title: Engagement in HIV care among Kenyan adults and adolescents: results from a national population-based survey.
abstract: BACKGROUND
  Increasing access to care and treatment for HIV-infected persons is a goal in Kenya's response to the HIV epidemic. Using data from the second Kenya AIDS Indicator Survey (KAIS 2012), we describe coverage of services received among adults and adolescents who were enrolled in HIV care.
  
  
  METHODS
  KAIS 2012 was a population-based survey that collected information from persons aged 15-64 years that included self-reported HIV status, and for persons reporting HIV infection, use of HIV care and antiretroviral therapy (ART). Blood specimens were collected and tested for HIV. HIV-positive specimens were tested for CD4 counts and viral load.
  
  
  RESULTS
  Among 363 persons who reported HIV infection, 93.4% [95% confidence interval (CI): 87.2 to 99.6] had ever received HIV care. Among those receiving HIV care, 96.3% (95% CI: 94.1 to 98.4) were using cotrimoxazole prophylaxis, and 74.6% (95% CI: 69.0 to 80.2) were receiving ART. A lower proportion of persons in care and not on ART reported using cotrimoxazole (89.5%, 95% CI: 82.5 to 96.5 compared with 98.6%, 95% CI: 97.1 to 100) and had a CD4 count measurement done (72.9%, 95% CI: 64.0 to 81.9 compared with 90.0%, 95% CI: 82.8 to 97.3) than persons in care and on ART, respectively. Among persons in care and not on ART, 23.2% (95% CI: 6.8 to 39.7) had CD4 counts ≤350 cells per microliter. Viral suppression was observed in 75.3% (95% CI: 68.7 to 81.9) of persons on ART.
  
  
  CONCLUSIONS
  Linkage and retention in care are high among persons with known HIV infection. However, improvements in care for the pre-ART population are needed. Viral suppression rates were comparable to developed settings.
authors.affiliation: *National AIDS and Sexually Transmitted Infection (STI) Control Programme, Ministry of Health, Nairobi, Kenya; †Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya; ‡United States Agency for International Development, Nairobi, Kenya; and §Global Health Sciences, University of California, San Francisco, CA.
authors.forename: Rose
authors.initials: R
authors.lastname: Wafula
authors.forename: Sarah
authors.initials: S
authors.lastname: Masyuko
authors.forename: Lucy
authors.initials: L
authors.lastname: Ng'ang'a
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kim
authors.forename: Anthony
authors.initials: A
authors.lastname: Gichangi
authors.forename: Irene
authors.initials: I
authors.lastname: Mukui
authors.forename: James
authors.initials: J
authors.lastname: Batuka
authors.forename: Evelyn W
authors.initials: EW
authors.lastname: Ngugi
authors.forename: William K
authors.initials: WK
authors.lastname: Maina
authors.forename: Sandra
authors.initials: S
authors.lastname: Schwarcz
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006306:Health Surveys; D006801:Humans; D007630:Kenya; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D044966:Anti-Retroviral Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
references.citation: J Acquir Immune Defic Syndr. 2013 May 1;63(1):112-9
references.pmid: 23392459
references.citation: Clin Infect Dis. 2005 May 1;40(9):1350-4
references.pmid: 15825038
references.citation: N Engl J Med. 1998 Mar 26;338(13):853-60
references.pmid: 9516219
references.citation: J Acquir Immune Defic Syndr. 2014 May 1;66 Suppl 1:S116-22
references.pmid: 24732815
references.citation: N Engl J Med. 2011 Aug 11;365(6):493-505
references.pmid: 21767103
references.citation: AIDS. 2010 Nov 13;24(17):2717-25
references.pmid: 20935554
references.citation: J Acquir Immune Defic Syndr. 2014 May 1;66 Suppl 1:S130-7
references.pmid: 24732817
references.citation: J Acquir Immune Defic Syndr. 2014 May 1;66 Suppl 1:S13-26
references.pmid: 24445338
references.citation: J Acquir Immune Defic Syndr. 2013 Jun 1;63(2):e84-6
references.pmid: 23666144
references.citation: J Infect Dis. 2009 Dec 1;200(11):1714-23
references.pmid: 19852669
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Dec 2;60(47):1618-23
references.pmid: 22129997
references.citation: J Acquir Immune Defic Syndr. 2014 May 1;66 Suppl 1:S3-12
references.pmid: 24732819
references.citation: J Acquir Immune Defic Syndr. 2013 Jun 1;63(2):e64-71
references.pmid: 23429504
references.citation: J Acquir Immune Defic Syndr. 2013 Aug 1;63(4):498-505
references.pmid: 23572010
references.citation: Clin Infect Dis. 2013 Feb;56(4):598-605
references.pmid: 23243180
references.citation: PLoS Med. 2011 Jul;8(7):e1001056
references.pmid: 21811403
references.citation: JAMA. 1996 Jul 10;276(2):105-10
references.pmid: 8656501
references.citation: Sex Transm Infect. 2010 Oct;86(5):388-90
references.pmid: 20876757