What Is the Impact of Home-Based HIV Counseling and Testing on the Clinical Status of Newly Enrolled Adults in a Large HIV Care Program in Western Kenya?

Wachira, Juddy; Kimaiyo, Sylvester; Ndege, Samson; Mamlin, Joseph J.; Braitstein, Paula

doi:10.1093/cid/cir789

Cited by 74 publications

(80 citation statements)

References 24 publications

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“…Our study provides a further insight into the gender disparity in the early stages of the cascade of care. First, men were less likely than women inclined to get tested for HIV, mostly because of their absence due to labour migration, which was also found in other sites in subSaharan Africa [11,30,31]. We managed to reach 80% testing coverage among eligible men by repeating visits, including during weekends.…”

Section: Discussionmentioning

confidence: 92%

“…Community-based and mobile HIV testing and counselling services (HTC) increase rates of test uptake and reach people at an earlier stage of their HIV infection [7][8][9][10][11]. Community testing approaches are considered cost-effective in high prevalence settings [12] and have been recommended by WHO in generalised HIV epidemic settings in addition to facility-based HIV testing since 2013 [13].…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi

Maman

Ben‐Farhat

Chilima

et al. 2016

Tropical Med Int Health

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Abstractobjective HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi. conclusions In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.keywords linkage to care, population survey, sub-Saharan Africa, cascade of care, epidemiology

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi

Maman

Ben‐Farhat

Chilima

et al. 2016

Tropical Med Int Health

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“…These findings are consistent with other studies in Africa in which male HIV testing rates and enrollment figures consistently lag behind those of women. [27][28][29][30][31][32] Although facility-based testing through antenatal clinics and other programs has contributed substantially to increasing women's HIV testing coverage, similar increases among men have not been noted because men constitute a smaller proportion of overall daily health facility attendance tending to only seek care when severely ill. 33 In addition, providers may not emphasize the importance of testing to their male patients outside of high-probability diagnostic settings (tuberculosis clinics, in-patient wards), and many facility-based male testing initiatives are often promoted through antenatal care testing, which may be difficult logistically, socially, or culturally to attract large numbers of men. 34 The main reason provided for not testing, regardless of health care utilization group, was that it was either unnecessary or the person was too busy.…”

Section: Discussionmentioning

confidence: 99%

Health Care Utilization and Access to Human Immunodeficiency Virus (HIV) Testing and Care and Treatment Services in a Rural Area with High HIV Prevalence, Nyanza Province, Kenya, 2007

Ackers

Hightower

Obor³

et al. 2014

The American Journal of Tropical Medicine and Hygiene

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Abstract. We present health and demographic surveillance system data to assess associations with health care utilization and human immunodeficiency virus (HIV) service receipt in a high HIV prevalence area of western Kenya. Eighty-six percent of 15,302 residents indicated a facility/clinician for routine medical services; 60% reported active (within the past year) attendance. Only 34% reported a previous HIV test, and self-reported HIV prevalence was 6%. Active attendees lived only slightly closer to their reported service site (2.8 versus 3.1 km; P 0.001) compared with inactive attendees. Multivariate analysis showed that younger respondents ( 30 years of age) and active and inactive attendees were more likely to report an HIV test compared with non-attendees; men were less likely to report HIV testing. Despite traveling farther for HIV services (median distance = 4.4 km), 77% of those disclosing HIV infection reported HIV care enrollment. Men and younger respondents were less likely to enroll in HIV care. Socioeconomic status was not associated with HIV service use. Distance did not appear to be the major barrier to service receipt. The health and demographic surveillance system data identified patterns of service use that are useful for future program planning.

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“…Home-based counseling and testing (HBCT) successfully identifies HIV earlier in the course of disease progression compared with other testing modalities. 1,2 However the benefits of HBCT for improving patient outcomes will not be fully realized unless those diagnosed engage with care in a timely manner.…”

Section: Introductionmentioning

confidence: 99%

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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What Is the Impact of Home-Based HIV Counseling and Testing on the Clinical Status of Newly Enrolled Adults in a Large HIV Care Program in Western Kenya?

Abstract: HBCT is effective at getting HIV-infected persons enrolled in HIV care before they become ill.

Cited by 74 publications

References 24 publications

Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi

Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi

Health Care Utilization and Access to Human Immunodeficiency Virus (HIV) Testing and Care and Treatment Services in a Rural Area with High HIV Prevalence, Nyanza Province, Kenya, 2007

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

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