Home-based HIV counselling and testing in Western Kenya

Kimaiyo, Sylvester; Mc, Were; Shen, Changyu; Ndege, Samson; Braitstein, Paula; Sidle, John E.; Mamlin, Joseph J.

doi:10.4314/eamj.v87i3.62195

Cited by 42 publications

(53 citation statements)

References 12 publications

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“…The percentage of men out of total persons tested was reported in 25 home HTC studies 5,14,18,29,31,32,37,38,41–45,63,64,66,68–72,88–90 , two home with self-testing 11,75 , 10 mobile 10,13,68,72,91–99 , 3 index partner 47,49,88 , 3 campaign 46,47,76 , 2 workplace 100,101 , 20 facility VCT 52,54,61,64,81,88,89,92,93,95,96,98,102–107 , and 13 facility PITC 58,60,82–84,86,99,108–113 (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…Percentage of participants reporting testing for the first time was included in 20 home HTC studies 5,14,18,29,31,32,38,41–44,63,65,66,68–72,88 , 11 mobile 10,12,68,93–95,97,103,114 , 3 campaign 46,47,77 , 3 key populations 25,115,116 , and 7 facility VCT 12,54,91,93,95,106 , and 5 facility PITC 58,86,88,111,112 . Pooled percentages of first-time testers were higher for community than facility modalities (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

437

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

437

532

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“…8 Briefly, AMPATH is a large clinical care system that has enrolled over 150,000 individuals into HIV care since 2001. 9,10 AMPATH implemented HBCT, including community mobilization, in-home HIV testing and counseling with rapid results, and passive referrals to care in six catchment areas from 2007 through 2012.…”

Section: Methodsmentioning

confidence: 99%

“…9,10 AMPATH implemented HBCT, including community mobilization, in-home HIV testing and counseling with rapid results, and passive referrals to care in six catchment areas from 2007 through 2012. 2,8 The goal of the HBCT initiative was to provide HIV testing to all adults (aged 13 and older) living in the catchment areas. Data presented here are from one high prevalence sub-county, Bunyala, where HBCT was conducted from December 2009 to February 2011.…”

Section: Methodsmentioning

confidence: 99%

“…The objective of this study was to use HBCT data from Bunyala, a high prevalence sub-county in western Kenya, 2,8 together with clinical data from AMPATH (Academic Model Providing Access to Healthcare), the largest HIV care provider in the region, to measure engagement in the early phases of HIV care at the population-level. Using this population-based framework, we focused on the steps of the HIV care continuum through initiation of ART.…”

Section: Introductionmentioning

confidence: 99%

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Linkage to and engagement in HIV care in western Kenya: an observational study using population-based estimates from home-based counselling and testing

Genberg¹,

Naanyu²,

Wachira³

et al. 2015

The Lancet HIV

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Summary Background There is limited research characterizing the HIV care continuum with population-based data in sub-Saharan Africa. The objectives of this study were to: 1) describe engagement in care among all known HIV-positive adults in one sub-county of western Kenya; and 2) determine the time to and predictors of linkage and engagement among adults newly diagnosed via home-based counseling and testing (HBCT). Methods AMPATH (Academic Model Providing Access to Healthcare) has provided HIV care in western Kenya since 2001 and HBCT since 2007. Following a widespread HBCT program in Bunyala sub-county, electronic medical records (EMR) were reviewed to identify uptake of care among individuals with previously known (self-reported) infection and new (identified by HBCT) HIV diagnoses as of June 2014. Engagement in HIV care was defined as an initial encounter with an HIV care provider. Cox regression analysis was used to examine the predictors of engagement among those newly diagnosed. Findings Of the 3,482 infected adults identified, 61% had previously known infections, among whom 84% (n = 1778/2122) had ever had at least one clinical encounter within AMPATH. While 73% were registered in the EMR, only 15% (n = 209/1360) of the newly diagnosed had seen a clinician over a median of 3·4 years. The median time to engagement among the newly diagnosed was 60 days (interquartile range: 10–411 days). Interpretation Engagement in care was high among those who at the time of HBCT were already known HIV-positive, but few who were newly diagnosed in HBCT saw an HIV care provider. Funding This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID under the terms of Cooperative Agreement No. AID-623-A-12-0001. The HBCT program was supported by grants from Abbott Laboratories, the Purple ville Foundation, and the Global Business Coalition. Abbott Laboratories provided test kits and logistical support. Further support was provided by the National Institute of Mental Health (K01MH099966, PI: Genberg) and the Bill and Melinda Gates Foundation. The contents of this study are the sole responsibility of the authors and do not necessarily reflect the views of USAID, NIMH, BMGF, or the United States Government.

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Optimal timing of HIV home‐based counselling and testing rounds in Western Kenya

et al. 2018

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IntroductionWeaknesses in care programmes providing anti‐retroviral therapy (ART) persist and are often instigated by late HIV diagnosis and poor linkage to care. We investigated the potential for a home‐based counselling and testing (HBCT) campaign to be improved through the optimal timing and enhancement of testing rounds to generate greater health outcomes at minimum cost.MethodsUsing a mathematical model of HIV care calibrated to longitudinal data from The Academic Model Providing Access To Healthcare (AMPATH) in Kenya, we simulated HBCT campaigns between 2016 and 2036, assessing the impact and total cost of care for each, for a further 20 years.ResultsWe find that simulating five equally spaced rounds averts 1.53 million disability‐adjusted life‐years (DALYs) at a cost of $1617 million. By altering the timing of HBCT rounds, a four‐round campaign can produce greater impact for lower cost. With “front‐loaded” rounds, the cost per DALY averted is reduced by 12% as fewer rounds are required ($937 vs. $1060). Furthermore, improvements to HBCT coverage and linkage to care avert over two million DALYs at a cost per DALY averted of $621 (41% less than the reference scenario).ConclusionsCountries implementing HBCT can reduce costs by optimally timing rounds and generate greater health outcomes through improving linkage, coverage, and retention. Tailoring HBCT campaigns to individual settings can enhance patient outcomes for minimal cost.

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Home-based HIV counselling and testing in Western Kenya

Cited by 42 publications

References 12 publications

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Linkage to and engagement in HIV care in western Kenya: an observational study using population-based estimates from home-based counselling and testing

Optimal timing of HIV home‐based counselling and testing rounds in Western Kenya

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