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Acute HIV study provides improved clinical care, counseling and HIV/AIDS related referral to patients at UNC Project-Kamuzu Central Hospital sexually transmitted infection (STI) clinic in Lilongwe, Malawi
G. Kamanga1, C. Mapanje1, N. Nyirenda1, N. Bonongwe1, B. Ndalama1, S. Phakati1, F. Martinson1, M. McCauley2, C. Gay3, I. Hoffman3, M. Cohen3, For CHAVI 001
1UNC Project, Lilongwe, Malawi, 2Family Health International, Chapel Hill, United States, 3UNC - Chapel Hill, Chapel Hill, United States
Background: CHAVI 001 is a multi-site, acute HIV infection (AHI) study focused on investigating transmission of HIV-1, host responses, and genetic factors that determine HIV transmission and viral set point. Participants are recruited from an STI clinic in Lilongwe, Malawi, which is run in collaboration with the UNC Project. Since the study relies on determining the HIV status of STI clients, strategies were implemented to increase uptake of HIV testing.
Methods: In an effort to improve study enrollment in 2005, clinic improvements were made to ensure patient comfort, privacy and efficiency of service provision. Staff were added and trained in HIV, AHI, STI, and risk reduction counseling. All AHI and selected established HIV clients based on HIV rapid and RNA testing were enrolled into the CHAVI study. Sequential CD4 cell count assessments allowed for initiation of cotrimoxazole preventive therapy (CPT) and ART intervention based on immunologic status versus reliance on standard of care clinical staging alone.
Results: Between November 2006 and December 2008, 8847/ 14005 (63%) of new STI clinic attendees were tested for HIV and 2566 (29%) were positive. Prior to the initiation of the CHAVI study, HIV testing uptake was only 29% (3152/10825). 66/92 (72%) of the CHAVI enrollees met the criteria for CPT (CD4 count < 500) and 62 (94%) were started on CPT. All 31 participants eligible for ART (CD4 < 250) were counseled and immediately referred for HIV care and 24 (77%) subsequently started ART.
Conclusions: The CHAVI 001 study fostered the utilization of research resources and practical strategies to improve the quality of clinical care, HIV testing and counseling and referral. Our clinic's experience has demonstrated that HIV testing is an entry point to HIV care and support and that the CHAVI study served as a catalyst.
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