Population-based estimates of engagement in HIV care and mortality using double-sampling methods following home-based counseling and testing in western Kenya

Autoři: Becky L. Genberg aff001;  Joseph W. Hogan aff003;  Yizhen Xu aff003;  Monicah Nyambura aff004;  Caren Tarus aff004;  Elyne Rotich aff004;  Catherine Kafu aff004;  Juddy Wachira aff004;  Suzanne Goodrich aff006;  Paula Braitstein aff004
Působiště autorů: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America aff001;  Department of Health Services, Policy & Practice, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States of America aff002;  Department of Biostatistics, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States of America aff003;  Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya aff004;  College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya aff005;  Division of Infectious Diseases, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America aff006;  Epidemiology Division, Office of Global Public Health Education & Training, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223187



Data on engagement in HIV care from population-based samples in sub-Saharan Africa are limited. The objective of this study was to use double-sampling methods to estimate linkage to HIV care, ART initiation, and mortality among all adults diagnosed with HIV by a comprehensive home-based counseling and testing (HBCT) program in western Kenya.


HBCT was conducted door-to-door from December 2009 to April 2011 in three sub-counties of western Kenya by AMPATH (Academic Model Providing Access to Healthcare). For those identified as HIV-positive, data were merged with electronic medical records to determine engagement with HIV care. A randomly-drawn follow-up sample of 120 adults identified via HBCT who had not linked to care as of June 2015 in Bunyala sub-county were visited by trained fieldworkers to ascertain HIV care engagement and vital status. Double-sampled data were used to generate, via multinomial regression, predicted probabilities of engagement in care and mortality among those whose status could not be ascertained by matching with the electronic medical records in the three catchments.


Incorporating information from the double-sampling yielded estimates of prospective linkage to HIV care that ranged from 40–45%. Mortality estimates of those who did not engage in care following HBCT ranged from 12–16%. Among those who linked to care following HBCT, between 72–81% initiated ART.


In settings without universal national identifiers, rates of linkage to care from community-based programs may be subject to substantial underestimation. Follow-up samples of those with missing information can be used to partially correct this bias, as has been demonstrated previously for mortality among those who were lost-to-care programs. There is a need for harmonized data systems across health systems and programs.

Klíčová slova:

Africa – Death rates – Electronic medical records – Health care – HIV diagnosis and management – Kenya – Schools


1. UNAIDS. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS. 2014.

2. UNAIDS. Ending Aids Progress Towards the 90-90-90 Targets. Global Aids Update. 2017.

3. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases. 2011;52:793–800. doi: 10.1093/cid/ciq243 21367734

4. Kilmarx PH, Mutasa-Apollo T. Patching a leaky pipe: the cascade of HIV care. Curr Opin HIV AIDS. 2012 Dec;8(1):59–64.

5. Haber N, Tanser F, Bor J, Naidu K, Mutevedzi T, Herbst K, et al. From HIV infection to therapeutic response: a population-based longitudinal HIV cascade-of-care study in KwaZulu-Natal, South Africa. Lancet HIV. Elsevier; 2017 May;4(5):e223–30. doi: 10.1016/S2352-3018(16)30224-7 28153470

6. Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: A systematic review. PLoS Med. 2011;8(7):e1001056. doi: 10.1371/journal.pmed.1001056 21811403

7. Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, et al. Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis. Trop Med Int Heal. 2012;17(12):1509–20.

8. Rachlis B, Naanyu V, Wachira J, Genberg B, Koech B, Kamene R, et al. Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health. 2016;16(1):741.

9. Wachira J, Naanyu V, Genberg B, Koech B, Akinyi J, Kamene R, et al. Health facility barriers to HIV linkage and retention in Western Kenya. BMC Health Serv Res. 2014;14(1):646.

10. Layer EH, Kennedy CE, Beckham SW, Mbwambo JK, Likindikoki S, Davis WW, et al. Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania. Chung MH, editor. PLoS One. Public Library of Science; 2014 Aug;9(8):e104961. doi: 10.1371/journal.pone.0104961 25119665

11. Rachlis B, Ochieng D, Geng E, Rotich E, Ochieng V, Maritim B, et al. Implementation and operational research: evaluating outcomes of patients lost to follow-up in a large comprehensive care treatment program in western Kenya. J Acquir Immune Defic Syndr. 2015;68(4):e46–55. doi: 10.1097/QAI.0000000000000492 25692336

12. Geng EH, Odeny TA, Lyamuya RE, Nakiwogga-Muwanga A, Diero L, Bwana M, et al. Estimation of mortality among HIV-infected people on antiretroviral treatment in east Africa: A sampling based approach in an observational, multisite, cohort study. Lancet HIV. 2015;2(3):107–16.

13. Einterz RM, Kimaiyo SN, Mengech HNK, Khwa-Otsyula BO, Esamai F, Quigley F, et al. Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med. 2007;82(8):812–8. doi: 10.1097/ACM.0b013e3180cc29f1 17762264

14. Inui TS, Nyandiko WM, Kimaiyo SN, Frankel RM, Muriuki T, Mamlin JJ, et al. AMPATH: Living proof that no one has to die from HIV. J Gen Intern Med. 2007 Nov;22(12):1745–50. doi: 10.1007/s11606-007-0437-4 17972138

15. Kimaiyo S, Were MC, Shen C, Ndege S, Braitstein P, Sidle J, et al. Home-based HIV counselling and testing in western Kenya. East Afr Med J. 2010;87(3):100–8. doi: 10.4314/eamj.v87i3.62195 23057305

16. Genberg BL, Naanyu V, Wachira J, Hogan JW, Sang E, Nyambura M, et al. Linkage to and engagement in HIV care in western kenya: An observational study using population-based estimates from home-based counselling and testing. Lancet HIV. 2015;2(1):e20–6. doi: 10.1016/S2352-3018(14)00034-4 25621303

17. Sayers A, Ben-Shlomo Y, Blom AW, Steele F. Probabilistic record linkage. Int J Epidemiol. 2016;45(3):954–64. doi: 10.1093/ije/dyv322 26686842

18. Bassett I, Regan S, Luthuli P, Mbonambi H, Bearnot B, Pendleton A, et al. Linkage to care following community-based mobile HIV testing compared with clinic-based testing in Umlazi Township, Durban, South Africa. HIV Med. 2014;15(6):367–72. doi: 10.1111/hiv.12115 24251725

19. Ruzagira E, Baisley K, Kamali A, Biraro S, Grosskurth H. Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review. Trop Med Int Heal. 2017;22(7):807–21.

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2019 Číslo 10
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