advanced search

<< Back To Home

WHAT IS THE IMPACT OF HOME BASED HIV COUNSELING AND TESTING ON CLINICAL STATUS OF NEWLY ENROLLED ADULTS?

Sunday, 15th of July 2012

‘HBCT is effective at getting HIV-infected persons enrolled in HIV care before they become ill.’

• WHAT IS THE IMPACT OF HOME-BASED HIV COUNSELING AND TESTING ON THE CLINICAL STATUS OF NEWLY ENROLLED ADULTS IN A LARGE HIV CARE PROGRAM IN WESTERN KENYA?  

Clin Infect Dis. (2012) 54 (2): 275-281.

Juddy Wachira1,4, Sylvester Kimaiyo4,5, Samson Ndege4,6, Joseph Mamlin2,4,5, and  Paula Braitstein2,3,4,5,7

+ Author Affiliations

1School of Health Physical Education and Recreation

2School of Medicine, Indiana University, Bloomington

3Regenstrief Institute, Indianapolis

4USAID-AMPATH (US Agency for International Development–Academic Model Providing Access to Healthcare) Partnership

5Moi University School of Medicine

6Moi University School of Public Health, Eldoret, Kenya

7Dalla Lana School of Public Health, University of Toronto, Canada

Correspondence: Paula Braitstein, PhD, Indiana University School of Medicine, 1001 W 10th St, OPW-M200, Indianapolis, IN 46202 (pbraitstein@yahoo.com).

 Abstract below; full text is at http://cid.oxfordjournals.org/content/54/2/275.full.pdf+html

(See the Editorial Commentary by Mills and Ford, on pages 282–4.)

Background. This article describes the effect point of entry into the human immunodeficiency virus (HIV) care program had on the clinical status of adults presenting for the first time to USAID-AMPATH (US Agency for International Development–Academic Model Providing Access to Healthcare) Partnership clinics for HIV care.

Methods. All patients aged ≥14 years enrolled between August 2008 and April 2010 were included. Points of entry to USAID-AMPATH clinics were home-based counseling and testing (HBCT), provider-initiated testing and counseling (PITC), HIV testing in the tuberculosis clinic, and voluntary counseling and testing (VCT). Tests for trend were calculated, and multivariable logistic regression was used to compare the effect of HBCT versus other points of entry on primary outcomes controlling for age and sex.

Results. There were 19 552 eligible individuals. Of these, 946 tested in HBCT, 10 261 in VCT, 8073 in PITC, and 272 in the tuberculosis clinic. The median (interquartile range) enrollment CD4 cell counts among those who tested HIV positive was 323 (194–491), 217 (87–404), 190 (70–371), and 136 cells/mm3 (59–266) for HBCT, VCT, PITC, and the tuberculosis clinic, respectively (P < .001). Compared with those patients whose HIV infection was diagnosed in the tuberculosis clinic, those who tested positive in HBCT were, controlling for age and sex, less likely to have to have World Health Organization stage III or IV HIV infection at enrollment (adjusted odds ratio [AOR], 0.04; 95% confidence interval [CI], .03–.06), less likely to enroll with a CD4 cell count of <200 cells/mm3 (AOR, 0.20; 95% CI, .14–.28), and less likely to enroll into care with a chief complaint (AOR, 0.08; 95% CI, .05–.12).

Conclusions. HBCT is effective at getting HIV-infected persons enrolled in HIV care before they become ill.