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A Patient-Centered Multicomponent Strategy for Accelerated Linkage to Care Following Community-Wide HIV Testing in Rural Uganda and Kenya


INTRODUCTION:As countries move towards universal HIV treatment, many individuals fail to link to care following diagnosis of HIV. Efficient and effective linkage strategies are needed. METHODS:We implemented a patient-centered, multi-component linkage strategy in the SEARCH "test-and-treat" trial (NCT 01864603) in Kenya and Uganda. Following population-based, community-wide HIV testing, eligible participants were (1) introduced to clinic staff after testing, (2) provided a telephone "hot-line" for enquiries, (3) provided an appointment reminder phone call, (4) given transport reimbursement upon linkage, and (5) tracked if linkage appointment was missed. We estimated the proportion linked to care within one year and evaluated factors associated with linkage at 7, 30 and 365 days after diagnosis. RESULTS:Among 71,308 adults tested, 6,811(9.6%) were HIV-infected; of these, 4,760(69.9%) were already in HIV care, 30.1% were not. Among 2,051 not in care, 58% were female, median age was 32(IQR 26-40)years, and median CD4 count was 493(IQR 331-683)cells/µL. Half (49.7%) linked within one week, and 73.4% within one year. Individuals who were younger (15-34 vs.>35 years, aRR 0.83,95%CI:0.74-0.94), tested at home vs. community campaign (aRR=0.87,95%CI:0.81-0.94),had a high-HIV-risk vs. low-risk occupation(aRR=0.81,95% CI:0.75-0.88) and were wealthier(aRR 0.90,95% CI:0.83-0.97)were less likely to link. Linkage did not differ by marital status, stable residence, level of education or having a phone contact. CONCLUSION:Using a multi-component linkage strategy, high proportions of people living with HIV but not in care linked rapidly following HIV testing.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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