ORIGINAL PAPER Early Uptake of HIV Clinical Care After Testing HIV-Positive During Home-Based Testing and Counseling in Western Kenya Amy Medley • Marta Ackers • Manase Amolloh • Patrick Owuor • Helen Muttai • Beryl Audi • Manquins Sewe • Kayla Laserson Published online: 18 October 2012 Ó Springer Science+Business Media New York 2012 Abstract Home-based HIV testing and counseling (HBTC) has the potential to increase access to HIV testing. However, the extent to which HBTC programs successfully link HIV-positive individuals into clinical care remains unclear. To determine factors associated with early enrollment in HIV clinical care, adult residents (aged C13 years) in the Health and Demographic Surveillance System in Kisumu, Kenya were offered HBTC. All HIV-positive residents were referred to nearby HIV clinical care centers. Two to four months after HBTC, peer educators conducted home visits to consenting HIV-positive residents. Overall, 9,895 (82 %) of 12,035 residents accepted HBTC; 1,087 (11 %) were HIV-positive; and 737 (68 %) received home visits. Of those receiving home visits, 42 % reported HIV care attendance. Factors associated with care attendance inclu- ded: having disclosed, living with someone attending HIV care, and wanting to seek care after diagnosis. Residents who reported their current health as excellent or who doubted their HBTC result were less likely to report care attendance. While findings indicate that HBTC was well- received in this setting, less than half of HIV-positive indi- viduals reported current care attendance. Identification of effective strategies to increase early enrollment and retention in HIV clinical care is critical and will require coordination between testing and treatment program staff and systems. Keywords HIV/AIDS Á HIV testing and counseling Á Antiretroviral therapy Á Kenya Introduction In Kenya, an East African country of 38.8 million people, an estimated 6.3 % of adults are living with HIV [1]. HIV prevalence is higher among women (8.0 %) than men (4.3 %). Among married couples, rates of HIV sero- discordance are high with an estimated 43 % of HIV- positive women and 44 % of HIV-positive men living with an HIV-negative partner [1]. However, most Kenyans remain unaware of their HIV status. In a recent national survey, only 58 % of women and 42 % of men aged 15–64 years reported that they had ever been tested for HIV in their lifetime and 31 % of HIV-positive individuals were unaware of their status [1]. Early identification of HIV-positive individuals through HIV testing and counseling (HTC) and linkage of these individuals to HIV care and treatment services reduces the morbidity and mortality experienced by the HIV-positive individual [2, 3] and the risk of transmission to HIV-negative partners [4–6]. The Government of Kenya has made the expansion of HTC services a national goal and aims to pro- vide HIV testing to at least 80 % of all adolescents and adults by 2013 [7]. A variety of HIV testing approaches are being utilized to reach this goal including provider-initiated HTC offered as part of routine care in health facilities, commu- nity-based HIV testing services (both mobile and standalone clinics), and home-based HIV testing and counseling services (HBTC). A. Medley (&) Á M. Ackers U.S. Centers for Disease Control and Prevention (CDC), MS E04, 1600 Clifton Road NE, Atlanta, GA 30333, USA e-mail: igm8@cdc.gov M. Amolloh Á P. Owuor Á B. Audi Á M. Sewe Á K. Laserson Kenya Medical Research Institute (KEMRI), Nairobi, Kenya H. Muttai Á K. Laserson U.S. Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya 123 AIDS Behav (2013) 17:224–234 DOI 10.1007/s10461-012-0344-5