A successful model for rapid triage of symptomatic patients at an HIV testing site in Haiti

• Published in: International health Vol. 8; no. 2; pp. 96 - 100
• Main Authors: Esperance, Morgan C., Koenig, Serena P., Guiteau, Colette, Homeus, Fabienne, Devieux, Jessy, Edouard, Jenny, Bertrand, Rachel, Joseph, Patrice, Bellot, Clovy, Decome, Diessy, Pape, Jean W., Severe, Patrice
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-03-2016
• Subjects: Adult; Anti-Retroviral Agents - administration & dosage; Anti-Retroviral Agents - therapeutic use; Female; Haiti - epidemiology; HIV Infections - diagnosis; HIV Infections - drug therapy; Humans; Male; Mass Screening; Middle Aged; Original; Social Workers; Triage - organization & administration; Haiti; AIDS; HIV; Attrition; Human resources; Retention in care
• ISSN: 1876-3413; 1876-3405
• DOI: 10.1093/inthealth/ihv042

Background
Attrition from HIV testing to antiretroviral therapy (ART) initiation is high. Strengthening linkages in care from testing to treatment may reduce attrition. This study addresses the question: can social workers accurately identify symptomatic patients during HIV testing and fast-track them for rapid provision of services?
Methods
This study took place at the Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) in Port-au-Prince, Haiti. We compared symptoms reported by social workers at HIV testing using a checklist to diagnoses made by physicians on an intake exam to determine if social workers could accurately identify symptomatic patients.
Results
Among the 437 HIV-positive patients included in the study, social workers reported stage-associated symptoms in 100% of patients diagnosed with WHO stage 3 or 4 conditions and in 87% of patients with WHO stage 1 or 2 conditions. The sensitivity, specificity, positive predictive value, and negative predictive value of social worker-reported symptoms for the diagnosis of a WHO stage 3 or 4 condition was 100%, 47%, 31%, and 100%, respectively.
Conclusions
Social workers can identify symptomatic patients at HIV testing and refer them for fast-tracked services. This strategy may increase the rate of ART initiation among eligible patients.