Abstract
BackgroundHIV testing is the first step to stop transmission. We aimed to evaluate HIV testing history and new diagnoses among adult outpatients in Kenya aged 18–39 years seeking care for symptoms of acute HIV infection (AHI).MethodsThe Tambua Mapema Plus study, a stepped-wedge trial, enrolled patients presenting to care at six primary care facilities with symptoms of AHI for a targeted HIV-1 nucleic acid (NA) testing intervention compared with standard provider-initiated testing using rapid antibody tests. Intervention participants underwent a questionnaire and NA testing, followed by rapid tests if NA-positive. Multinomial logistic regression was used to analyse factors associated with never testing or testing > 1 year ago (“late retesting”) relative to testing ≤ 1 year ago (“on-time testers”). Logistic regression was used to analyse factors associated with new diagnosis. All analyses were stratified by sex.ResultsOf 1,500 intervention participants, 613 (40.9%) were men. Overall, 250 (40.8%) men vs. 364 (41.0%) women were late retesters, and 103 (16.8%) men vs. 50 (5.6%) women had never tested prior to enrolment. Younger age, single status, lower education level, no formal employment, childlessness, sexual activity in the past 6 weeks, and > 1 sexual partner were associated with testing history among both men and women. Intimate partner violence > 1 month ago, a regular sexual partner, and concurrency were associated with testing history among women only. New diagnoses were made in 37 (2.5%) participants (17 men and 20 women), of whom 8 (21.6%) had never tested and 16 (43.2%) were late retesters. Newly-diagnosed men were more likely to have symptoms for > 14 days, lower education level and no religious affiliation and less likely to be young, single, and childless than HIV-negative men; newly-diagnosed women were more likely to report fever than HIV-negative women. Among men, never testing was associated with fivefold increased odds (95% confidence interval 1.4–20.9) of new diagnosis relative to on-time testers in adjusted analyses.ConclusionMost new HIV diagnoses were among participants who had never tested or tested > 1 year ago. Strengthening provider-initiated testing targeting never testers and late retesters could decrease time to diagnosis among symptomatic adults in coastal Kenya.Trial registrationClinicalTrials.gov Identifier: NCT03508908 registered on 26/04/2018.
Highlights
HIV testing is the first step to stop transmission
Our study evaluated the correlates of testing history and new HIV diagnosis among adults aged 18–39 years seeking care for symptoms of an acute infectious illness who met our risk score criteria
Our findings underscore the importance of facility-based HIV testing among adults presenting with symptoms of acute HIV infection (AHI), in order to avoid diagnostic delays and facilitate early linkage to HIV care and treatment
Summary
HIV testing is the first step to stop transmission. We aimed to evaluate HIV testing history and new diagnoses among adult outpatients in Kenya aged 18–39 years seeking care for symptoms of acute HIV infection (AHI). Within Eastern and Southern Africa, groups that have gaps in terms of access to and uptake of HIV testing services (HTS) include key populations, partners of PLWH, men and young people [1]. In Eastern and Southern Africa, despite a larger burden of women infected with HIV compared to men, testing rates, treatment coverage and viral suppression were higher among women, resulting in lower AIDS-related mortality rates among women compared to men in 2019 [2]. Several factors are associated with a lower likelihood of HIV testing in studies conducted in sub-Saharan Africa (SSA) including younger age (adolescents), male sex, less than primary education, lower socioeconomic status and having multiple sexual partners [3]. HIV testing has largely been integrated within antenatal care (ANC) services and has led to greater test coverage for women, with an estimated 60.7% of women in SSA receiving HIV testing as part of ANC [14]
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