Factors Associated with Early Uptake of HIV Care and Treatment Services after Testing HIV+ during Home-based Testing and Counseling in Rural Western Kenya
Paper 1077 Factors Associated with Early Uptake of HIV Care and Treatment Services after Testing HIV+ during Home-based Testing and Counseling in Rural Western Kenya Manase Amolloh1, A Medley2, P Owuor1, B Audi1, M Sewe1, H Muttai3, K Laserson3, and M Ackers2 1Kenya Med Res Inst, Nairobi; 2CDC, Atlanta, GA, US; and 3CDC, Nairobi, Kenya Background: The extent to which individuals who test HIV+ during home-based HIV testing and counseling (HBTC) later access care and treatment services remains unclear. We describe characteristics associated with seeking HIV care services within 6 months of diagnosis among HIV+ persons identified through HBTC. Methods: Trained counsellors offered HBTC to all adult residents of the Kenya Medical Research Institute (KEMRI)/Center for Disease Control and Prevention (CDC) Health and Demographic Surveillance System (HDSS) in Nyanza Province. Identified HIV-infected residents were referred to nearby care and treatment clinics. Then, 2 to 6 months after HBTC, peer educators contacted all consenting HIV+ residents in their home and administered a brief questionnaire. A multivariable logistic regression model, adjusted for age, gender, marital status, and village, was used to identify predictors of HIV clinic attendance. Results: Overall, 10,585 (83%) of the 12,746 HDSS residents approached by a counsellor accepted HBTC; 1140 (11%) were HIV+ and peer educators interviewed 752 (70%). Of HIV+ residents, 60% tested as individuals, 22% as a family, and 18% as a couple; 36% had disclosed to a spouse or partner, and 41% reported being currently enrolled in HIV care. Factors significantly associated with care enrolment included being female (AOR 1.1, 95%CI 1.0 to 1.2), having disclosed (AOR 1.2, 95%CI 1.1 to 1.3), and reporting current health status as fair or poor (AOR 1.3, 95%CI 1.2 to 1.4). Participants who tested as a couple or family were more likely to disclose (AOR 1.5, 95%CI 1.4 to 1.6) and to enroll in care (AOR 1.2, 95%CI 1.1 to 1.3) than participants testing as individuals. The main reason for not seeking care was still feeling strong (19%). Conclusions: HBTC was well received by the community and increased individuals and families knowledge of HIV status. Overall, 41% of HIV+ individuals who were interviewed sought care within 6 months of HBTC. Future HBTC activities should target men and continue to encourage individuals to test as couples or families to facilitate disclosure and subsequent enrollment into care. Given that early linkage of HIV+ individuals into prevention, care, and treatment services reduces morbidity, mortality, and HIV transmission risk to sex partner(s), HBTC counsellors should emphasize the importance of early care among asymptomatic persons. Counselors should also provide regular follow-up visits to encourage individuals to seek care and treatment services.