Simultaneous HIV and lymphocyte CD4+ testing as an intervention for improving linkage to care - experience of a voluntary counselling and testing facility-based pilot programme

Introduction: Simultaneous lymphocyte CD4+ and HIV testing has been proposed as a method for shortening the time between human immunodeficency syndrome (HIV) diagnosis and combined anti-retroviral therapy (cART) initiation, thus improving clinical outcomes. Here, we investigate its impact on the linkage to care in voluntary counselling and testing centers (VCT) in Warsaw. Material and methods: All clients, who presented at the two VCTs in Warsaw and had positive ELISA tests, were offered the lymphocyte CD4+ test simultaneously with the WB test. All tests were anonymous. Data collected between 2012-2013 from the VCTs were linked with HIV clinic records using the WB test numbers as unique identifiers. Persons registered in HIV clinics were considered linked to care. Results: In total, during 2012-2013, one hundred and twenty-three clients were tested as HIV-positive in the VCTs. Of these, 30 had their lymphocyte CD4+ count tested, while 42 (65.8%) clients were linked to HIV care. The linkage rate did not differ between the lymphocyte CD4+ test groups (66.7% of tested vs. 65.6% of non-tested for the lymphocyte CD4+; p = 0.91). There was also no significant difference in time to linkage, p = 0.52. In total, 66 (65.8%) clients started cART - 19 (28.8%) in the lymphocyte CD4+ group, and 47 (71.2%) in other (p = 0.07). However, there was a significant difference in the time for starting cART, p = 0.005. Conclussion: In Poland, a resource-rich country, simultaneous lymphocyte CD4+ and HIV testing at counselling and testing centers had no effect on linkage to care, but did have a positive impact on time to starting cART.