Effect of POC CD4 testing at HIV diagnosis on attrition prior to ART initiation among youth in Khayelitsha, South Africa Pre-treatment losses to care remains a challenge Youth and adolescents are at greater risk of attrition from both ART and pre-ART care POC CD4 testing introduced at a youth-only clinic Reduction in attrition between HIV testing and ART initiation? Before-and-after observational study design, comparing lab-based CD4 testing with POC Ensuring HIV positve pts start treatment when needed remains a challenge to improve access to ARVs Youth are particularly vulnerable, shown to be at greater risk of attrition from both ART care and pre-ART care POC CD4 testing has been shown to improve linkage to ART care, and we introduced this at a youth-only clinic for those aged 12 to 25. We sought to determine whether there was an associated reduction in attrition between HIV testing and ART initiaiton Through a before and after obs study comparing lab-based CD4 testing with POC testing

28 days 34 days 67% 91% 81% 44% 90% 50% Group A (Before) Group B (After) HIV Testing Blood sample drawn for CD4 counting WHO Staging* ART preparation counseling session C1 ART Initiation CD4 Result ART eligibility assessed ART preparation counseling session C2 ART preparation counseling session C3 Visit 1 Visit 2 Visit 3 Visit 4 Visit 5 Visit 6 HIV Testing Blood sample drawn for CD4 counting Visit 1 WHO Staging 34 days CD4 Result 28 days ART eligibility assessed RR=2.4, 95% CI 1.8-3.4 67% 90% ART preparation counseling session C1 Visit 2 ART preparation counseling session C2 Visit 3 ART eligibility assessment improved (relative risk =2.4 95% CI: 1.8-3.4) The proportion of eligible patients who initiated ART: 44% (lab-based) and 50% (POC) (p=0.6) Of those eligible patients who started ART preparation counseling 81% (lab-based) and 91% (POC) (p=0.2) initiated ART Time between HIV-testing and ART initiation was reduced from 34 to 28 days 81% P=0.2 91% ART preparation counseling session C3 Visit 4 ART Initiation Visit 5 44% 50% P=0.6

Conclusion POC CD4 testing improved assessment for ART eligibility Most youth aware of their treatment needs on day of HIV diagnosis Small sample size and change in ART eligibility guidelines limited this study Further studies to determine whether youth who are aware of their ART eligibility at HIV diagnosis return to care earlier Youth that started ART preparation counseling were likely to complete ART preparation counseling, initiate ART Additional strategies to POC CD4 testing on the day of HIV diagnosis need to be piloted to increase youth returning for further care and support After POC was introduced most HIV positive youth were made aware of their treatment needs on the day of HIV diagnosis This study was limited by a small sample size, as well as changes in the ART eligibility guidelines during the study period, rendering the sample for comparison to be very small Eligible patients who started preparation counseling were likely to go on to initiate ART Further studies to determine whether knowledge of treatment needs ensures earlier access to ART And strategies on the day of HIV diagnosis need to be piloted to ensure more youth return for further care and support