BACKGROUND: Knowledge of HIV status is the entry point for linkage to prevention, care, and treatment, and the first step toward achieving the UNAIDS 90-90-90 targets. Most countries rely on proxies for estimating testing saturation, including periodic population-based sampling and yield (number positive among those tested). We conducted a community-based "Hybrid" HIV testing services (HTS) program to identify persons unaware of their HIV-positive status. SETTING: Homa Bay County, Kenya; July-September, 2016. METHODS: We conducted community mapping, household census, multi-disease community health campaigns (CHCs), and home-based tracking. HIV testing eligibility was based on 2015 national guidelines. The previously unidentified fraction (PUF) was defined as the proportion of newly identified persons living with HIV (PLWH) out of all previously identified and newly identified PLWH. RESULTS: The Hybrid HTS program reached 28,885 persons in total: 25,340 residents and 3545 nonresidents. There were 19,288 persons reached through CHCs and tracking. Of 11,316 individuals eligible for HIV testing, 9463 (83%) accepted testing, including 1230 (13%) first-time testers. There were 115 newly identified PLWH of 1589 total HIV-positive persons, representing a 7.2% PUF. Of 93 newly identified PLWH at the CHCs, 68% initiated same-day antiretroviral therapy. CONCLUSION: The Hybrid HTS program identified persons previously unaware of their HIV-positive status, thereby enabling linkage to care and same-day treatment and reducing onward transmission risk. An approach focused on identifying persons unaware of their HIV-positive status in combination with ascertaining the PUF has the potential to better target testing strategies to identify >90% of PLWH in a community.
BACKGROUND: Knowledge of HIV status is the entry point for linkage to prevention, care, and treatment, and the first step toward achieving the UNAIDS 90-90-90 targets. Most countries rely on proxies for estimating testing saturation, including periodic population-based sampling and yield (number positive among those tested). We conducted a community-based "Hybrid" HIV testing services (HTS) program to identify persons unaware of their HIV-positive status. SETTING: Homa Bay County, Kenya; July-September, 2016. METHODS: We conducted community mapping, household census, multi-disease community health campaigns (CHCs), and home-based tracking. HIV testing eligibility was based on 2015 national guidelines. The previously unidentified fraction (PUF) was defined as the proportion of newly identified persons living with HIV (PLWH) out of all previously identified and newly identified PLWH. RESULTS: The Hybrid HTS program reached 28,885 persons in total: 25,340 residents and 3545 nonresidents. There were 19,288 persons reached through CHCs and tracking. Of 11,316 individuals eligible for HIV testing, 9463 (83%) accepted testing, including 1230 (13%) first-time testers. There were 115 newly identified PLWH of 1589 total HIV-positive persons, representing a 7.2% PUF. Of 93 newly identified PLWH at the CHCs, 68% initiated same-day antiretroviral therapy. CONCLUSION: The Hybrid HTS program identified persons previously unaware of their HIV-positive status, thereby enabling linkage to care and same-day treatment and reducing onward transmission risk. An approach focused on identifying persons unaware of their HIV-positive status in combination with ascertaining the PUF has the potential to better target testing strategies to identify >90% of PLWH in a community.
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Authors: Richard Hayes; Sian Floyd; Ab Schaap; Kwame Shanaube; Peter Bock; Kalpana Sabapathy; Sam Griffith; Deborah Donnell; Estelle Piwowar-Manning; Wafaa El-Sadr; Nulda Beyers; Helen Ayles; Sarah Fidler Journal: PLoS Med Date: 2017-05-02 Impact factor: 11.069
Authors: Carol S Camlin; Adam Akullian; Torsten B Neilands; Monica Getahun; Patrick Eyul; Irene Maeri; Sarah Ssali; Elvin Geng; Monica Gandhi; Craig R Cohen; Moses R Kamya; Thomas Odeny; Elizabeth A Bukusi; Edwin D Charlebois Journal: J Int AIDS Soc Date: 2018-07 Impact factor: 5.396
Authors: Gabriel Chamie; Tamara D Clark; Jane Kabami; Kevin Kadede; Emmanuel Ssemmondo; Rachel Steinfeld; Geoff Lavoy; Dalsone Kwarisiima; Norton Sang; Vivek Jain; Harsha Thirumurthy; Teri Liegler; Laura B Balzer; Maya L Petersen; Craig R Cohen; Elizabeth A Bukusi; Moses R Kamya; Diane V Havlir; Edwin D Charlebois Journal: Lancet HIV Date: 2016-01-26 Impact factor: 12.767
Authors: Yujung Choi; Saduma Ibrahim; Lawrence P Park; Craig R Cohen; Elizabeth A Bukusi; Megan J Huchko Journal: BMC Womens Health Date: 2022-04-18 Impact factor: 2.742
Authors: Beth A Tippett Barr; David Lowrance; Cheryl Case Johnson; Rachel Clare Baggaley; John H Rogers; Shirish K Balachandra; Joseph Barker; Thokozani Kalua; Sudhir Bunga; Daniel Low-Beer; Danielle Payne; Marc G Bulterys; Andreas Jahn Journal: Bull World Health Organ Date: 2021-09-30 Impact factor: 9.408