Abstract
BackgroundThe Kenyan Ministry of Health and partners implemented a community-based integrated prevention campaign (IPC) in Western Kenya in 2008. The aim of this study was to determine whether the IPC, compared to Voluntary Counselling and Testing (VCT) services, was able to identify HIV positive individuals earlier in the clinical course of HIV infection following testing.MethodsA total of 1,752 adults aged over 15 years who tested HIV positive through VCT services or the IPC, and subsequently registered at initial clinic visit between September 2008 and September 2010, were considered in the analysis. Multivariable logistic regression models were developed to assess the association of CD4 count and WHO clinical stage of HIV infection at first clinic appointment with age group, gender, marital status and HIV testing source.ResultsMale gender and marital status were independently associated with late HIV presentation (WHO clinical stage 3 or 4 or CD4 count ≤350 cells/μl) at initial clinic visit. Patients testing HIV positive during the IPC had significantly higher mean CD4 count at initial clinic visit compared to individuals who tested HIV positive via VCT services. Patients testing HIV positive during the IPC had more than two times higher odds of presenting early with CD4 count greater than 350 cells/μl (adjusted OR 2.15, 95% CI 1.28 – 3.61, p = 0.004) and presenting early with WHO clinical stage 1 or 2 of HIV infection (adjusted OR 2.39, 95% CI 1.24 – 4.60, p = 0.01) at initial clinic visit compared to individuals who tested HIV positive via VCT services.ConclusionThe community-based integrated prevention campaign identified HIV positive individuals earlier in the course of HIV infection, compared to Voluntary Counselling and Testing services. Community-based campaigns, such as the IPC, may be able to assist countries to achieve earlier testing and initiation of ART in the course of HIV infection. Improving referral mechanisms and strengthening linkages between HIV testing and treatment services remain a challenge and electronic medical record (EMR) systems may support monitoring of patients throughout the HIV care and treatment continuum.
Highlights
The Kenyan Ministry of Health and partners implemented a community-based integrated prevention campaign (IPC) in Western Kenya in 2008
Missing data Of 1,752 patient records initially included in the analysis, just over one half did not record CD4 count and one quarter of patient records did not record World Health Organization (WHO) clinical stage on the initial visit form (Table 1)
Patients who tested HIV positive via Voluntary Counselling and Testing (VCT) services had more than two times higher odds of presenting to initial clinic visit in WHO clinical stage 3 or 4 of HIV infection than those who tested HIV positive during the IPC (Table 2)
Summary
The Kenyan Ministry of Health and partners implemented a community-based integrated prevention campaign (IPC) in Western Kenya in 2008. Patients with advanced HIV disease at the Haskew et al BMC Public Health (2015) 15:16 time of starting ART, defined by low CD4 count and World Health Organization (WHO) clinical stage 3 or 4 of infection, are less likely to respond to treatment and have a higher mortality rate compared with those who start treatment earlier [4,5,6]. Those who survive suffer more morbidity and utilise more health care resources than would otherwise have been necessary, placing increased financial burden on health services [7]. Late presentation poses a higher cumulative risk of HIV transmission to others, considering that earlier presentation and access to ART can reduce viral load and risk of onward transmission [6,8,9,10]
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