RP-Department of Community Health

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Browsing RP-Department of Community Health by Author "Bukusi, David"

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    Assisted Partner Services (APS) among Patients Attending HIV Comprehensive Care Clinic in Kenya: Randomized Controlled Trial (RCT)
    (International Journal of Medical Science and Health Research, 2018) Kimani, Harun; Bukusi, David; Maingi, Peter; Macharia, Peter; Otieno, Felix A.; Muiruri, Peter; Farquhar, Carey
    Introduction: Assisted Partner Services (APS) for HIV involves interviewing HIV infected individuals about their sexual partners and then locating these partners to offer HIV testing and inform them about the exposure. Several studies have shown APS to be effective and acceptable among newly diagnosed individuals, however few have studied APS among individuals with chronic HIV infection. Methods: HIV-infected individuals receiving care at Kenyatta National Hospital Comprehensive Care Center (CCC) were randomized to community versus health facility based notification. Index case in the Health facility arm were offered standard of care which is contract testing where they were encouraged to bring their partners for testing. In the community arm which was the intervention arm, the index cases were offered immediate assisted partner notification where health advisers consented the index cases for their partners to be confidentially contacted and tested for HIV. Smart phone tablet with a Open Data Kit questionnaire was used to collect data. The two approaches were compared using the ODDS Ratio with 95% confidence intervals and the results given below. Results: Index cases randomized to health facility arm were 201 while 218 index cases in the community arm of whom 262 (62.5%) were women and majority aged between 40-49 years 87 (39.9%). The community based assisted partner notification yielded 1 partner per index and among these 113 partners were traced (51.8%) and 101 partners were HIV tested (89.3%). Of those tested, 35 of 101 were HIV-positive. When compared to facility passive referral, there was a 2.6-fold increase in partner testing with 58 (28.9%) of 201 testing for HIV in the health facility arm (Odds ratio [OR] 2.65; 95% confidence interval [CI]: 1.77, 3.98 p<0.001). Discussion or conclusion: Community based partner tracing has high potential of reaching HIV exposed partners of a HIV infected index case. It is acceptable to both index cases and their partners and enables health workers provide services that enable partners to be enrolled into care.