Expanded eligibility for HIV testing increases HIV diagnoses—A cross-sectional study in seven health facilities in western Kenya

Abstract

Homa Bay, Siaya, and Kisumu counties in western Kenya have the highest estimated HIV prevalence (16.3–21.0%) in the country, and struggle to meet program targets for HIV testing services (HTS). The Kenya Ministry of Health (MOH) recommends annual HIV testing for the general population. We assessed the degree to which reducing the interval for retesting to less than 12 months increased diagnosis of HIV in outpatient departments (OPD) in western Kenya. We conducted a retrospective analysis of routinely collected program data from seven high-volume (>800 monthlyOPD visits) health facilities in March–December, 2017. Data from persons ≥15 years of age seeking medical care (patients) in the OPD and non-care-seekers (non-patients) accompanying patients to the OPD were included. Outcomes were meeting MOH (routine) criteria versus criteria for a reduced retesting interval (RRI) of <12 months, and HIV test result. STATA version 14.2 was used to calculate frequencies and proportions, and to test for differences using bivariate analysis. During the 9-month period, 119,950 clients were screened for HIV testing eligibility, of whom 79% (94,766) were eligible and 97% (92,153) received a test. Among 92,153 clients tested, the median age was 28 years, 57% were female and 40% (36,728) were non-patients. Overall, 20% (18,120) of clients tested met routine eligibility criteria: 4% (3,972) had never been tested, 10% (9,316) reported a negative HIV test in the past >12 months, and 5% (4,832) met other criteria. The remaining 80% (74,033) met criteria for a RRI of < 12 months. In total 1.3% (1,185) of clients had a positive test. Although the percent yield was over 2-fold higher among those meeting routine criteria (2.4% vs. 1.0%; p<0.001), 63% (750) of all HIV infections were found among clients tested less than 12 months ago, the majority (81%) of whom reported having a negative test in the past 3–12 months. Non-patients accounted for 45% (539) of all HIV-positive persons identified. Percent yield was higher among non-patients as compared to patients (1.5% vs. 1.2%; p-value = <0.001) overall and across eligibility criteria and age categories. The majority of HIV diagnoses in the OPD occurred among clients reporting a negative HIV test in the past 12 months, clients ineligible for testing under the current MOH guidelines. Nearly half of all HIV-positive individuals identified in the OPD were non-patients. Our findings suggest that in the setting of a generalized HIV epidemic, retesting persons reporting an HIV-negative test in the past 3–12 months, and routine testing of non-patients accessing the OPD are key strategies for timely diagnosis of persons living with HIV.

Development and Validation of a Sociodemographic and Behavioral Characteristics-Based Risk-Score Algorithm for Targeting HIV Testing Among Adults in Kenya

“…Although we did not assess socioeconomic status directly, we found manual/domestic or trade/sales/service occupations were associated with higher risk of HIV infection, which might be explained by an unidentified interplay between source of income and behavior, including increased opportunity for social interaction and travel. Our findings are also consistent with program data from western Kenya which found that patients who had never been tested for HIV, or had a negative HIV test result > 12 months prior were more likely HIV-positive [76]. Most patients (95%) had been tested for HIV within the previous 12 months, reflecting intensified HIV testing efforts to increase ART coverage in the study region [77][78][79][80].…”

Mapping geographic clusters of new HIV diagnoses to inform granular-level interventions for HIV epidemic control in western Kenya

“…Although several studies have documented a correlation between widowhood and higher HIV infection [ 44 , 45 , 50 ], a significant association between widowed individuals and HIV-positive diagnosis was not observed in this study. Similar to findings observed in facility-based testing [ 51 ], individuals never tested for HIV, and those tested > 12 months prior, were more likely to be diagnosed HIV-positive. The association between increasing age and higher likelihood of HIV diagnosis found in this study is consistent with higher HIV prevalence observed in older age groups [ 52 – 54 ].…”

HIV screening in the dental setting in New York State

“…One study further suggests routine HIV testing for not only patients but also those who accompany patients to the health care facilities in the communities of high HIV prevalence. [41] In general, our findings suggest that routine HIV screening in dental setting is beneficial where routine HIV screening in primary care setting is mandated, because our data show that a large percent of dental patients have never been tested for HIV, have not seen a primary care provider or have not been offered an HIV screening test by a primary care provider in the past year.…”