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: 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


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Článek vyšel v časopise


2019 Číslo 10