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

ABSTRACT

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.