The impact of home-based HIV counseling and testing on care-seeking and incidence of common infectious disease syndromes in rural western Kenya

BMC Infectious Diseases

Daniel R Feikin²  Robert F Breiman²  Deron Burton²  Marta Ackers³  Warren Dalal³  Barrack Aura²  Allan Audi²  Kayla F Laserson⁴  Manase Amolloh¹  Godfrey Bigogo² 

[1] Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578, 40100 Kisumu, Kenya;International Emerging Infections Program – Kenya, Centers for Disease Control & Prevention, Nairobi, Kenya;Division of Global HIV and AIDS, Centers for Disease Control & Prevention, Atlanta, GA, USA;Center for Global Health, Centers for Disease Control & Prevention, Atlanta, GA, USA

关键词: Healthcare seeking;    Infectious disease incidence;    Home based HIV counseling and testing;   

Others  :  1127409
DOI  :  10.1186/1471-2334-14-376

 received in 2014-01-31, accepted in 2014-06-30,  发布年份 2014

【 摘 要 】

Background

In much of Africa, most individuals living with HIV do not know their status. Home-based counseling and testing (HBCT) leads to more HIV-infected people learning their HIV status. However, there is little data on whether knowing one’s HIV-positive status necessarily leads to uptake of HIV care, which could in turn, lead to a reduction in the prevalence of common infectious disease syndromes.

Methods

In 2008, Kenya Medical Research Institute (KEMRI) in collaboration with the Centers for Disease Control and Prevention (CDC) offered HBCT to individuals (aged ≥13 years) under active surveillance for infectious disease syndromes in Lwak in rural western Kenya. HIV test results were linked to morbidity and healthcare-seeking data collected by field workers through bi-weekly home visits. We analyzed changes in healthcare seeking behaviors using proportions, and incidence (expressed as episodes per person-year) of acute respiratory illness (ARI), severe acute respiratory illness (SARI), acute febrile illness (AFI) and diarrhea among first-time HIV testers in the year before and after HBCT, stratified by their test result and if HIV-positive, whether they sought care at HIV Patient Support Centers (PSCs).

Results

Of 9,613 individuals offered HBCT, 6,366 (66%) were first-time testers, 698 (11%) of whom were HIV-infected. One year after HBCT, 50% of HIV-infected persons had enrolled at PSCs – 92% of whom had started cotrimoxazole and 37% of those eligible for antiretroviral treatment had initiated therapy. Among HIV-infected persons enrolled in PSCs, AFI and diarrhea incidence decreased in the year after HBCT (rate ratio [RR] 0.84; 95% confidence interval [CI] 0.77 – 0.91 and RR 0.84, 95% CI 0.73 – 0.98, respectively). Among HIV-infected persons not attending PSCs and among HIV-uninfected persons, decreases in incidence were significantly lower. While decreases also occurred in rates of respiratory illnesses among HIV-positive persons in care, there were similar decreases in the other two groups.

Conclusions

Large scale HBCT enabled a large number of newly diagnosed HIV-infected persons to know their HIV status, leading to a change in care seeking behavior and ultimately a decrease in incidence of common infectious disease syndromes through appropriate treatment and care.

【 授权许可】

   
2014 Bigogo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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