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?

Juddy Wachira, Sylvester Kimaiyo, Samson Ndege, Joseph Mamlin, Paula Braitstein

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

(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 19552 eligible individuals. Of these, 946 tested in HBCT, 10261 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.

Original languageEnglish (US)
Pages (from-to)275-281
Number of pages7
JournalClinical Infectious Diseases
Volume54
Issue number2
DOIs
StatePublished - Jan 15 2012

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Kenya
Counseling
HIV
Tuberculosis
United States Agency for International Development
Odds Ratio
Virus Diseases
Confidence Intervals
CD4 Lymphocyte Count
Delivery of Health Care
Logistic Models

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

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? / Wachira, Juddy; Kimaiyo, Sylvester; Ndege, Samson; Mamlin, Joseph; Braitstein, Paula.

In: Clinical Infectious Diseases, Vol. 54, No. 2, 15.01.2012, p. 275-281.

Research output: Contribution to journalArticle

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abstract = "(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 19552 eligible individuals. Of these, 946 tested in HBCT, 10261 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.",
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