Abstract:
Background—There is limited research characterizing the HIV care continuum with population-
based data in sub-Saharan Africa. The objectives of this study were to: 1) describe engagement in care among all known HIV-positive adults in one sub-county of western Kenya; and 2) determine
the time to and predictors of linkage and engagement among adults newly diagnosed via home-
based counseling and testing (HBCT).
Methods—AMPATH (Academic Model Providing Access to Healthcare) has provided HIV care
in western Kenya since 2001 and HBCT since 2007. Following a widespread HBCT program in
Bunyala sub-county, electronic medical records (EMR) were reviewed to identify uptake of care
among individuals with previously known (self-reported) infection and new (identified by HBCT)
HIV diagnoses as of June 2014. Engagement in HIV care was defined as an initial encounter with
an HIV care provider. Cox regression analysis was used to examine the predictors of engagement
among those newly diagnosed.
Findings—Of the 3,482 infected adults identified, 61% had previously known infections, among
whom 84% (n = 1778/2122) had ever had at least one clinical encounter within AMPATH. While
73% were registered in the EMR, only 15% (n = 209/1360) of the newly diagnosed had seen a
clinician over a median of 3·4 years. The median time to engagement among the newly diagnosed
was 60 days (interquartile range: 10–411 days).nterpretation—Engagement in care was high among those who at the time of HBCT were
already known HIV-positive, but few who were newly diagnosed in HBCT saw an HIV care
provider.
