Does provider-initiated counselling and testing (PITC) strengthen early diagnosis and treatment initiation? Results from an analysis of an urban cohort of HIV-positive patients in Lusaka, Zambia

Introduction: Building on earlier works demonstrating the effectiveness and acceptability of provider-initiated counselling and testing (PITC) services in integrated outpatient departments of urban primary healthcare clinics (PHCs), this study seeks to understand the relative utility of PITC services for identifying clients with early-stage HIV-related disease compared to traditional voluntary testing and counselling (VCT) services.We additionally seek to determine whether there are any significant differences in the clinical and demographic profile of PITC and VCT clients.\ud \ud Methods: Routinely collected, de-identified data were collated from two cohorts of HIV-positive patients referred for HIV treatment, either from PITC or VCT in seven urban-integrated PHCs. Univariate and multivariate analyses were conducted to compare the two cohorts across demographic and clinical characteristics at enrolment.\ud \ud Results: Forty-five per cent of clients diagnosed via PITC had CD4<200, and more than 70% (i.e. two thirds) had CD4<350 at enrolment, with significantly lower CD4 counts than that of VCT clients (p<0.001). PITC clients were more likely to be male (p<0.0005) and less likely to have secondary or tertiary education (p