HIV Testing Uptake and Prevalence Among Adolescents and Adults in a Large Home-Based HIV Testing Program in Western Kenya

Wachira, Juddy; Ndege, Samson; Koech, Julius; Vreeman, Rachel C.; Ayuo, Paula; Braitstein, Paula

doi:10.1097/qai.0b013e3182a14f9e

Cited by 27 publications

(25 citation statements)

References 16 publications

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“…[12–15] Given the low prevalence among their male peers, our data are also consistent with prior research attributing incident HIV among adolescent women, in part, to sexual transmission from older men. [16, 17] These data highlight the importance of engaging adult men in HIV testing and treatment.…”

Section: Discussionsupporting

confidence: 88%

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Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya

Kadede

Ruel

Kabami

et al. 2016

Aids

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Objective We sought to increase adolescent HIV testing across rural communities in east Africa and identify predictors of undiagnosed HIV. Design Hybrid mobile testing. Methods We enumerated 116,326 adolescents (10–24 years) in 32 communities of Uganda and Kenya (SEARCH:NCT01864603): 98,694 (85%) reported stable (≥6 months of prior year) residence. In each community we performed hybrid testing: 2- week multi-disease community health campaign (CHC) that included HIV testing, followed by home-based testing of CHC non-participants. We measured adolescent HIV testing coverage and prevalence, and determined predictors of newly-diagnosed HIV among HIV+ adolescents using multivariable logistic regression. Results 86,421 (88%) stable adolescents tested for HIV; coverage was 86%, 90%, and 88% in early (10–14), mid (15–17) and late (18–24) adolescents, respectively. Self- reported prior testing was 9%, 26%, and 55% in early, mid and late adolescents tested, respectively. HIV prevalence among adolescents tested was 1.6% and 0.6% in Ugandan women and men, and 7.1% and 1.5% in Kenyan women and men, respectively. Prevalence increased in mid-adolescence for women, and late adolescence for men. Among HIV+ adolescents, 58% reported newly-diagnosed HIV. In multivariate analysis of HIV+ adolescents, predictors of newly-diagnosed HIV included male gender (OR=1.97 [95%CI: 1.42–2.73]), Ugandan residence (OR=2.63 [95%CI: 2.08–3.31]), and single status (OR=1.62 [95%CI: 1.23–2.14] vs. married). Conclusions The SEARCH hybrid strategy tested 88% of stable adolescents for HIV, a substantial increase over the 28% reporting prior testing. The majority (57%) of HIV+ adolescents were new diagnoses. Mobile HIV testing for adults should be leveraged to reach adolescents for HIV treatment and prevention.

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Section: Discussionsupporting

confidence: 88%

“…[18] Third, self-reported prior testing is subject to bias, but our findings are consistent with prior research. [10, 15] Lastly, in Uganda and Kenya adolescents >12 years can access HIV testing independent of parental consent; our findings may not be generalizable to settings where parental consent is required up to 18 or 21 years.…”

Section: Discussionmentioning

confidence: 74%

Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya

Kadede

Ruel

Kabami

et al. 2016

Aids

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“…Percentage of participants reporting testing for the first time was included in 20 home HTC studies 5,14,18,29,31,32,38,41–44,63,65,66,68–72,88 , 11 mobile 10,12,68,93–95,97,103,114 , 3 campaign 46,47,77 , 3 key populations 25,115,116 , and 7 facility VCT 12,54,91,93,95,106 , and 5 facility PITC 58,86,88,111,112 . Pooled percentages of first-time testers were higher for community than facility modalities (Fig.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

435

513

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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“…22 In addition, adolescent women may have less access to voluntary HIV counseling and testing services because of barriers such as need for parental consent, unfriendly HIV testing environments in health facilities, lack of knowledge of where and how to get an HIV test, fear of the test itself, and fear of discovering their HIV status. 2–4,26,28,31,32 Failure to know their HIV status before pregnancy is a missed opportunity to adolescents for pregnancy planning, initiation of ART before pregnancy, and active choices about how to reduce the risk of HIV transmission to the unborn baby. This further supports efforts to improve access to HIV testing for adolescents.…”

Section: Discussionmentioning

confidence: 99%

PMTCT Service Uptake Among Adolescents and Adult Women Attending Antenatal Care in Selected Health Facilities in Zimbabwe

Musarandega¹,

Machekano

Chideme³

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Age-disaggregated analyses of prevention of mother-to-child transmission (PMTCT) program data to assess the uptake of HIV services by pregnant adolescent women are limited but are critical to understanding the unique needs of this vulnerable high-risk population.Methods:We conducted a retrospective analysis of patient-level PMTCT data collected from 2011 to 2013 in 36 health facilities in 5 districts of Zimbabwe using an electronic database. We compared uptake proportions for PMTCT services between adolescent (≤19 years) and adult (>19 years) women. Multivariable binomial regression analysis was used to estimate the association of the women's age group with each PMTCT service indicator.Results:The study analyzed data from 22,215 women aged 12–50 years (22.5% adolescents). Adolescents were more likely to present to antenatal care (ANC) before 14 weeks of gestational age compared with older women [adjusted relative risk (aRR) = 1.34; 95% confidence interval: 1.22 to 1.47] with equally low rates of completion of 4 ANC visits. Adolescents were less likely to present with known HIV status (aRR = 0.34; 95% confidence interval: 0.29 to 0.41) but equally likely to be HIV tested in ANC. HIV prevalence was 5.5% in adolescents vs 20.1% in adults. While >84% of both HIV-positive groups received antiretroviral drugs for PMTCT, 44% of eligible adolescents were initiated on antiretroviral therapy vs 51.3% of eligible adults, though not statistically significant.Conclusions:Pregnant adolescents must be a priority for primary HIV prevention services and expanded HIV treatment services among pregnant women to achieve an AIDS-free generation in Zimbabwe and similar high HIV burden countries.

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HIV Testing Uptake and Prevalence Among Adolescents and Adults in a Large Home-Based HIV Testing Program in Western Kenya

Abstract: Sociodemographic and socioeconomic factors were independently associated with HIV testing and prevalence among the age groups. Community-based treatment and prevention strategies will need to consider these factors.

Cited by 27 publications

References 16 publications

Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya

Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

PMTCT Service Uptake Among Adolescents and Adult Women Attending Antenatal Care in Selected Health Facilities in Zimbabwe

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