Digitising point of care HIV test results to accurately measure, and improve performance towards, the UNAIDS 90-90-90 targets

Abstract

Introduction:\nHigh rates of pre-treatment loss to care among persons diagnosed with HIV persist. Linkage to care can be improved through active digitally-based surveillance. Currently, record-keeping for HIV diagnoses in South Africa is paper-based. Aggregated testing data are reported routinely, and only discordant findings result in a specimen being tested at a laboratory and digitised. \nMethods:\nThe Western Cape Province in South Africa has a Provincial Health Data Centre (PHDC) where person-level routine data are consolidated in a single database, leveraging the existence of a unique patient identifier. To facilitate improved surveillance, a pre-carbonated point-of-care test (PoCT) form was piloted, where one copy was routed to the centralised laboratory and digitised for PHDC inclusion. We evaluated the utility of the intervention using cross-sectional and retrospective cohort analyses, as well as comparisons with reported aggregate data.\nResults:\nFrom May 2017 to June 2018, 11337 digitised point-of-care HIV testing records were linked to the PHDC. Overall, 96% of records in the aggregate dataset were digitised, with 97% linked to the PHDC. Of those tested, 79% were female (median age 27 years). Linkage demonstrated that 51.3% of patients testing HIV-positive were retesting. Of those truly newly diagnosed, 81% were linked to HIV care and 25% were initiated on antiretroviral therapy immediately.\nConclusion:\nDigitisation of PoCT results is feasible and provides individuated HIV testing data to assist in linkage to care and in differentiating newly diagnosed patients from positive patients retesting. Actionable and accurate data can improve the measurement of performance towards the UNAIDS 90-90-90 targets.