Plazy M. auteur aut IRD Diallo A. auteur aut IRD Hlabisa T. auteur aut IRD Okesola N. auteur aut IRD Iwuji C. auteur aut IRD Herbst K. auteur aut IRD Boyer S. auteur aut IRD Lert F. auteur aut IRD McGrath N. auteur aut IRD Pillay D. auteur aut IRD Dabis F. auteur aut IRD Larmarange Joseph auteur aut IRD Orne-Gliemann J. auteur aut IRD ANRS TasP Study Group auteur aut IRD text journalArticle eng text/pdf reformatted digital access Background : Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa.Methods : In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012-2016, resident individuals ?16 years were offered home-based HIV testing every six months.Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to ?re-refer? people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up.Results : Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47-2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07-7.48).Conclusions : Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets specialized AFRIQUE DU SUD 052MALTRA03 056SOCSAN e0280479 [17 ] 2023 1932-6203 https://www.documentation.ird.fr/hor/fdi:010087820 10.1371/journal.pone.0280479 1932-6203 [F B010087820] https://www.documentation.ird.fr/hor/fdi:010087820 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2023-08/010087820.pdf IRD - Base Horizon / Pleins textes 2023-04-12 2025-02-24 fdi:010087820 fre