Sofia De Anda1, Anne Njoroge1,2, Irene Njuguna2,3, Matthew D Dunbar4, Felix Abuna2, Paul Macharia5, Bourke Betz1, Peter Cherutich5, David Bukusi6, Carey Farquhar1,3,7, David A Katz7. 1. Department of Global Health, University of Washington, Seattle, WA. 2. Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. 3. Department of Epidemiology, University of Washington, Seattle, WA. 4. Center for Demography and Ecology, University of Washington, Seattle, WA. 5. Kenya Ministry of Health, Nairobi, Kenya. 6. Voluntary Counseling and Testing (VCT) and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya; and. 7. Departments of Medicine University of Washington, Seattle, WA.
Abstract
BACKGROUND: Despite a doubling of HIV testing coverage in Kenya over the past decade, approximately 2 in 10 people with HIV remained unaware of their infection in 2018. HIV testing is most effective in identifying people with undiagnosed HIV through frequent and strategic testing in populations at high risk. An assessment of testing frequency and predictors of first-time and repeat testing is critical for monitoring effectiveness of testing strategies. METHODS: We conducted a cross-sectional analysis of adults aged ≥18 years who tested HIV-positive at 4 HIV testing and counseling clinics in Kenya from February 2015 to February 2016. We categorized individuals based on testing history, used Wilcoxon rank-sum tests to assess differences in intervals between the most recent and current HIV test, and used log-binomial regression to determine characteristics associated with first-time and repeat testing. RESULTS: Among 1136 people testing HIV-positive, 336 (30%) had never tested before and 800 (70%) had, of whom 208 (26%) had previously tested positive. Among previously negative repeat testers, the median intertest interval was 414 days in key/priority populations (interquartile range = 179-1072) vs. 538 in the general population (interquartile range = 228-1299) (P = 0.09). Compared with previously negative repeat testers, being a first-time tester was associated with being age ≥40 years [vs. 18-24; adjusted risk ratio = 1.67, 95% confidence interval (CI): 1.23 to 2.26], men (vs. women; adjusted risk ratio = 1.45, 95% CI: 1.21 to 1.71), and testing through provider-initiated testing and counseling (vs. client initiated; 1.19, 95% CI: 1.00 to 1.40). CONCLUSIONS: There is a need to increase HIV testing among older individuals and men, increase testing frequency in key/priority populations, and maintain provider-initiated and facility-based testing to reach first-time testers.
BACKGROUND: Despite a doubling of HIV testing coverage in Kenya over the past decade, approximately 2 in 10 people with HIV remained unaware of their infection in 2018. HIV testing is most effective in identifying people with undiagnosed HIV through frequent and strategic testing in populations at high risk. An assessment of testing frequency and predictors of first-time and repeat testing is critical for monitoring effectiveness of testing strategies. METHODS: We conducted a cross-sectional analysis of adults aged ≥18 years who tested HIV-positive at 4 HIV testing and counseling clinics in Kenya from February 2015 to February 2016. We categorized individuals based on testing history, used Wilcoxon rank-sum tests to assess differences in intervals between the most recent and current HIV test, and used log-binomial regression to determine characteristics associated with first-time and repeat testing. RESULTS: Among 1136 people testing HIV-positive, 336 (30%) had never tested before and 800 (70%) had, of whom 208 (26%) had previously tested positive. Among previously negative repeat testers, the median intertest interval was 414 days in key/priority populations (interquartile range = 179-1072) vs. 538 in the general population (interquartile range = 228-1299) (P = 0.09). Compared with previously negative repeat testers, being a first-time tester was associated with being age ≥40 years [vs. 18-24; adjusted risk ratio = 1.67, 95% confidence interval (CI): 1.23 to 2.26], men (vs. women; adjusted risk ratio = 1.45, 95% CI: 1.21 to 1.71), and testing through provider-initiated testing and counseling (vs. client initiated; 1.19, 95% CI: 1.00 to 1.40). CONCLUSIONS: There is a need to increase HIV testing among older individuals and men, increase testing frequency in key/priority populations, and maintain provider-initiated and facility-based testing to reach first-time testers.
Authors: Maria F Nardell; Bethany Hedt-Gauthier; Valerie A Earnshaw; Laura M Bogart; Janan J Dietrich; Ingrid Courtney; Gugulethu Tshabalala; Jacob Bor; Catherine Orrell; Glenda Gray; David R Bangsberg; Ingrid T Katz Journal: AIDS Behav Date: 2021-10-27
Authors: Malango T Msukwa; Ellen W MacLachlan; Salem T Gugsa; Joe Theu; Ireen Namakhoma; Fred Bangara; Christopher L Blair; Danielle Payne; Kathryn G Curran; Melissa Arons; Khumbo Namachapa; Nellie Wadonda; Alinune N Kabaghe; Trudy Dobbs; Vedapuri Shanmugam; Evelyn Kim; Andrew Auld; Yusuf Babaye; Gabrielle O'Malley; Rose Nyirenda; George Bello Journal: BMJ Open Date: 2022-09-23 Impact factor: 3.006
Authors: Maria F Nardell; Oluwatomi Adeoti; Carson Peters; Bernard Kakuhikire; Caroline Govathson-Mandimika; Lawrence Long; Sophie Pascoe; Alexander C Tsai; Ingrid T Katz Journal: J Int AIDS Soc Date: 2022-03 Impact factor: 5.396