Assessment of standard HIV testing services delivery to injured persons seeking emergency care in Nairobi, Kenya: A prospective observational study

Abstract

Emergency departments (EDs) in Africa are contact points for key groups for HIV testing services (HTS) but understanding of ED-testing delivery is limited which may impeded program impacts. This study evaluated the offering and uptake of standard HTS among injured persons seeking ED care at Kenyatta National Hospital (KNH) in Nairobi, Kenya. An ED population of adult injured persons was prospectively enrolled (1 March—25 May 2021) and followed through ED disposition. Participants requiring admission were followed through hospital discharge and willing participants were contacted at 28-days for follow up. Data on population characteristics and HTS were collected by personnel distinct from clinicians responsible for standard HTS. Descriptive analyses were performed and prevalence values with 95% confidence intervals (CI) were calculated for HIV parameters. The study enrolled 646 participants. The median age was 29 years with the majority male (87.8%). Most ED patients were discharged (58.9%). A prior HIV diagnosis was reported by 2.3% of participants and 52.7% reported their last testing as >6 months prior. Standard ED-HTS were offered to 49 or 8.6% of participants (95% CI: 5.8–9.9%), among which 89.8% accepted. For ED-tested participants 11.4% were newly diagnosed with HIV (95% CI: 5.0–24.0%). Among 243 participants admitted, testing was offered to 6.2% (95% CI: 3.9–9.9%), with 93.8% accepting. For admitted participants tested 13.3% (95% CI: 4.0–35.1%) were newly diagnosed (all distinct from ED cases). At 28-day follow up an additional 22 participants reported completing testing since ED visitation, with three newly diagnosed. During the full follow-up period the HIV prevalence in the population tested was 10.3% (95% CI: 5.3–19.0%); all being previously undiagnosed. Offering of standard HTS was infrequent, however, when offered, uptake and identification of new HIV diagnoses were high. These data suggest that opportunities exist to improve ED-HTS which could enhance identification of undiagnosed HIV.

Implementation and Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) Program in Nairobi, Kenya: A Quasi-Experimental Prospective Study

“…Prior data from the study setting demonstrated that 5.6% of injured patients completed ED-HIV testing. 25 To be able to identify a 10% absolute increase in the proportion of injured patients completing testing, a sample size of >175 participant per assessment period was need (80% power, alpha <0.05). 47 Descriptive analyses were performed for systems level and participant level data using frequencies with percentages or medians with associated interquartile ranges (IQR) as appropriate.…”

“…Prior data from the study setting demonstrated that 5.6% of injured patients completed ED-HIV testing. 25 To be able to identify a 10% absolute increase in the proportion of injured patients completing testing, a sample size of > 175 participant per assessment period was need (80% power, alpha <0.05). 47…”

“…17,19,20 Data from sub-Saharan Africa shows patients seeking injury treatments have high HIV burdens and are often first diagnosed during those evaluations. 21–25 Globally, young people and men are most likely to experience injuries, 26,27 and KPs have elevated risks for interpersonal violence, gender-based violence, and self-harm. 28,29 In Kenya, data from the National AIDS and STIs Control Programme (NASCOP) demonstrates high prevalence of violence experienced by SW (48%), PWID (44%), and MSM (20%).…”

HIV self-testing acceptability among injured persons seeking emergency care in Nairobi, Kenya

“…The current study is an a priori exploratory secondary analysis of data from a prospective evaluation of the delivery of standard HTS to injured persons seeking emergency care at Kenyatta National Hospital (KNH) [ 18 ]. KNH, located in Nairobi, is the largest public health centre in Kenya.…”

“…Additionally prior work in Western Kenya has found the HIV-positivity rate to be 22.7% in an ED setting [ 17 ]. A 2021 study from Nairobi of ED-based HIV-testing found a prevalence of infection of 11.4% among a cohort of predominately male-injured patients, a prevalence of disease twofold higher than the general population, illustrating the high-risk HIV profile among the ED patients [ 18 ]. The provision of HIVST kits from EDs in high-income settings has been shown to be acceptable to patients and successful in increasing HIV testing but data from populations in Africa at high risk for HIV have not been established [ 6 , 19 ].…”