Trends and predictors of new HIV diagnosis and time since last test at testing encounters among adults in Kilifi, Kenya, 2006-2017

Peter M Mugo,Mahmoud Shally,Elizabeth Wahome,Susan M Graham,Eduard J Sanders,Khamisi Mohamed,Clara A Agutu,Ibrahim Fauz,Elise M Van Der Elst,Tobias F Rinke De Wit,Teresia Mumba,Margaret Juma,Joseph Nzioka,Anisa Omar

doi:10.12688/wellcomeopenres.15401.1

Abstract

Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of new HIV diagnosis, first-time testing (FTT), and late retesting (previous test more than one year ago for GP or three months for KP). Methods: Data was collected routinely at three voluntary counselling and testing (VCT) centres in Kilifi County between 2006 and 2017. We analysed test encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 25,670 test encounters (32% FTT), we observed significant declines in HIV positivity (proportion of encounters with a new HIV diagnosis) among GP men, GP women, and first-time testers, but not among MSM and FSW. FTT and late retesting decreased for both GP and KP, but remained much higher in KP than GP. In 2017, less than 20% of KP were testing quarterly as recommended. HIV positivity was higher at FTT and late retesting encounters (relative to on-time retesting); at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment, sexually transmitted infection (STI) symptoms, or no religious affiliation. HIV positivity was lower in GP men and younger clients. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: New HIV diagnoses were most common among first-time testers and late re-testers. While late retesting decreased steadily over the period reviewed, achievement of the county’s 90% HIV diagnosis target will require redoubled efforts to increase retesting among the most at risk populations.

Highlights

Kenya has the fifth-largest human immunodeficiency virus (HIV) epidemic in the world[1], with 1.5 million adults living with HIV in 20172
56% of encounters were among men, 68% among never-married individuals, 73% among Christians, and 40% among those with primary or no education; 91% were among general populations (GP) and 9% among key populations (KP); 32% were first-time testing (FTT) encounters and 19% were late retesting encounters
Time trends in prevalence of first-time testing For GP, we observed a statistically significant decline in overall FTT prevalence among men, women, and women 18–24 years (Figure 2)

Summary

Introduction

Kenya has the fifth-largest human immunodeficiency virus (HIV) epidemic in the world[1], with 1.5 million adults living with HIV in 20172. Key populations, including men who have sex with men (MSM) and female sex workers (FSW) remain disproportionately affected by HIV. We analysed test encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 25,670 test encounters (32% FTT), we observed significant declines in HIV positivity (proportion of encounters with a new HIV diagnosis) among GP men, GP women, and first-time testers, but not among MSM and FSW. HIV positivity was higher at FTT and late retesting encounters (relative to on-time retesting); at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment, sexually transmitted infection (STI) symptoms, or no religious affiliation. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower

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Discussion

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