title: Stage of HIV presentation at initial clinic visit following a community-based HIV testing campaign in rural Kenya.
abstract: BACKGROUND
  The Kenyan Ministry of Health and partners implemented a community-based integrated prevention campaign (IPC) in Western Kenya in 2008. The aim of this study was to determine whether the IPC, compared to Voluntary Counselling and Testing (VCT) services, was able to identify HIV positive individuals earlier in the clinical course of HIV infection following testing.
  
  
  METHODS
  A total of 1,752 adults aged over 15 years who tested HIV positive through VCT services or the IPC, and subsequently registered at initial clinic visit between September 2008 and September 2010, were considered in the analysis. Multivariable logistic regression models were developed to assess the association of CD4 count and WHO clinical stage of HIV infection at first clinic appointment with age group, gender, marital status and HIV testing source.
  
  
  RESULTS
  Male gender and marital status were independently associated with late HIV presentation (WHO clinical stage 3 or 4 or CD4 count ≤ 350 cells/μl) at initial clinic visit. Patients testing HIV positive during the IPC had significantly higher mean CD4 count at initial clinic visit compared to individuals who tested HIV positive via VCT services. Patients testing HIV positive during the IPC had more than two times higher odds of presenting early with CD4 count greater than 350 cells/μl (adjusted OR 2.15, 95% CI 1.28 - 3.61, p = 0.004) and presenting early with WHO clinical stage 1 or 2 of HIV infection (adjusted OR 2.39, 95% CI 1.24 - 4.60, p = 0.01) at initial clinic visit compared to individuals who tested HIV positive via VCT services.
  
  
  CONCLUSIONS
  The community-based integrated prevention campaign identified HIV positive individuals earlier in the course of HIV infection, compared to Voluntary Counselling and Testing services. Community-based campaigns, such as the IPC, may be able to assist countries to achieve earlier testing and initiation of ART in the course of HIV infection. Improving referral mechanisms and strengthening linkages between HIV testing and treatment services remain a challenge and electronic medical record (EMR) systems may support monitoring of patients throughout the HIV care and treatment continuum.
authors.affiliation: Uamuzi Bora, PO Box 2153-50100, Kakamega, Kenya. john.haskew@uamuzibora.org.
authors.forename: John
authors.initials: J
authors.lastname: Haskew
authors.affiliation: British Antarctic Survey Medical Unit, Plymouth, UK. kenrick@kenners.org.
authors.forename: Kenrick
authors.initials: K
authors.lastname: Turner
authors.affiliation: Uamuzi Bora, PO Box 2153-50100, Kakamega, Kenya. gunnar.ro@uamuzibora.org.|University of Durham, Durham, UK. gunnar.ro@uamuzibora.org.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Rø
authors.affiliation: East and North Hertfordshire NHS Trust, London, UK. andrewho@andrewho.co.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ho
authors.affiliation: Elizabeth Glazer Paediatric AIDS Foundation, Nairobi, Kenya. daviesomari@yahoo.com.
authors.forename: Davies
authors.initials: D
authors.lastname: Kimanga
authors.affiliation: Ministry of Health, Nairobi, Kenya. sksharif@outlook.com.
authors.forename: Shahnaaz
authors.initials: S
authors.lastname: Sharif
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003153:Community Health Services; D003376:Counseling; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D012424:Rural Population; D012747:Sexual Partners