From HIV diagnosis to treatment

Conclusion

In conclusion, an HIV diagnosis is not always sufficient to ensure that infected persons are subsequently able to access HIV treatment, including ART. In this paper, we described the methods that we used to document delays in referral uptake at a hospital-based ART site following diagnosis in a rural VCT clinic, and the lessons learned through this process. The implementation of this simple referral system helped to assess the effectiveness of the VCT clinic as an entry point for HIV treatment and facilitated timely access to treatment for HIV-positive individuals in this rural area.

Similar systems to monitor referral uptake and linkages between HIV services could be readily implemented in other settings. A failure to strengthen referral procedures as HIV testing expands would be an unacceptable lost opportunity to ensure the highest of ethical standards and a commitment to promoting equitable access to life-prolonging antiretroviral drugs.

Competing interests
The authors declare that they have no competing interests.

Authors’ contributions

RN was responsible for the overall management of the referral system, liaison with stakeholders, and the data collection and analysis. He co-wrote the first draft of the manuscript. AW contributed to the design of the referral system, co-wrote the first draft of the manuscript, and co-designed the qualitative study. MR co-designed the qualitative study, recruited and trained qualitative researchers, and provided advice on the qualitative work. SK contributed to the design and implementation of the referral system, and the design of the evaluation. MU, director of the whole cohort study, provided overall advice, facilitated the coordination between the stakeholders, and contributed to drafting the manuscript. JB provided technical support in designing the qualitative study. BZ, technical advisor for the whole cohort study, conceived the initial idea for the referral system, provided advice, and contributed to drafting the manuscript. All co-authors read and commented on the draft versions of the paper and participated in the editing process.

References

References

• WHO: Towards universal access by 2010: How WHO is working with countries to scale up HIV prevention, treatment, care and support. Geneva: World Health Organization; 2006.
  
• Lawn SD, Harries AD, Anglaret X, Myer L, Wood R: Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa.
  AIDS 2008, 22:1897-1908.
  
• WHO: Guidance on ethics and equitable access to HIV treatment and care. Geneva: World Health Organization; 2004.
  
• Rennie S, Behets F: Desperately seeking targets: the ethics of routine HIV testing in low-income countries.
  Bull World Health Organ 2006, 84:52-57.
  
• WHO: Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress report. Geneva: World Health Organization; 2007.
  
• Guidelines for HIV testing and counselling in clinical settings ... full References ... »

Ray Nsigaye, Alison Wringe, Maria Roura, Samuel Kalluvya, Mark Urassa, Joanna Busza and Basia Zaba

1 Tazama Project, National Institute of Medical Research, Mwanza, Tanzania

2 Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK

3 HIV/AIDS Unit, Bugando University College of Health Sciences, Mwanza, Tanzania

Journal of the International AIDS Society 2009, 12:31doi:10.1186/1758-2652-12-31

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