The Geography of Emergency Department-Based HIV Testing in South Africa: Can Patients Link to Care?

Background: Emergency Departments (EDs) can serve as clinical sites for identification of new HIV infections and their entry into care. We examined if HIV-positive patients who present to EDs in South Africa are able successfully link care. Methods: conducted a one-year longitudinal prospective cohort study four hospitals across the Eastern Cape, between July 2016 2018. All adult, non-critical presenting ED were systematically approached, asked about status, and, unknown, offered point-of-care (POC) test. further consented participate follow-up assess subsequent linkage care distance from “home” ED. Linkage was defined self-reported (telephonic) or evidence repeated CD4/viral load testing National Health Laboratory System (NHLS) at either 6- 12-months post index visit. Findings: A total 983 study. In 12 months following visit, 34∙1% demonstrated (335/983), 23∙8% did not (234/983), 42∙1% (414/983) lost follow-up. Though statistically significant, higher percentage young men those with trauma-related complaint considerable proportion (105/454, 23∙2%,) resided 50 more km sites, though there significant difference rate lived closer ED. Interpretation: Innovative implementation strategies required overcome patient-level factors structural barriers within health system improve both known newly diagnosed patients. Strategies should consider use facilitated using case management approaches same day ART initiation, amongst others. Funding Information: This research supported by African Medical Research Council, Division Intramural Research, Institute Allergy Infectious Diseases, Institutes Health, Johns Hopkins Center Global Health. The funding bodies had no role design collection, analysis, interpretation data writing manuscript. Declaration Interests: authors have nothing disclose. Ethics Approval Statement: approved University School Medicine Institutional Review Board (IRB00105801), Human Ethics Committees (HREC) Cape Town (Ref 856/2015), Walter Sisulu HREC 069/15). Written consent obtained all participants collection demographic POC testing.