Abstract
To inform targeted HIV testing, we developed and externally validated a risk-score algorithm that incorporated behavioral characteristics. Outpatient data from five health facilities in western Kenya, comprising 19,458 adults ≥ 15 years tested for HIV from September 2017 to May 2018, were included in univariable and multivariable analyses used for algorithm development. Data for 11,330 adults attending one high-volume facility were used for validation. Using the final algorithm, patients were grouped into four risk-score categories: ≤ 9, 10–15, 16–29 and ≥ 30, with increasing HIV prevalence of 0.6% [95% confidence interval (CI) 0.46–0.75], 1.35% (95% CI 0.85–1.84), 2.65% (95% CI 1.8–3.51), and 15.15% (95% CI 9.03–21.27), respectively. The algorithm’s discrimination performance was modest, with an area under the receiver-operating-curve of 0.69 (95% CI 0.53–0.84). In settings where universal testing is not feasible, a risk-score algorithm can identify sub-populations with higher HIV-risk to be prioritized for HIV testing.
Highlights
With the global commitment to end the human immunodeficiency virus (HIV) epidemic by 2030 [1, 2], the Joint United Nations Programme on HIV/AIDS (UNAIDS), in 2014, set ambitious “90–90–90” targets for accelerating antiretroviral therapy (ART) coverage [1] in order to reduce HIV transmission [3,4,5,6] and HIV-related morbidity and mortality [6] worldwide
Characteristics of Patients at the Five Health Facilities Used for Risk‐Score Algorithm Development
99.9% (27,685/27,692) of adults attending OPD services were screened for HIV testing eligibility, and 87% (21,764/24,966) of those eligible were tested for HIV
Summary
With the global commitment to end the human immunodeficiency virus (HIV) epidemic by 2030 [1, 2], the Joint United Nations Programme on HIV/AIDS (UNAIDS), in 2014, set ambitious “90–90–90” targets for accelerating antiretroviral therapy (ART) coverage [1] in order to reduce HIV transmission [3,4,5,6] and HIV-related morbidity and mortality [6] worldwide. The UNAIDS 90–90–90 targets aim for 90% of people living with HIV to know their HIV status, 90% of people with diagnosed HIV infection to receive ART, and 90% of people receiving ART to achieve viral suppression [1, 2]. In 2018, the Sub-Saharan Africa region had an estimated 25.6 million people living with HIV (68% of all people living with HIV globally) and 1.08 million new HIV infections. By 2018, the region had achieved 64% ART coverage, with 16.4 million people accessing ART [7]. Increasing ART coverage in the Sub-Saharan Africa region is a global priority. Kenya has an adult HIV prevalence of 4.7%, and in 2018, had an estimated 1.6 million people living with HIV and 46,000 new HIV infections [8].
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