Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya

Abstract

BackgroundWe examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya.MethodsWe analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method.ResultsMajority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %–6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV.ConclusionHealth facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC.

Feasibility and utility of active case finding of HIV-infected children and adolescents by provider-initiated testing and counselling: evidence from the Laquintinie hospital in Douala, Cameroon

“…In order to contribute to the global efforts for ending AIDS, we designed and implemented a strategy for universal HIV testing and enrolment to care of all infected children/adolescents in RLS. Our model of multiple entry points to healthcare was highly accepted by parents/legal guardians (> 99%), similar to findings from Uganda (92.8%) and Kenya (82.5%) [ 11 , 13 , 14 ]. These indicate a high success rate of such approach in RLS, which contributes in achieving the 90% HIV diagnosis among children/adolescents with unknown status [ 9 ].…”

Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study

“…A number of studies on HIV testing and linkage to care in other SSA countries have reported linkage rates of more than 60%. 15 21 26–29 Our encouraging findings likely reflect a combination of health system and social changes, including reduction in stigma. Our study itself may also have increased linkage to care through regularly contacting and following up HIV-positive individuals.…”

Methods, outcomes, and costs of a 2.5 year comprehensive facility-and community-based HIV testing intervention in Bukoba Municipal Council, Tanzania, 2014-2017

“…In urban and mixed urban and rural communities in which both facility- and community-based HTC strategies can be implemented, however, limited data has been available to inform the prioritization of finite HTC resources for the general population. Although many studies have evaluated comprehensive door-to-door HBHTC in sub-Saharan Africa, we found only one that did so in combination with PITC in urban settings [8]. In Nairobi, Kenya, Muhula and colleagues compared facility-based PITC and client initiated testing with CBHTC; however, the relative contribution of testing strategies to new diagnoses identified and associated costs were not reported [8].…”

“…Although many studies have evaluated comprehensive door-to-door HBHTC in sub-Saharan Africa, we found only one that did so in combination with PITC in urban settings [8]. In Nairobi, Kenya, Muhula and colleagues compared facility-based PITC and client initiated testing with CBHTC; however, the relative contribution of testing strategies to new diagnoses identified and associated costs were not reported [8].…”