High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa

J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):e1-8. doi: 10.1097/QAI.0b013e31829b567d.


Objective: For antiretroviral therapy (ART) to have a population-level HIV prevention impact, high levels of HIV testing and effective linkages to HIV care among HIV-infected persons are required.

Methods: We piloted home-based counseling and testing (HBCT) with point-of-care CD4 count testing and follow-up visits to facilitate linkage of HIV-infected persons to local HIV clinics and uptake of ART in rural KwaZulu-Natal, South Africa. Lay counselor follow-up visits at months one, three and six evaluated the primary outcome of linkage to care. Plasma viral load was measured at baseline and month six.

Results: 671 adults were tested for HIV (91% coverage) and 201 (30%) were HIV-infected, of which 73 (36%) were new diagnoses. By month three, 90% of HIV-infected persons not on ART at baseline had visited an HIV clinic and 80% of those eligible for ART at baseline by South African guidelines (CD4≤200 cells/μL at the time of the study) had initiated ART. Among HIV-infected participants who were eligible for ART at baseline, mean viral load decreased by 3.23 log10 copies/mL (p<0.001) and the proportion with viral load suppression increased from 20% to 80% between baseline and month six.

Conclusions: In this pilot of HBCT and linkages to care in KwaZulu-Natal, 91% of adults were tested for HIV. Linkage to care was ∼90% both among newly-identified HIV-infected persons as well as known HIVinfected persons who were not engaged in care. Among those eligible for ART, a high proportion initiated ART and achieved viral suppression, indicating high adherence and reduced infectiousness.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Serodiagnosis / statistics & numerical data*
  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Counseling / organization & administration
  • Counseling / statistics & numerical data*
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • Health Knowledge, Attitudes, Practice
  • Home Care Services* / organization & administration
  • Home Care Services* / statistics & numerical data
  • Humans
  • Male
  • Mass Screening* / organization & administration
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data
  • Pilot Projects
  • Point-of-Care Systems
  • Prevalence
  • Referral and Consultation* / organization & administration
  • Referral and Consultation* / statistics & numerical data
  • Rural Population
  • South Africa / epidemiology
  • Viral Load


  • Anti-HIV Agents