1. Linkage to care following home- based HIV counseling and testing 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention Kuala Lumpur, Malaysia July 1, 2013

2. Why is this important?  Combatting HIV/AIDS requires universal knowledge of HIV status  Shift to community-based models  ‘Test & Treat’  Strong evidence on home-based testing  HBHCT may pose unique challenges  Need to eliminate leakages in cascade

3. So they’ll test. But then what?

4. To answer these questions...  Sub-study of Good Start  All HIV+ clients from HBHCT arm (n=492)  3-part study:  Prospective cohort (n=359)  Cox regression (n=196)  Qualitative (n=30)

5. Key cohort findings  62.1% (95% CI: 55.73% - 68.47%) linked to care within 3 months of HBHCT (n=359)  Median CD4: 340.5 cells/mm 3 (n=226) ART initiation by CD4 count ≤200 cells/mm 3 201-350 cells/mm 3 >350 cells/mm 3 Clients with CD4 data (n=226) 33/45 ( 73.3% )13/72 (16.3%)2/109 (1.8%)

6. Key Cox regression findings  Younger age (16-24 years) (AHR 0.50 ; 95% CI: 0.28 – 0.91)  Disbelief of HIV test results (AHR 0.48 ; 95% CI: 0.30 – 0.77)  Difficulty finding time to seek care (AHR 0.40 ; 95% CI: 0.24 – 0.67) *Outcome = providing a blood sample for a facility-based CD4 count

7. Key Cox regression findings  Believing ART can make you sick (AHR 0.56 ; 95% CI: 0.35 – 0.89)  Living with ≥ 2 adults (AHR 0.52 ; 95% CI: 0.35 – 0.77)  Belief in availability of drugs/supplies (AHR 1.78 ; 95% CI: 1.07 – 2.96)  Drinking alcohol (AHR 0.52 ; 95% CI: 0.34 – 0.80)

8. Discussion  Barriers to linkage occur at all levels  Need to implement and evaluate interventions to address key barriers

9. Thank You