title: Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi.
abstract: OBJECTIVE
  HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi.
  
  
  METHODS
  Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care.
  
  
  RESULTS
  Of 8277 individuals eligible for the survey, 7270 (87.8%) participated and were tested for HIV. The overall HIV prevalence was 17.0%. Among HIV-positive participants, 77.0% knew their status and 72.8% were in care. Women (adjusted odds ratio [aOR] 6.5, 95% CI 3.2-13.1) and older participants (40-59 vs. 15-29 years, aOR 10.1, 95% CI 4.0-25.9) were more likely to be aware of their positive status. Of those newly diagnosed, 47.5% were linked to care within 3 months. Linkage to care was higher among older participants (40-59 vs. 15-29, adjusted hazard ratio [aHR] 3.39, 95% CI 1.83-6.26), women (aHR 1.73, 95% CI 1.12-2.67) and those eligible for ART (aHR 1.61, 95% CI 1.03-2.52).
  
  
  CONCLUSIONS
  In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France. david.maman@epicentre.msf.org.
authors.forename: D
authors.initials: D
authors.lastname: Maman
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Ben-Farhat
authors.affiliation: Community Health Sciences Unit, Malawi Ministry of Health, Lilongwe, Malawi.
authors.forename: B
authors.initials: B
authors.lastname: Chilima
authors.affiliation: Médecins Sans Frontières, Lilongwe, Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Masiku
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Salumu
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.|Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Ford
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Mendiharat
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Szumilin
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Masson
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France.|UMI 233, Institut de Recherche pour le Développement, Montpellier, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Etard
mesh_terms: D000293:Adolescent; D000328:Adult; D001364:Awareness; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006297:Health Services Accessibility; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011795:Surveys and Questionnaires; D019562:Viral Load
keywords: Afrique subsaharienne; Epidemiología; Vinculación con atención sanitaria; cascada de tratamiento; cascade de soins; cascade of care; connexion aux soins; enquête de population; epidemiology; estudio de poblaciones; linkage to care; population survey; sub-Saharan Africa; África Subsahariana; épidémiologie