Azih 
Swaziland National AIDS Programme, Swaziland Ministry of Health, Mbabane, Swaziland

Harriet Nuwagaba-Biribonwoha, Margaret L. McNairy 
ICAP at Columbia University, New York, New York, United States of America

Peter Preko 
CTS Global assigned to Centers for Disease Control and Prevention Country Office, Mbabane, Swaziland

Rebecca L. Morgan 
McMaster University, Hamilton, Ontario, Canada

Makhosazana Dlamini 
Population Services International Country Program, Mbabane, Swaziland

Johnita Byrd 
ICF International, Atlanta, Georgia, United States of America

Peter Ehrenkranz 
Bill & Melinda Gates Foundation, Seattle, Washington, United States of America

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