Stage of HIV presentation at initial clinic visit following a community-based HIV testing campaign in rural Kenya

Abstract

BackgroundThe Kenyan Ministry of Health and partners implemented a community-based integrated prevention campaign (IPC) in Western Kenya in 2008. The aim of this study was to determine whether the IPC, compared to Voluntary Counselling and Testing (VCT) services, was able to identify HIV positive individuals earlier in the clinical course of HIV infection following testing.MethodsA total of 1,752 adults aged over 15 years who tested HIV positive through VCT services or the IPC, and subsequently registered at initial clinic visit between September 2008 and September 2010, were considered in the analysis. Multivariable logistic regression models were developed to assess the association of CD4 count and WHO clinical stage of HIV infection at first clinic appointment with age group, gender, marital status and HIV testing source.ResultsMale gender and marital status were independently associated with late HIV presentation (WHO clinical stage 3 or 4 or CD4 count ≤350 cells/μl) at initial clinic visit. Patients testing HIV positive during the IPC had significantly higher mean CD4 count at initial clinic visit compared to individuals who tested HIV positive via VCT services. Patients testing HIV positive during the IPC had more than two times higher odds of presenting early with CD4 count greater than 350 cells/μl (adjusted OR 2.15, 95% CI 1.28 – 3.61, p = 0.004) and presenting early with WHO clinical stage 1 or 2 of HIV infection (adjusted OR 2.39, 95% CI 1.24 – 4.60, p = 0.01) at initial clinic visit compared to individuals who tested HIV positive via VCT services.ConclusionThe community-based integrated prevention campaign identified HIV positive individuals earlier in the course of HIV infection, compared to Voluntary Counselling and Testing services. Community-based campaigns, such as the IPC, may be able to assist countries to achieve earlier testing and initiation of ART in the course of HIV infection. Improving referral mechanisms and strengthening linkages between HIV testing and treatment services remain a challenge and electronic medical record (EMR) systems may support monitoring of patients throughout the HIV care and treatment continuum.

Factors associated with late presentation for HIV/AIDS care in Harare City, Zimbabwe, 2015

“…Furthermore, the median delay for care after testing positive varied between cases and controls (2 days and 30 days respectively). This is consistent with what was found out in Kenya during a community testing campaign where there was a delay between testing and linkage to care [ 7 ]. The delay was attributed to lack of training on the part of service providers.…”

The impact of “male clinics” on health-seeking behaviors of adult men in rural Kenya

“…These findings are consistent with previous research [12, 23–25]. As a result, many men access health services primarily for curative care [26–27] and at an advanced stage of a health issue [16–17].…”

“…Furthermore, clinics are often viewed as “female spaces,” because females usually make up most of the patient and caregiver population in these settings [12]. As a result, it is common for men to only seek care during emergencies or in the later stages of preventable illnesses [15–17].…”

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

“…The proportion of individuals with CD4 count of less than 350 cells μL −1 at HIV diagnosis was reported in 7 home 14,38,42,43,65,72,73 , 3 mobile 91,94,114 , 3 campaign 46,47,76 , 8 facility VCT 60,81,107,126,127,129–131 and 5 facility PITC studies 61,81,99,126,130 . Community-based strategies identified HIV-positive individuals at higher CD4 counts than facility HTC, with campaign having the lowest proportion with CD4 count less than 350 cells μL −1 (26%, 95% CI = 22–30%) (Fig.…”