Abstract:
Population-level estimates of linkage to HIV care
among children and adolescents (CAs) can facilitate progress toward
95-95-95 goals.
Setting: This study was conducted in Bunyala, Chulaimbo, and
Teso North subcounties, Western Kenya.
Methods: Linkage to care was defined among CAs diagnosed with
HIV through Academic Model Providing Access to Healthcare
(AMPATH)’s home-based counseling and testing initiative (HBCT)
by merging HBCT and AMPATH Medical Record System data.
Using follow-up data from Bunyala, we examined factors associated
with linkage or death, using weighted multinomial logistic regression
to account for selection bias from double-sampled visits. Based on
the estimated model, we imputed the trajectory for each person in 3
subcounties until a simulated linkage or death occurred or until the
end of 8 years when an individual was simulated to be censored.
Results: Of 720 CAs in the analytic sample, 68% were between
0 and 9 years and 59% were female. Probability of linkage among
CAs in the combined 3 subcounties was 48%–49% at 2 years and
64%–78% at 8 years while probability of death was 13% at 2 years
and 19% at 8 years. Single or double orphanhood predicted linkage
(adjusted odds ratio [aOR]: 2.66, 95% confidence interval [CI]: 1.33 to
5.32) and death (aOR: 9.85 [95% CI: 2.21 to 44.01]). Having a mother
known to be HIV-positive also predicted linkage (aOR = 1.94, 95%
CI: 0.97 to 3.86) and death (aOR: 14.49, 95% CI: 3.32 to 63.19).
Conclusion: HIV testers/counselors should continue to ensure
linkage among orphans and CAs with mothers known to be HIV-
positive and also to support other CAs to link to HIV care.
