Abstract

Does home-based counseling and testing (HBCT) work? Findings from Western Kenya

S. Kimaiyo^1,2, S. Ndege³, J. Wachira⁴, J. Mamlin², P. Braitstein<sup>1,5

1</sup>Moi University School of Medicine, Eldoret, Kenya, ²USAID-AMPATH Partnership, Eldoret, Kenya, ³Moi University School of Public Health, Eldoret, Kenya, ⁴Indiana University, Indianapolis, United States, ⁵Indiana University School of Medicine, Indianapolis, United States

Background: Our objective was to describe what effect the 'point of entry' into the HIV care program (where the patient self-reportedly tested HIV-positive) had on the enrolment CD4 and WHO clinical stage of adults presenting for the first time to USAID-AMPATH Partnership clinics for HIV care.
Methods: All individuals aged ≥13 years residing in the catchment were offered Home-Based Counseling and Testing (HBCT). We identified the point of entry to USAID-AMPATH clinics and compared the enrolment WHO clinical stage and CD4 count between them using Pearson's Chi-Square and Kruskal-Wallis tests. Points of entry/testing were HBCT vs. provider-initiated testing and counseling (PITC) vs. tuberculosis (TB) clinic vs. voluntary counseling and testing (VCT).
Results: There were 11,558 individuals eligible for analysis: 65% female, median age 35.8 years. Of these, 3911 individuals tested HIV-positive in PITC, 183 in the TB clinic, 7000 through VCT, and 464 through HBCT. There were no major differences in the proportions of men and women or in median age between the groups. The median (interquartile range, IQR) enrolment CD4 count among those who tested HIV-positive in PITC was 196 (76-372), vs. 164 (74-300) in the TB clinic, 208 (87-394) in VCT, and 280 (147-471) in HCT (p< 0.001). Only 2% of persons who tested HIV-positive in HBCT were WHO Stage IV at enrolment, compared to 8% from PITC, 9% from the TB clinic, and 5% from VCT. Similarly, 70% of those tested in HBCT enrolled at WHO Stage 1, compared to 35% from PITC, 13% from the TB clinic, and 38% from VCT (p< 0.001).
Conclusion: These data demonstrate that HCT is effective at getting HIV-infected persons to enroll in HIV care at much earlier stages of HIV disease and while their immune systems are still relatively intact.