%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Maman, D.
%A Ben-Farhat, J.
%A Chilima, B.
%A Masiku, C.
%A Salumu, L.
%A Ford, N.
%A Mendiharat, P.
%A Szumilin, E.
%A Masson, S.
%A Etard, Jean-François
%T Factors associated with HIV status awareness and linkage to care following home based testing in rural Malawi
%D 2016
%L fdi:010068700
%G ENG
%J Tropical Medicine and International Health
%@ 1360-2276
%K linkage to care ; population survey ; sub-Saharan Africa ; cascade of care ; epidemiology
%K MALAWI ; AFRIQUE SUBSAHARIENNE
%M ISI:000388283900009
%N 11
%P 1442-1451
%R 10.1111/tmi.12772
%U https://www.documentation.ird.fr/hor/fdi:010068700
%> https://www.documentation.ird.fr/intranet/publi/2016/12/010068700.pdf
%V 21
%W Horizon (IRD)
%X 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.
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