title: Family model of HIV care and treatment: a retrospective study in Kenya.
abstract: BACKGROUND
  Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal.
  
  
  METHODS
  A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach.
  
  
  RESULTS
  Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively.
  
  
  CONCLUSIONS
  The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.|Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.|Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 50 Beale St., Suite 1200, San Francisco, CA 94105, USA.
authors.forename: Jayne
authors.initials: J
authors.lastname: Lewis Kulzer
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.|Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Penner
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Reson
authors.initials: R
authors.lastname: Marima
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Patrick
authors.initials: P
authors.lastname: Oyaro
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Arbogast O
authors.initials: AO
authors.lastname: Oyanga
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.|Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Starley B
authors.initials: SB
authors.lastname: Shade
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.|Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Cinthia C
authors.initials: CC
authors.lastname: Blat
authors.affiliation: Provincial AIDS/STD Control Operations, Kenya Ministry of Health, Nairobi, Kenya.
authors.forename: Lennah
authors.initials: L
authors.lastname: Nyabiage
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.|Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Christina W
authors.initials: CW
authors.lastname: Mwachari
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Hellen C
authors.initials: HC
authors.lastname: Muttai
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Family AIDS Care and Education Services (FACES), Research Care and Training Program, Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.|Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000451:nursing*; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult