Early uptake of HIV clinical care after testing HIV-positive during home-based testing and counseling in western Kenya.
Home-based HIV testing and counseling (HBTC) has the potential to increase access to HIV testing. However, the extent to which HBTC programs successfully link HIV-positive individuals into clinical care remains unclear. To determine factors associated with early enrollment in HIV clinical care, adult residents (aged ≥13 years) in the Health and Demographic Surveillance System in Kisumu, Kenya were offered HBTC. All HIV-positive residents were referred to nearby HIV clinical care centers. Two to four months after HBTC, peer educators conducted home visits to consenting HIV-positive residents. Overall, 9,895 (82 %) of 12,035 residents accepted HBTC; 1,087 (11 %) were HIV-positive; and 737 (68 %) received home visits. Of those receiving home visits, 42 % reported HIV care attendance. Factors associated with care attendance included: having disclosed, living with someone attending HIV care, and wanting to seek care after diagnosis. Residents who reported their current health as excellent or who doubted their HBTC result were less likely to report care attendance. While findings indicate that HBTC was well-received in this setting, less than half of HIV-positive individuals reported current care attendance. Identification of effective strategies to increase early enrollment and retention in HIV clinical care is critical and will require coordination between testing and treatment program staff and systems.
U.S. Centers for Disease Control and Prevention (CDC), MS E04, 1600 Clifton Road NE, Atlanta, GA 30333, USA. igm8@cdc.gov
Amy
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Medley
Marta
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Ackers
Manase
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Amolloh
Patrick
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Owuor
Helen
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Muttai
Beryl
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Audi
Manquins
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Sewe
Kayla
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Laserson
D015492:AIDS Serodiagnosis; D000328:Adult; D037001:Directive Counseling; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006297:Health Services Accessibility; D006699:Home Care Services / Q000458:organization & administration*; D006792:House Calls; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010379:Peer Group; D011159:Population Surveillance; D015995:Prevalence; D019035:Rural Health Services; D012424:Rural Population; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult