Management of HIV positive men under testing sessionDr. J. Otchere-Darko MDBophelo Pele Male Circumcision Centre (Orange Farm)

Contents

•Introduction•Process•Follow-up•Conclusion

Introduction• VCT –started in 2000,now changed to HCT for NSP

goal• Conducted by Society for Family Health(SFH) with

New Start• Free service offered as per WHO guidelines• HCT: Offered during group male circumcision

session(age group:15 years and up) (01 May,2010)• Age group for uptake:18 yr -45yr• +/- 76% of men approve for testing after HCT• Counselling done individually with same counsellor• Results ready in +/- 10 – 15 minutes

Men tested negative( +/- 97%)

•Referred for male circumcision and risk reduction reinforced•To return after 3 days

Men tested positve•+/- 3% after HCT and 9% after VCT-males, 18%- females•CD4 >200- male circumcision may be done (90%)•Extra counselling given about 6 weeks abstinence

•Men who refuse test (22%) proceed to male circumcision as for “negatives”

Men tested positive(Process)• CD4 count test done

immediately (onsite laboratory)

• +/- 79%:CD4> 200 cells/ul- wellness counselling re-emphasized

-Male circumcision may proceed

• +/- 21%:CD4< 200 cells/ul-referral to local ARV accredited clinics with a letter (duplicated)

• TB and STI screening requested on form

Follow-up• Done by referral co-ordinator• Visits: weekly to different sites to collect

forms/coupons• Telephone calls :to re-emphasise importance of

clinic visit • Encouraged to bring partners for testing, but

uncommon (as most have multiple partners, not stable ones -4% return )

• CD4 count repeated at clinic for confirmation• Time span for follow-up: 2 weeks• Social support needs referred to local social

worker

Cont’d• Findings: +/- 20% local clinic attendance after 1

week : +/- 25% after 2 weeks and ARV’s

commenced• Most reasons for no clinic follow-up: denial,

fear, “shock”, good health,or disbelief in results• May return for circumcision once CD4 count or

health improves• 0% return rate for male circumcision among the

men with CD4 count < 200

Key challenges• Very low clinic follow-up rate• Poor clinic services• Discordant partners due to window period or

true ones• Follow-up of partners(multiple partners)• CD4 counts: difference between immunological

and clinical status

Conclusion• High testing rate after HCT (+/- 76%)-very

encouraging• Male circumcision- used as an entry point for

HAART as well as HIV testing • Low positive result percentage (+/- 8%:maximum

for VCT and HCT)• Follow-up :can be a challenge but a very

important step; but still room to learn

Acknowledgements Prof. Bertran Auvert (University of Versailles) Dr. Dirk Taljaard (CHAPS)Dr. Dino Rech (CHAPS) Cynthia Nhlapo (SFH) Scott Billy (SFH) Dr. Kim Dickson (WHO)Julia Samuelson (WHO)

Thank you!!