Abbreviated HIV counselling and testing and enhanced referral to care in Uganda: a factorial randomised controlled trial

Rhoda K Wanyenze; Moses R Kamya; Robin Fatch; Harriet Mayanja-Kizza; Steven Baveewo; Gregory Szekeres; David R Bangsberg; Thomas Coates; Judith A Hahn

doi:10.1016/S2214-109X(13)70067-6

Abbreviated HIV counselling and testing and enhanced referral to care in Uganda: a factorial randomised controlled trial

Lancet Glob Health. 2013 Sep;1(3):e137-45. doi: 10.1016/S2214-109X(13)70067-6. Epub 2013 Aug 23.

Authors

Rhoda K Wanyenze¹, Moses R Kamya², Robin Fatch³, Harriet Mayanja-Kizza², Steven Baveewo², Gregory Szekeres⁴, David R Bangsberg⁵, Thomas Coates⁴, Judith A Hahn³

Affiliations

¹ Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda. Electronic address: rwanyenze@hotmail.com.
² Department of Medicine, Makerere University School of Medicine, Kampala, Uganda.
³ Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
⁴ Division of Infectious Diseases, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
⁵ Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA, USA.

Abstract

Background: HIV counselling and testing and linkage to care are crucial for successful HIV prevention and treatment. Abbreviated counselling could save time; however, its effect on HIV risk is uncertain and methods to improve linkage to care have not been studied.

Methods: We did this factorial randomised controlled study at Mulago Hospital, Uganda. Participants were randomly assigned to abbreviated or traditional HIV counselling and testing; HIV-infected patients were randomly assigned to enhanced linkage to care or standard linkage to care. All study personnel except counsellors and the data officer were masked to study group assignment. Participants had structured interviews, given once every 3 months. We compared sexual risk behaviour by counselling strategy with a 6·5% non-inferiority margin. We used Cox proportional hazards analyses to compare HIV outcomes by linkage to care over 1 year and tested for interaction by sex. This trial is registered with ClinicalTrials.gov (NCT00648232).

Findings: We enrolled 3415 participants; 1707 assigned to abbreviated counselling versus 1708 assigned to traditional. Unprotected sex with an HIV discordant or status unknown partner was similar in each group (232/823 [27·9%] vs 251/890 [28·2%], difference -0·3%, one-sided 95% CI 3·2). Loss to follow-up was lower for traditional counselling than for abbreviated counselling (adjusted hazard ratio [HR] 0·61, 95% CI 0·44-0·83). 1003 HIV-positive participants were assigned to enhanced linkage (n=504) or standard linkage to care (n=499). Linkage to care did not have a significant effect on mortality or receipt of co-trimoxazole. Time to treatment in men with CD4 cell counts of 250 cells per μL or fewer was lower for enhanced linkage versus standard linkage (adjusted HR 0·60, 95% CI 0·41-0·87) and time to HIV care was decreased among women (0·80, 0·66-0·96).

Interpretation: Abbreviated HIV counselling and testing did not adversely affect risk behaviour. Linkage to care interventions might decrease time to enrolment in HIV care and antiretroviral treatment and thus might affect secondary HIV transmission and improve treatment outcomes.

Funding: US National Institute of Mental Health.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adult
CD4 Lymphocyte Count
Counseling / methods*
Disease Management
Female
HIV Infections / blood
HIV Infections / diagnosis*
HIV Infections / therapy
Humans
Male
Proportional Hazards Models
Referral and Consultation*
Risk Assessment
Risk-Taking*
Sex Factors
Sexual Behavior
Time-to-Treatment*
Uganda
Unsafe Sex
Young Adult

Associated data

ClinicalTrials.gov/NCT00648232

Abstract

Publication types

MeSH terms

Associated data

Grants and funding