Expanded eligibility for HIV testing increases HIV diagnoses-A cross-sectional study in seven health facilities in western Kenya

Homa Bay, Siaya, and Kisumu counties in western Kenya have the highest estimated HIV prevalence (16.3-21.0%) in the country, and struggle to meet program targets for HIV testing services (HTS). The Kenya Ministry of Health (MOH) recommends annual HIV testing for the general population. We assessed t...

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Published in:PloS one 2019-12, Vol.14 (12), p.e0225877
Main Authors: Joseph, Rachael H, Musingila, Paul, Miruka, Fredrick, Wanjohi, Stella, Dande, Caroline, Musee, Polycarp, Lugalia, Fillet, Onyango, Dickens, Kinywa, Eunice, Okomo, Gordon, Moth, Iscah, Omondi, Samuel, Ayieko, Caren, Nganga, Lucy, Zielinski-Gutierrez, Emily, Muttai, Hellen, De Cock, Kevin M
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adolescent
Adult
Age
AIDS
Antiretroviral drugs
Biology and Life Sciences
Bivariate analysis
Clients
Counseling services
Counties
Criteria
Cross-Sectional Studies
Diagnosis
Disease control
Disease prevention
Eligibility Determination
Epidemics
Health care facilities
Health Facilities
Health risks
Health services
HIV
HIV Infections - diagnosis
HIV Infections - epidemiology
HIV-1
Human immunodeficiency virus
Humans
Infections
Kenya - epidemiology
Local government
Medical diagnosis
Medical tests
Medicine and health sciences
Middle Aged
Patients
People and Places
Retrospective Studies
Tuberculosis
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cited_by cdi_FETCH-LOGICAL-c526t-2902aa8dd1140d6f1ce0138326862efae34dd8d5e793e57182d68fb0b5eadab43
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container_issue 12
container_start_page e0225877
container_title PloS one
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creator Joseph, Rachael H
Musingila, Paul
Miruka, Fredrick
Wanjohi, Stella
Dande, Caroline
Musee, Polycarp
Lugalia, Fillet
Onyango, Dickens
Kinywa, Eunice
Okomo, Gordon
Moth, Iscah
Omondi, Samuel
Ayieko, Caren
Nganga, Lucy
Zielinski-Gutierrez, Emily
Muttai, Hellen
De Cock, Kevin M
description Homa Bay, Siaya, and Kisumu counties in western Kenya have the highest estimated HIV prevalence (16.3-21.0%) in the country, and struggle to meet program targets for HIV testing services (HTS). The Kenya Ministry of Health (MOH) recommends annual HIV testing for the general population. We assessed the degree to which reducing the interval for retesting to less than 12 months increased diagnosis of HIV in outpatient departments (OPD) in western Kenya. We conducted a retrospective analysis of routinely collected program data from seven high-volume (>800 monthlyOPD visits) health facilities in March-December, 2017. Data from persons ≥15 years of age seeking medical care (patients) in the OPD and non-care-seekers (non-patients) accompanying patients to the OPD were included. Outcomes were meeting MOH (routine) criteria versus criteria for a reduced retesting interval (RRI) of 12 months, and 5% (4,832) met other criteria. The remaining 80% (74,033) met criteria for a RRI of < 12 months. In total 1.3% (1,185) of clients had a positive test. Although the percent yield was over 2-fold higher among those meeting routine criteria (2.4% vs. 1.0%; p
doi_str_mv 10.1371/journal.pone.0225877
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The Kenya Ministry of Health (MOH) recommends annual HIV testing for the general population. We assessed the degree to which reducing the interval for retesting to less than 12 months increased diagnosis of HIV in outpatient departments (OPD) in western Kenya. We conducted a retrospective analysis of routinely collected program data from seven high-volume (&gt;800 monthlyOPD visits) health facilities in March-December, 2017. Data from persons ≥15 years of age seeking medical care (patients) in the OPD and non-care-seekers (non-patients) accompanying patients to the OPD were included. Outcomes were meeting MOH (routine) criteria versus criteria for a reduced retesting interval (RRI) of &lt;12 months, and HIV test result. STATA version 14.2 was used to calculate frequencies and proportions, and to test for differences using bivariate analysis. During the 9-month period, 119,950 clients were screened for HIV testing eligibility, of whom 79% (94,766) were eligible and 97% (92,153) received a test. Among 92,153 clients tested, the median age was 28 years, 57% were female and 40% (36,728) were non-patients. Overall, 20% (18,120) of clients tested met routine eligibility criteria: 4% (3,972) had never been tested, 10% (9,316) reported a negative HIV test in the past &gt;12 months, and 5% (4,832) met other criteria. The remaining 80% (74,033) met criteria for a RRI of &lt; 12 months. In total 1.3% (1,185) of clients had a positive test. Although the percent yield was over 2-fold higher among those meeting routine criteria (2.4% vs. 1.0%; p&lt;0.001), 63% (750) of all HIV infections were found among clients tested less than 12 months ago, the majority (81%) of whom reported having a negative test in the past 3-12 months. Non-patients accounted for 45% (539) of all HIV-positive persons identified. Percent yield was higher among non-patients as compared to patients (1.5% vs. 1.2%; p-value = &lt;0.001) overall and across eligibility criteria and age categories. The majority of HIV diagnoses in the OPD occurred among clients reporting a negative HIV test in the past 12 months, clients ineligible for testing under the current MOH guidelines. Nearly half of all HIV-positive individuals identified in the OPD were non-patients. 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eligibility for HIV testing increases HIV diagnoses-A cross-sectional study in seven health facilities in western Kenya</title><author>Joseph, Rachael H ; Musingila, Paul ; Miruka, Fredrick ; Wanjohi, Stella ; Dande, Caroline ; Musee, Polycarp ; Lugalia, Fillet ; Onyango, Dickens ; Kinywa, Eunice ; Okomo, Gordon ; Moth, Iscah ; Omondi, Samuel ; Ayieko, Caren ; Nganga, Lucy ; Zielinski-Gutierrez, Emily ; Muttai, Hellen ; De Cock, Kevin M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-2902aa8dd1140d6f1ce0138326862efae34dd8d5e793e57182d68fb0b5eadab43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>AIDS</topic><topic>Antiretroviral drugs</topic><topic>Biology and Life Sciences</topic><topic>Bivariate analysis</topic><topic>Clients</topic><topic>Counseling 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USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Joseph, Rachael H</au><au>Musingila, Paul</au><au>Miruka, Fredrick</au><au>Wanjohi, Stella</au><au>Dande, Caroline</au><au>Musee, Polycarp</au><au>Lugalia, Fillet</au><au>Onyango, Dickens</au><au>Kinywa, Eunice</au><au>Okomo, Gordon</au><au>Moth, Iscah</au><au>Omondi, Samuel</au><au>Ayieko, Caren</au><au>Nganga, Lucy</au><au>Zielinski-Gutierrez, Emily</au><au>Muttai, Hellen</au><au>De Cock, Kevin M</au><au>Raifman, Julia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Expanded eligibility for HIV testing increases HIV diagnoses-A cross-sectional study in seven health facilities in western Kenya</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-12-27</date><risdate>2019</risdate><volume>14</volume><issue>12</issue><spage>e0225877</spage><pages>e0225877-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Homa Bay, Siaya, and Kisumu counties in western Kenya have the highest estimated HIV prevalence (16.3-21.0%) in the country, and struggle to meet program targets for HIV testing services (HTS). The Kenya Ministry of Health (MOH) recommends annual HIV testing for the general population. We assessed the degree to which reducing the interval for retesting to less than 12 months increased diagnosis of HIV in outpatient departments (OPD) in western Kenya. We conducted a retrospective analysis of routinely collected program data from seven high-volume (&gt;800 monthlyOPD visits) health facilities in March-December, 2017. Data from persons ≥15 years of age seeking medical care (patients) in the OPD and non-care-seekers (non-patients) accompanying patients to the OPD were included. Outcomes were meeting MOH (routine) criteria versus criteria for a reduced retesting interval (RRI) of &lt;12 months, and HIV test result. STATA version 14.2 was used to calculate frequencies and proportions, and to test for differences using bivariate analysis. During the 9-month period, 119,950 clients were screened for HIV testing eligibility, of whom 79% (94,766) were eligible and 97% (92,153) received a test. Among 92,153 clients tested, the median age was 28 years, 57% were female and 40% (36,728) were non-patients. Overall, 20% (18,120) of clients tested met routine eligibility criteria: 4% (3,972) had never been tested, 10% (9,316) reported a negative HIV test in the past &gt;12 months, and 5% (4,832) met other criteria. The remaining 80% (74,033) met criteria for a RRI of &lt; 12 months. In total 1.3% (1,185) of clients had a positive test. Although the percent yield was over 2-fold higher among those meeting routine criteria (2.4% vs. 1.0%; p&lt;0.001), 63% (750) of all HIV infections were found among clients tested less than 12 months ago, the majority (81%) of whom reported having a negative test in the past 3-12 months. Non-patients accounted for 45% (539) of all HIV-positive persons identified. Percent yield was higher among non-patients as compared to patients (1.5% vs. 1.2%; p-value = &lt;0.001) overall and across eligibility criteria and age categories. The majority of HIV diagnoses in the OPD occurred among clients reporting a negative HIV test in the past 12 months, clients ineligible for testing under the current MOH guidelines. Nearly half of all HIV-positive individuals identified in the OPD were non-patients. Our findings suggest that in the setting of a generalized HIV epidemic, retesting persons reporting an HIV-negative test in the past 3-12 months, and routine testing of non-patients accessing the OPD are key strategies for timely diagnosis of persons living with HIV.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31881031</pmid><doi>10.1371/journal.pone.0225877</doi><orcidid>https://orcid.org/0000-0002-3371-7740</orcidid><orcidid>https://orcid.org/0000-0002-9777-1391</orcidid><orcidid>https://orcid.org/0000-0003-4644-1568</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
ispartof PloS one, 2019-12, Vol.14 (12), p.e0225877
issn 1932-6203
1932-6203
language eng
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source Publicly Available Content Database; PubMed Central
subjects Acquired immune deficiency syndrome
Adolescent
Adult
Age
AIDS
Antiretroviral drugs
Biology and Life Sciences
Bivariate analysis
Clients
Counseling services
Counties
Criteria
Cross-Sectional Studies
Diagnosis
Disease control
Disease prevention
Eligibility Determination
Epidemics
Health care facilities
Health Facilities
Health risks
Health services
HIV
HIV Infections - diagnosis
HIV Infections - epidemiology
HIV-1
Human immunodeficiency virus
Humans
Infections
Kenya - epidemiology
Local government
Medical diagnosis
Medical tests
Medicine and health sciences
Middle Aged
Patients
People and Places
Retrospective Studies
Tuberculosis
title Expanded eligibility for HIV testing increases HIV diagnoses-A cross-sectional study in seven health facilities in western Kenya
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