Linkage to and engagement in HIV care in western Kenya: an observational study using population-based estimates from home-based counselling and testing

被引:57
作者
Genberg, Becky L. [1 ]
Naanyu, Violet [3 ,5 ]
Wachira, Juddy [3 ,5 ]
Hogan, Joseph W. [2 ,5 ]
Sang, Edwin [5 ]
Nyambura, Monicah [5 ]
Odawa, Michael [5 ]
Duefield, Corey [2 ]
Ndege, Samson [4 ,5 ]
Braitstein, Paula [3 ,5 ,6 ,7 ,8 ]
机构
[1] Brown Univ, Dept Hlth Serv Policy & Practice, Providence, RI 02912 USA
[2] Brown Univ, Dept Biostat, Providence, RI 02912 USA
[3] Moi Univ, Coll Hlth Sci, Sch Med, Eldoret, Kenya
[4] Moi Univ, Sch Publ Hlth, Eldoret, Kenya
[5] Acad Model Providing Access Healthcare AMPATH, Eldoret, Kenya
[6] Indiana Univ Sch Med, Indianapolis, IN 46202 USA
[7] Regenstrief Inst Hlth Care, Indianapolis, IN 46202 USA
[8] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON M5T 3M7, Canada
来源
LANCET HIV | 2015年 / 2卷 / 01期
基金
比尔及梅琳达.盖茨基金会;
关键词
ANTIRETROVIRAL THERAPY PROGRAMS; SUB-SAHARAN AFRICA; SOUTH-AFRICA; INFECTED PATIENTS; PATIENTS LOST; RURAL KENYA; FOLLOW-UP; RISK; PREVENTION; STRATEGIES;
D O I
10.1016/S2352-3018(14)00034-4
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background Few population-based studies exist on the HIV care continuum in sub-Saharan Africa. We aimed to describe engagement in care in all adults with an existing diagnosis of HIV and to assess the time to and predictors of linkage and engagement in adults newly diagnosed via home-based counselling and testing (HBCT) in a high-prevalence setting in western Kenya. Methods Data were derived from AMPATH (Academic Model Providing Access to Healthcare), which has provided HIV care in western Kenya since 2001 and the HBCT programme, which has been operating since 2007. After a widespread HBCT programme in Bunyala subcounty from December, 2009, to February, 2011, we reviewed electronic medical records to identify uptake of care in individuals (aged 13 years or older) with previously known (self-reported) infection and new (identified at HBCT) HIV diagnoses as of June 1, 2014. We defined engagement in HIV care as an initial encounter with an HIV care provider. We used Cox regression analysis to examine the predictors of engagement in care for newly diagnosed individuals. Findings Of the 3482 adults with HIV identified at HBCT, 2122 (61%) had previously been diagnosed with HIV, of whom 1778 (84%) had had at least one clinical encounter within AMPATH. 993 (73%) of the 1360 individuals with new diagnoses at HBCT were registered in the electronic medical records, although only 209 (15%) had seen a clinician over a median of 3.4 years since diagnosis. The median time to engagement in the newly diagnosed individuals was 60 days (IQR 10-411). Interpretation Creative and innovative strategies are needed to support people to engage with care when they are newly diagnosed with HIV through population-based case-finding initiatives.
引用
收藏
页码:E20 / E26
页数:7
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