1. 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

2. 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
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: )
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

3. 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