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Factors associated with HIV status awareness and linkage to care following home based testing in rural Malawi | Journal Article / Research | MSF Science Portal
Journal Article
|Research

Factors associated with HIV status awareness and linkage to care following home based testing in rural Malawi

Maman D, Ben-Farhat J, Chilima B, Masiku C, Salumu L, Ford NP, Mendiharat P, Szumilin E, Masson S, Etard JF
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Abstract
OBJECTIVE
HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi.

METHOD
Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care.

RESULTS
Of 8277 individuals eligible for the survey, 7270 (87.8%) participated and were tested for HIV. The overall HIV prevalence was 17.0%. Among HIV-positive participants, 77.0% knew their status and 72.8% were in care. Women (adjusted odds ratio [aOR] 6.5, 95% CI 3.2-13.1) and older participants (40-59 vs. 15-29 years, aOR 10.1, 95% CI 4.0-25.9) were more likely to be aware of their positive status. Of those newly diagnosed, 47.5% were linked to care within 3 months. Linkage to care was higher among older participants (40-59 vs. 15-29, adjusted hazard ratio [aHR] 3.39, 95% CI 1.83-6.26), women (aHR 1.73, 95% CI 1.12-2.67) and those eligible for ART (aHR 1.61, 95% CI 1.03-2.52).

CONCLUSIONS
In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.

Countries

Malawi

Subject Area

models of careHIV/AIDS

Languages

English
DOI
10.1111/tmi.12772
Published Date
07 Oct 2016
PubMed ID
27714902
Journal
Tropical Medicine and International Health
Volume | Issue | Pages
Volume 21, Issue 11, Pages 1442-1451
Issue Date
2016-10-07
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