@article{fdi:010076320, title = {{L}inkage to {HIV} care after home-based {HIV} counselling and testing in sub-{S}aharan {A}frica : a systematic review}, author = {{R}uzagira, {E}. and {B}aisley, {K}. and {K}amali, {A}. and {B}iraro, {S}. and {G}rosskurth, {H}. and {L}armarange, {J}oseph and {W}orking {G}roup on {L}inkage to {HIV} {C}are and et al.}, editor = {}, language = {{ENG}}, abstract = {{B}ackground: {H}ome-based {HIV} counselling and testing ({HBHCT}) has the potential to increase {HIV} testing uptake in sub-{S}aharan {A}frica ({SSA}), but data on linkage to {HIV} care after {HBHCT} are scarce. {W}e conducted a systematic review of linkage to care after {HBHCT} in {SSA}. {M}ethods: {F}ive databases were searched for studies published between 1st {J}anuary 2000 and 19th {A}ugust 2016 that reported on linkage to care among adults newly identified with {HIV} infection through {HBHCT}. {E}ligible studies were reviewed, assessed for risk of bias and findings summarised using the {PRISMA} guidelines. {R}esults: {A} total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care {CD}4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of {HIV} clinic visit) in addition to routine referral to facilitate linkage to care. {T}ime intervals for ascertaining linkage ranged from 1week to 12months post-{HBHCT}. {L}inkage ranged from 8.2% [95% confidence interval ({CI}), 6.8-9.8%] to 99.1% (95% {CI}, 96.9-99.9%). {L}inkage was generally lower (<33%) if {HBHCT} was followed by referral only, and higher (>80%) if additional strategies were used. {O}nly one study assessed linkage by means of a randomised trial. {F}ive studies had data on cotrimoxazole ({CTX}) prophylaxis and 12 on {ART} eligibility and initiation. {CTX} uptake among those eligible ranged from 0% to 100%. {T}he proportion of persons eligible for {ART} ranged from 16.5% (95% {CI}, 12.1-21.8) to 77.8% (95% {CI}, 40.0-97.2). {ART} initiation among those eligible ranged from 14.3% (95% {CI}, 0.36-57.9%) to 94.9% (95% {CI}, 91.3-97.4%). {A}dditional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of {CTX} and/or {ART}. {M}ost of the studies were susceptible to risk of outcome ascertainment bias. {A} pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. {C}onclusion: {O}nly few studies from {SSA} investigated linkage to care among adults newly diagnosed with {HIV} through {HBHCT}. {L}inkage was often low after routine referral but higher if additional interventions were used to facilitate it. {T}he effectiveness of linkage strategies should be confirmed through randomised controlled trials.}, keywords = {{OUGANDA}}, booktitle = {}, journal = {{T}ropical {M}edicine and {I}nternational {H}ealth}, volume = {22}, numero = {7}, pages = {807--821}, ISSN = {1360-2276}, year = {2017}, DOI = {10.1111/tmi.12888}, URL = {https://www.documentation.ird.fr/hor/fdi:010076320}, }