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

Abstract

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.

Screening for HIV and linkage to care in adolescents: insights from a systematic review of recent interventions in high- versus low- and middle-income settings

“…All of the studies from high-income countries took place in the US (N=14)16,29–41 and will be referred to as US from here forward. The low- and middle-income countries included South Africa (N=6),42–47 Kenya (N=4),48–51 Bangladesh (N=2),52,53 Zambia (N=2),45,54 Liberia (N=1),55 Ethiopia (N=1),56 Malawi (N=1),57 Mozambique (N=1),58 Myanmar (N=1),59 Ghana (N=1),60 Indonesia (N=1),61 Zimbabwe (N=1),62 Uganda (N=1),48 and Haiti (N=1)63 with two studies taking place in more than one country 45,48. The interventions were organized into six categories as defined in Table 3.…”

Early Adopters of Human Immunodeficiency Virus Preexposure Prophylaxis in a Population-based Combination Prevention Study in Rural Kenya and Uganda

“…Younger adults (aged 18-25 years) were less likely to initiate PrEP, in multivariate analysis among individuals who self-identified for PrEP and in univariate analysis among those identified by risk score. Given the rapid increase in HIV prevalence by the time youth (particularly young women) reach their mid-20s in SEARCH communities [28] and in much of southern and eastern Africa [29,30], this is a priority population for HIV prevention efforts. A recent study found that oral PrEP was acceptable to young men and women in Cape Town [31].…”

Barriers to, and emerging strategies for, HIV testing among adolescents in sub-Saharan Africa

“…A study from Kenya and Uganda that used mobile community health campaigns where HTC was offered over 2 weeks, followed by door-to-door HTC reported 88% uptake of HTC among adolescents and young people aged 10 to 24 years (44). This was a significant increase in HTC uptake as only 28% of respondents reported prior HIV testing (44). Although there was high coverage of HTC, the number needed to test to identify one HIV positive adolescent was 88 in Uganda and 23 in Kenya.…”