Background: In resource-limited settings, the increased availability of HIV testing services, scale-up of antiretroviral therapy (ART), and revised ART initiation guidelines has led to increased accessibility to HIV care. We hypothesized that HIV-infected persons are seeking care earlier compared with the era of initial ART roll-out in sub-Saharan Africa. We investigated the median CD4 count at presentation to care and the proportion presenting with CD4 counts <100 cells/µL from 2005 to 2013.
Methods: Data on CD4 counts at enrollment in care were obtained from 8 urban municipal clinics in Kampala District (KCCA clinics) where HIV care services are supported by PEPFAR and the Infectious Disease Institute (IDI) in Uganda. Multiple linear regression examined associations with CD4 count by year. Results were adjusted for clinic site with robust standard errors to account for clustering.
Results: A total of 59327 HIV-infected persons were registered for care in the KCCA clinics in 2005 – 2013, of whom 21895 (36.9%) had documented CD4 results at entry into care. Of these, 73% were women; median age was 32 years (Interquartile range: 26, 39). The median CD4 count increased steadily through the study period from 168 cells/µL in 2005 to 263 cells/µL in 2013 (Figure 1). Overall, there was a 20% reduction in the proportion of people presenting with CD4 <100 cells/µL from 24.7% in 2005 to 20.2% in 2013 (P<0.001). During the study period, a greater proportion of men (35.6%) presented with CD4<100 than women (24.3%, P<0.001). After adjusting for age, gender, and clinic site, the mean increase in CD4 count at presentation per year was 6.0 cells/µL per year (95%CI: 1.0 to 12.0 cells/µL per year).
Conclusions: For persons in whom CD4 counts were available, there has been a gradual, sustained increase in median CD4 counts at presentation to HIV care in Kampala, Uganda from 2005 to 2013; however, a substantial proportion (20%) still present with advanced AIDS and CD4<100. In light of the current ART start guidelines, more effort is required to ensure eligible patients enroll into care.