Active voluntary counseling and testing with integrated CD4 count service can enhance early HIV testing and early CD4 count measurement: experiences from the Thai Red Cross Anonymous Clinic in Bangkok, Thailand.

Background: Low CD4 count at antiretroviral therapy initiation is common both in developed and developing countries. Active voluntary counseling and testing (VCT) center with integrated CD4 count service may facilitate early HIV testing and CD4 count measurement. Method: We analyzed data from clients who had HIV testing at our VCT center between June 1, 2006 to May 31, 2009. HIV testing was provided through routine VCT, health check-up, nutrition, and sexual health services. CD4 count measurement was available in the clinic. The first CD4 count and duration between HIV diagnosis and the first CD4 count measurement were extracted from the database along with available demographic data. Results: Among 19,525 Thai clients who had HIV testing, 2580 clients (13.2%) were tested HIV positive for the first time. CD4 count measurement was performed in 73.3% of HIV-positive clients and 91.4% of these occurred within the first month of HIV diagnosis. Median first CD4 count was 287.0 (IQR = 114.0-434.3) cells per cubic millimeter, 62% had CD4 count <350 cells per cubic millimeter. Conclusions: As HIV programs are moving toward earlier initiation of antiretroviral therapy, efforts are needed to promote "early HIV testing" among general population with different levels of HIV risks and to enhance "early CD4 count measurement" after HIV diagnosis.