Volume 90, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We present health and demographic surveillance system data to assess associations with health care utilization and human immunodeficiency virus (HIV) service receipt in a high HIV prevalence area of western Kenya. Eighty-six percent of 15,302 residents indicated a facility/clinician for routine medical services; 60% reported active (within the past year) attendance. Only 34% reported a previous HIV test, and self-reported HIV prevalence was 6%. Active attendees lived only slightly closer to their reported service site (2.8 versus 3.1 km; < 0.001) compared with inactive attendees. Multivariate analysis showed that younger respondents (< 30 years of age) and active and inactive attendees were more likely to report an HIV test compared with non-attendees; men were less likely to report HIV testing. Despite traveling farther for HIV services (median distance = 4.4 km), 77% of those disclosing HIV infection reported HIV care enrollment. Men and younger respondents were less likely to enroll in HIV care. Socioeconomic status was not associated with HIV service use. Distance did not appear to be the major barrier to service receipt. The health and demographic surveillance system data identified patterns of service use that are useful for future program planning.


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  1. Muller I, Smith T, Mellor S, Rare L, Genton B, , 1998. The effect of distance from home on attendance at a small rural health centre in Papua New Guinea. Int J Epidemiol 27: 878884.[Crossref] [Google Scholar]
  2. Buor D, , 2003. Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana. Int J Health Plann Manage 18: 293311.[Crossref] [Google Scholar]
  3. Burton DC, Flannery B, Onyango B, Larson C, Alaii J, Zhang X, Hamel MJ, Breiman RF, Feikin DR, , 2011. Healthcare-seeking behaviour for common infectious disease-related illnesses in rural Kenya: a community-based house-to-house survey. J Health Popul Nutr 29: 6170.[Crossref] [Google Scholar]
  4. Danso-Appiah A, De Vlas SJ, Bosompem KM, Habbema JD, , 2004. Determinants of health-seeking behaviour for schistosomiasis-related symptoms in the context of integrating schistosomiasis control within the regular health services in Ghana. Trop Med Int Health 9: 784794.[Crossref] [Google Scholar]
  5. Danso-Appiah A, Stolk WA, Bosompem KM, Otchere J, Looman CW, Habbema JD, de Vlas SJ, , 2010. Health seeking behaviour and utilization of health facilities for schistosomiasis-related symptoms in Ghana. PLoS Negl Trop Dis 4: e867.[Crossref] [Google Scholar]
  6. Feikin DR, Nguyen LM, Adazu K, Ombok M, Audi A, Slutsker L, Lindblade KA, , 2009. The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Trop Med Int Health 14: 5461.[Crossref] [Google Scholar]
  7. Harris B, Goudge J, Ataguba JE, McIntyre D, Nxumalo N, Jikwana S, Chersich M, , 2011. Inequities in access to health care in South Africa. J Public Health Policy 32 (Suppl 1): S102S123.[Crossref] [Google Scholar]
  8. Nteta TP, Mokgatle-Nthabu M, Oguntibeju OO, , 2010. Utilization of the primary health care services in the Tshwane Region of Gauteng Province, South Africa. PLoS ONE 5: e13909.[Crossref] [Google Scholar]
  9. Yao J, Murray AT, Agadjanian V, Hayford SR, , 2012. Geographic influences on sexual and reproductive health service utilization in rural Mozambique. Appl Geogr 32: 601607.[Crossref] [Google Scholar]
  10. Wilkinson D, Gouws E, Sach M, Karim SS, , 2001. Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa. Bull World Health Organ 79: 665671. [Google Scholar]
  11. Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, Aguilar AM, , 2006. Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med 62: 866876.[Crossref] [Google Scholar]
  12. Bhattarai A, Ali AS, Kachur SP, Martensson A, Abbas AK, Khatib R, Al-Mafazy AW, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Bjorkman A, , 2007. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med 4: e309.[Crossref] [Google Scholar]
  13. Burgert CR, Bigogo G, Adazu K, Odhiambo F, Buehler J, Breiman RF, Laserson K, Hamel MJ, Feikin DR, , 2011. Impact of implementation of free high-quality health care on health facility attendance by sick children in rural western Kenya. Trop Med Int Health 16: 711720.[Crossref] [Google Scholar]
  14. Kenya National Bureau of Statistics (KNBS) and ICF Macro, 2010. Kenya Demographic and Health Survey 2008–09. Calverton, MD: ICF Macro. [Google Scholar]
  15. Lifson AR, Demissie W, Tadesse A, Ketema K, May R, Yakob B, Metekia M, Slater L, Shenie T, , 2012. HIV/AIDS stigma-associated attitudes in a rural Ethiopian community: characteristics, correlation with HIV knowledge and other factors, and implications for community intervention. BMC Int Health Hum Rights 12: 6.[Crossref] [Google Scholar]
  16. Weinreb AA, Stecklov G, , 2009. Social inequality and HIV-testing: comparing home- and clinic-based testing in rural Malawi. Demogr Res 21: 627646.[Crossref] [Google Scholar]
  17. de Beer IH, Gelderblom HC, Schellekens O, Gaeb E, van Rooy G, McNally A, Wit FW, Tobias R de W, , 2012. University students and HIV in Namibia: an HIV prevalence survey and a knowledge and attitude survey. J Int AIDS Soc 15: 9.[Crossref] [Google Scholar]
  18. Zimbabwe National Statistics Agency and ICF Macro, 2012. Zimbabwe Demographic and Health Survey 2010–2011. Calverton, MD: ICF Macro. [Google Scholar]
  19. National Bureau of Statistics (NBS) Tanzania and ICF Macro, 2011. Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania: NBS and ICF Macro. [Google Scholar]
  20. World Health Organization, UNICEF, 2011. Global HIV/AIDS Response, Progress Report 2011. Geneva: World Health Organization. [Google Scholar]
  21. National AIDS and STI Congrol Programme (NASCOP), 2009. Kenya AIDS Indicator Survey 2007 (KAIS 2007) Final Report. Nairobi, Kenya: NASCOP. [Google Scholar]
  22. Division of Leprosy, Tuberculosis, and Lung Disease (DLTLD), 2007. Annual Report 2007. Nairobi, Kenya: DLTLD. [Google Scholar]
  23. Division of Malaria Control, Kenya National Bureau of Statistics (KNMS), ICF Macro, 2011. 2010 Kenya Malaria Indicator Survey. Nairobi, Kenya: KNBS and ICF Macro. [Google Scholar]
  24. Odhiambo FO, Laserson KF, Sewe M, Hamel MJ, Feikin DR, Adazu K, Ogwang S, Obor D, Amek N, Bayoh N, Ombok M, Lindblade K, Desai M, Ter Kuile F, Phillips-Howard P, van Eijk AM, Rosen D, Hightower A, Ofware P, Muttai H, Nahlen B, Decock K, Slutsker L, Breiman RF, Vulule JM, , 2012. Profile: the KEMRI/CDC Health and Demographic Surveillance System–Western Kenya. Int J Epidemiol 41: 977987.[Crossref] [Google Scholar]
  25. Hightower AW, Ombok M, Otieno R, Odhiambo R, Oloo AJ, Lal AA, Nahlen BL, Hawley WA, , 1998. A geographic information system applied to a malaria field study in western Kenya. Am J Trop Med Hyg 58: 266272. [Google Scholar]
  26. Gargano JW, Laserson K, Muttai H, Odhiambo F, Orimba V, Adamu-Zeh M, Williamson J, Sewe M, Nyabiage L, Owuor K, Broz D, Marston B, Ackers M, , 2012. The adult population impact of HIV care and antiretroviral therapy (ART) in a resource poor setting, 2003–2008. AIDS 26: 15451554.[Crossref] [Google Scholar]
  27. Wachira J, Kimaiyo S, Ndege S, Mamlin J, Braitstein P, , 2012. What is the impact of home-based HIV counseling and testing on the clinical status of newly enrolled adults in a large HIV care program in western Kenya? Clin Infect Dis 54: 275281.[Crossref] [Google Scholar]
  28. Tabana H, Doherty T, Swanevelder S, Lombard C, Jackson D, Zembe W, Naik R, , 2012. Knowledge of HIV status prior to a community HIV counseling and testing intervention in a rural district of South Africa: results of a community based survey. BMC Infect Dis 12: 73.[Crossref] [Google Scholar]
  29. Snow RC, Madalane M, Poulsen M, , 2010. Are men testing? Sex differentials in HIV testing in Mpumalanga Province, South Africa. AIDS Care 22: 10601065.[Crossref] [Google Scholar]
  30. Macpherson P, Lalloo DG, Choko AT, Mann GH, Squire SB, Mwale D, Manda E, Makombe SD, Desmond N, Heyderman R, Corbett EL, , 2012. Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi. Trop Med Int Health 1: 507517.[Crossref] [Google Scholar]
  31. Braitstein P, Boulle A, Nash D, Brinkhof MW, Dabis F, Laurent C, Schechter M, Tuboi SH, Sprinz E, Miotti P, Hosseinipour M, May M, Egger M, Bangsberg DR, Low N, Antiretroviral Therapy in Lower Income Countries Study Group, , 2008. Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration. J Womens Health (Larchmt) 17: 4755.[Crossref] [Google Scholar]
  32. Kigozi IM, Dobkin LM, Martin JN, Geng EH, Muyindike W, Emenyonu NI, Bangsberg DR, Hahn JA, , 2009. Late-disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in sub-Saharan Africa. J Acquir Immune Defic Syndr 52: 280289.[Crossref] [Google Scholar]
  33. Chirawu P, Langhaug L, Mavhu W, Pascoe S, Dirawo J, Cowan F, , 2010. Acceptability and challenges of implementing voluntary counselling and testing (VCT) in rural Zimbabwe: evidence from the Regai Dzive Shiri Project. AIDS Care 22: 8188.[Crossref] [Google Scholar]
  34. Byamugisha R, Astrom AN, Ndeezi G, Karamagi CA, Tylleskar T, Tumwine JK, , 2011. Male partner antenatal attendance and HIV testing in eastern Uganda: a randomized facility-based intervention trial. J Int AIDS Soc 14: 43.[Crossref] [Google Scholar]
  35. Obure CD, Vassall A, Michaels C, Terris-Prestholt F, Mayhew S, Stackpool-Moore L, Warren C, Integra Research Team Watts C, , , , 2012. Optimising the cost and delivery of HIV counselling and testing services in Kenya and Swaziland. Sex Transm Infect 88: 498503.[Crossref] [Google Scholar]
  36. Steen TW, Seipone K, Gomez F de L, Anderson MG, Kejelepula M, Keapoletswe K, Moffat HJ, , 2007. Two and a half years of routine HIV testing in Botswana. J Acquir Immune Defic Syndr 44: 484488.[Crossref] [Google Scholar]
  37. Nsigaye R, Wringe A, Roura M, Kalluvya S, Urassa M, Busza J, Zaba B, , 2009. From HIV diagnosis to treatment: evaluation of a referral system to promote and monitor access to antiretroviral therapy in rural Tanzania. J Int AIDS Soc 12: 31.[Crossref] [Google Scholar]
  38. Govindasamy D, van Schaik N, Kranzer K, Wood R, Mathews C, Bekker LG, , 2011. Linkage to HIV care from a mobile testing unit in South Africa by different CD4 count strata. J Acquir Immune Defic Syndr 58: 344352.[Crossref] [Google Scholar]
  39. Nglazi MD, van Schaik N, Kranzer K, Lawn SD, Wood R, Bekker LG, , 2012. An incentivized HIV counseling and testing program targeting hard-to-reach unemployed men in Cape Town, South Africa. J Acquir Immune Defic Syndr 59: e28e34.[Crossref] [Google Scholar]
  40. Ndirangu J, Barnighausen T, Tanser F, Tint K, Newell ML, , 2009. Levels of childhood vaccination coverage and the impact of maternal HIV status on child vaccination status in rural KwaZulu-Natal, South Africa. Trop Med Int Health 14: 13831393.[Crossref] [Google Scholar]
  41. Moore BM, Alex-Hart BA, George IO, , 2011. Utilization of health care services by pregnant mothers during delivery: a community based study in Nigeria. East Afr J Public Health 8: 4951. [Google Scholar]
  42. Cooke GS, Tanser FC, Barnighausen TW, Newell ML, , 2010. Population uptake of antiretroviral treatment through primary care in rural South Africa. BMC Public Health 10: 585.[Crossref] [Google Scholar]
  43. Hatcher AM, Turan JM, Leslie HH, Kanya LW, Kwena Z, Johnson MO, Shade SB, Bukusi EA, Doyen A, Cohen CR, , 2011. Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya. AIDS Behav 16: 12951307.[Crossref] [Google Scholar]
  44. Medley A, Ackers M, Amolloh M, Owuor P, Muttai H, Audi B, Sewe M, Laserson K, , 2012. Early uptake of HIV clinical care After testing HIV-positive during home-based testing and counseling in western Kenya. AIDS Behav 17: 224234.[Crossref] [Google Scholar]
  45. Walensky RP, Bassett IV, , 2011. HIV self-testing and the missing linkage. PLoS Med 8: e1001101.[Crossref] [Google Scholar]
  46. Torian LV, Wiewel EW, Liu KL, Sackoff JE, Frieden TR, , 2008. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus. Arch Intern Med 168: 11811187.[Crossref] [Google Scholar]
  47. Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C, Reid SE, , 2011. Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia. Bull World Health Organ 89: 32835A.[Crossref] [Google Scholar]
  48. Ferguson L, Grant AD, Watson-Jones D, Kahawita T, Ong'ech JO, Ross DA, , 2012. Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review. Trop Med Int Health 17: 564580.[Crossref] [Google Scholar]
  49. Dalal W, Feikin DR, Amolloh M, Ransom R, Burke H, Lugalia F, Ouma A, Laserson KF, Mermin J, Breiman RF, Bunnell R, , 2013. Home-based HIV testing and counseling in rural and urban Kenyan communities. J Acquir Immune Defic Syndr 62: e47e54.[Crossref] [Google Scholar]

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  • Received : 08 Apr 2013
  • Accepted : 07 Oct 2013
  • Published online : 05 Feb 2014

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