Linkage to care following home-based HIV counseling and testing

Linkage to care following home-based HIV counseling and testing 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention Kuala Lumpur, Malaysia July 1, 2013

Why is this important? • Combatting HIV/AIDS requires universal knowledge of HIV status • Shift to community-based models • ‘Test & Treat’ • Strong evidence on home-based testing • HBHCT may pose unique challenges • Need to eliminate leakages in cascade

So they’ll test. But then what?

To answer these questions... • Sub-studyof Good Start • All HIV+ clients from HBHCT arm (n=492) • 3-part study: • Prospective cohort (n=359) • Cox regression (n=196) • Qualitative (n=30)

Key cohort findings • 62.1% (95% CI: 55.73% - 68.47%) linked to care within 3 months of HBHCT (n=359) • Median CD4: 340.5cells/mm3 (n=226)

Key Cox regression findings • Younger age (16-24 years) (AHR 0.50; 95% CI: 0.28 – 0.91) • Disbelief of HIV test results (AHR 0.48; 95% CI: 0.30 – 0.77) • Difficulty finding time to seek care (AHR 0.40; 95% CI: 0.24 – 0.67) *Outcome = providing a blood sample for a facility-based CD4 count

Key Cox regression findings • Believing ART can make you sick(AHR 0.56; 95% CI: 0.35 – 0.89) • Living with ≥ 2 adults (AHR 0.52; 95% CI: 0.35 – 0.77) • Belief in availability of drugs/supplies (AHR1.78; 95% CI: 1.07 – 2.96) • Drinking alcohol (AHR 0.52; 95% CI: 0.34 – 0.80)

Discussion • Barriers to linkage occur at all levels • Need to implement and evaluate interventions to address key barriers

Thank You

Linkage to care following home-based HIV counseling and testing