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HIV testing efficiency has progressively improved in Kenya, 2018-2020

Title
HIV testing efficiency has progressively improved in Kenya, 2018-2020
Presenter
John Njenga
Authors
J. Njenga * (1), J. Mwangi (1), S. Anangwe (2), C. Mbaire (3), P. Yegon (4), M. Mugambi (5), D. Kimanga (1).
Institutions
(1) Division of Global HIV & TB (DGHT), Centre for Disease Control (CDC), Nairobi, Kenya, (2) Military HIV Research Program/Walter Reed Army Institute of Research (MHRP/WRAIR), Nairobi, Kenya, (3) PEPFAR Coordination Office, Nairobi, Kenya, (4) U.S. Agency for International Development, Nairobi, Kenya, (5) National AIDS Control and Prevention Program (NASCOP), Ministry of Health, Nairobi, Kenya

BACKGROUND: With the reducing pool of people living with HIV who do not know their status, Kenya has employed testing strategies aimed at reducing the number of tests required to identify a positive case, including conducting HIV risk assessment prior to testing. The impact of these strategies has not been assessed. We provide a temporal trend analysis of testing efficiency over the last 3 years in Kenya.
METHODS: We used aggregate testing data reported from 2018 to 2020 from 3772 facilities covering 42 out of the 47 counties under the PEPFAR program in Kenya. Calendar time was stratified into quarterly time periods. We conducted time trend analysis of HIV-1 testing efficiency, defined as the number of individuals needed to be tested to identify 1,000 HIV-1 cases using linear regression. We assessed if these trends differed significantly by age and sex.
RESULTS: Overall, the number of HIV tests needed to identify 1,000 HIV positive cases reduced from 117,877 in quarter 1 of 2018 to 38,708 in quarter 4 of 2020 at a rate of 6,255 per quarter, (test for trend, p=0.0001). For children aged below 15 years, testing efficiency increased from 309,044 in quarter 1 of 2018 to 64,831 in quarter 4 of 2020 at a rate of 20,514 tests per quarter (test of trend, p=0.0001) while among adults aged 15 years and above, testing efficiency increased from 106,775 tests to 5,591 over the same period (test of trend, p=0.0001). Trends in children and adults differed significantly (p=0.0001). Testing efficiency among male increased from 160,191 tests to 35,952 at a rate of 8,944 per quarter (test of trend, p=0.0002) while efficiency among female increased from 100,051 to 40,189 at a rate of 5,006 (test of trend, p=0.0001). Trends in males and females differed significantly (p=0.0001).
CONCLUSIONS: Kenya progressively improved testing efficiency between 2018 and 2020 across different sub populations albeit at different rates. Though the rate of reduction was high among children, the number needed to test remained relatively high; there is need for continued review of existing strategies to further bring this number down.