PMID- 25621303
OWN - NLM
STAT- MEDLINE
DCOM- 20160808
LR  - 20181113
IS  - 2352-3018 (Electronic)
IS  - 2352-3018 (Linking)
VI  - 2
IP  - 1
DP  - 2015 Jan
TI  - Linkage to and engagement in HIV care in western Kenya: an observational study 
      using population-based estimates from home-based counselling and testing.
PG  - e20-6
AB  - 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. 
      FUNDING: US President's Emergency Plan for AIDS Relief (PEPFAR), Abbott 
      Laboratories, the Purpleville Foundation, the Global Business Coalition, the US 
      National Institute of Mental Health, and the Bill & Melinda Gates Foundation.
FAU - Genberg, Becky L
AU  - Genberg BL
FAU - Naanyu, Violet
AU  - Naanyu V
FAU - Wachira, Juddy
AU  - Wachira J
FAU - Hogan, Joseph W
AU  - Hogan JW
FAU - Sang, Edwin
AU  - Sang E
FAU - Nyambura, Monicah
AU  - Nyambura M
FAU - Odawa, Michael
AU  - Odawa M
FAU - Duefield, Corey
AU  - Duefield C
FAU - Ndege, Samson
AU  - Ndege S
FAU - Braitstein, Paula
AU  - Braitstein P
LA  - eng
GR  - AID-623-A-12-0001/PEPFAR/United States
GR  - U01 AI069911/AI/NIAID NIH HHS/United States
GR  - P30 AI042853/AI/NIAID NIH HHS/United States
GR  - K01MH099966/MH/NIMH NIH HHS/United States
GR  - K01 MH099966/MH/NIMH NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - Netherlands
TA  - Lancet HIV
JT  - The lancet. HIV
JID - 101645355
SB  - IM
CIN - Lancet HIV. 2015 Jan;2(1):e4-5. PMID: 26424234
MH  - Adult
MH  - *Continuity of Patient Care/standards/statistics & numerical data
MH  - Counseling
MH  - Electronic Health Records
MH  - Female
MH  - HIV Infections/diagnosis/epidemiology
MH  - Humans
MH  - Kenya/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Standard of Care
PMC - PMC4302338
MID - NIHMS654322
COIS- Conflict of interest: The authors declare no conflicts of interest. Declaration 
      of interests We declare that we have no conflicts of interest.
EDAT- 2015/01/27 06:00
MHDA- 2016/08/09 06:00
PMCR- 2016/01/01
CRDT- 2015/01/27 06:00
PHST- 2015/01/27 06:00 [entrez]
PHST- 2015/01/27 06:00 [pubmed]
PHST- 2016/08/09 06:00 [medline]
PHST- 2016/01/01 00:00 [pmc-release]
AID - S2352-3018(14)00034-4 [pii]
AID - 10.1016/S2352-3018(14)00034-4 [doi]
PST - ppublish
SO  - Lancet HIV. 2015 Jan;2(1):e20-6. doi: 10.1016/S2352-3018(14)00034-4.