Home-based HIV testing and counseling in rural and urban Kenyan communities.
BACKGROUND
In sub-Saharan Africa, most people with HIV do not know they are infected.


METHODS
We conducted door-to-door home-based testing and counseling (HBTC) in rural western Kenya (Lwak) and an informal urban settlement in Nairobi (Kibera) in 2008. After consent, eligible persons (adults and adolescents aged 13 years or older and children aged 12 years or younger, whose biologic mother was HIV-infected or deceased) received parallel fingerstick HIV rapid testing and counseling. Persons newly diagnosed with HIV were referred to care services, fingerstick blood for CD4 testing was collected, and a one-month follow-up home visit was conducted.


RESULTS
Among 24,450 people who were offered HBTC, 19,966 (81.7%) accepted; 65.4% of whom were HIV-tested for the first time. Prevalence in adults aged 18 years or older being HIV-tested for the first time was 13.5% (12.6%, Kibera; 14.2%, Lwak). Among adults who reported a previously negative test, HIV prevalence was 7.4% (7.2%, Kibera; 7.6%, Lwak). Among all persons with HIV in these communities, two-thirds were newly diagnosed through HBTC. Median CD4 count among newly diagnosed adults was 403 [interquartile range (IQR) = 252-594]. Among couples, 38.0% in Kibera and 51.7% in Lwak were counseled together. Among HIV-infected people in a couple, 34.6% had an HIV-uninfected partner. Among newly diagnosed HIV-infected persons, at the one-month follow-up visit, 53.6% in Kibera and 43.6% in Lwak reported having visited an HIV patient support center.


CONCLUSIONS
HBTC acceptance was high and most HIV-infected persons did not previously know they had HIV. HBTC can be an effective strategy for early HIV diagnosis and treatment referral.
Global AIDS Program, Centers for Disease Control and Prevention, Nairobi, Kenya.
Warren
W
Dalal
Daniel R
DR
Feikin
Manase
M
Amolloh
Ray
R
Ransom
Heather
H
Burke
Fillet
F
Lugalia
Alice
A
Ouma
Kayla F
KF
Laserson
Jonathan
J
Mermin
Robert F
RF
Breiman
Rebecca
R
Bunnell
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D037001:Directive Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D006792:House Calls; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D019035:Rural Health Services; D019037:Urban Health Services; D055815:Young Adult