Surveillance of HIV assisted partner services using routine health information systems in Kenya

Abstract

BackgroundThe utilization of routine health information systems (HIS) for surveillance of assisted partner services (aPS) for HIV in sub-Saharan is sub-optimal, in part due to poor data quality and limited use of information technology. Consequently, little is known about coverage, scope and quality of HIV aPS. Yet, affordable electronic data tools, software and data transmission infrastructure are now widely accessible in sub-Saharan Africa.MethodsWe designed and implemented a cased-based surveillance system using the HIV testing platform in 18 health facilities in Kenya. The components of this system included an electronic HIV Testing and Counseling (HTC) intake form, data transmission on the Global Systems for Mobile Communication (GSM), and data collection using the Open Data Kit (ODK) platform. We defined rates of new HIV diagnoses, and characterized HIV-infected cases. We also determined the proportion of clients who reported testing for HIV because a) they were notified by a sexual partner b) they were notified by a health provider, or c) they were informed of exposure by another other source. Data collection times were evaluated.ResultsAmong 4351 clients, HIV prevalence was 14.2 %, ranging from 4.4–25.4 % across facilities. Regardless of other reasons for testing, only 107 (2.5 %) of all participants reported testing after being notified by a health provider or sexual partner. A similar proportion, 1.8 % (79 of 4351), reported partner notification as the only reason for seeking an HIV test. Among 79 clients who reported HIV partner services as the reason for testing, the majority (78.5 %), were notified by their sexual partners. The majority (52.8 %) of HIV-infected patients initiated their HIV testing, and 57.2 % tested in a Voluntary Counseling and Testing (VCT) site co-located in a health facility. Median time for data capture was 4 min (IQR: 3–15), with a longer duration for HIV-infected participants, and there was no reported data loss.ConclusionaPS surveillance using new technologies is feasible, and could be readily expanded into HIV registries in Kenya and other sub-Saharan countries. Partner services are under-utilized in Kenya but further documentation of coverage and implementation gaps for HIV and aPS services is required.

“HIV Changed My Life Forever”: An Illustrative Case of a Sub-Saharan African Migrant Woman Living with HIV in Belgium

“…Voluntary testing of HIV status as indicated in this illustrative case remains salient in the diagnosis, treatment and prevention of HIV, consistent with previous studies [ 44 , 45 , 46 ]. Had the participant not gone for testing, she might not have known that she was HIV-infected and taken measures to begin early medical care and follow-up.…”

Implementation experiences and insights from the scale‐up of an HIV assisted partner notification intervention in Central Asia

“…Altogether, 52% of partners tested through APN were women, and the proportion testing positive was similar to men (9.1% vs. 8.1%). Identifying and testing women at risk for HIV can be challenging in epidemics concentrated among PWID, where women face multiple and intersecting risks, including high levels of stigma/discrimination, lack of access to testing and HIV‐related prevention and care, and transmission risks from sexual partner(s) who inject, exchange of sex for drugs and risks associated with shared injecting equipment . PWID‐focused HIV case‐finding interventions may also miss non‐injecting female sexual partners of male PWID, especially those who are not spouses.…”

“…This would enable evaluations of which strategies are working best, what types of notifications are preferred, and allow additional research – including cost‐effectiveness studies – to be embedded within routine programming. Similar monitoring systems have been successfully developed for APN services in Kenya . Finally, public sector AIDS Centers and other partners should be encouraged to recognize the value of involving KP‐focused NGOs in conducting APN among PWID and other KPs because of their unique position in communities, and their ability to effectively provide services to sexual and injecting partners (including non‐spousal partners and those who do not identify as KP).…”

The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention

“…In Kenya, a PNS surveillance system was created from HIV registries to determine the proportion of individuals who sought HIV testing because they were notified of potential HIV exposure by a sexual partner, by a health provider or some other source. This system allowed the Ministry of Health to determine the coverage of assisted PNS and is now being used to identify populations and areas in need of targeted scale‐up .…”