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Early Uptake of HIV Clinical Care After Testing HIV-Positive During Home-Based Testing and Counseling in Western Kenya

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Abstract

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.

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Acknowledgments

This work received funding support through the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (cooperative agreement 5U19CI000323-05). The authors would like to express their gratitude to Maurice Ombok and Alan Rubin for their assistance with the GIS mapping data and to Jan Moore for her insightful comments on earlier drafts of this manuscript. The authors are also grateful for the extraordinary efforts of the HBTC counselors, the field and data management staff of the HDSS, and the facility-based peer educators without whom this study could not have taken place. The authors would also like to thank KEMRI and CDC/KEMRI administrative staff for the support they provided and continue to provide to the project. Finally, the authors would like to thank the HDSS residents for their continued participation. This paper was published with the approval of the director of the Kenya Medical Research Institute.

Conflict of interest

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. U.S. Centers for Disease Control and Prevention (CDC), MS E04, 1600 Clifton Road NE, Atlanta, GA, 30333, USA

    Amy Medley & Marta Ackers

  2. Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

    Manase Amolloh, Patrick Owuor, Beryl Audi, Manquins Sewe & Kayla Laserson

  3. U.S. Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya

    Helen Muttai & Kayla Laserson

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  1. Amy Medley
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Correspondence to Amy Medley.

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Medley, A., Ackers, M., Amolloh, M. et al. Early Uptake of HIV Clinical Care After Testing HIV-Positive During Home-Based Testing and Counseling in Western Kenya. AIDS Behav 17, 224–234 (2013). https://doi.org/10.1007/s10461-012-0344-5

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