Does onsite HIV self-testing enhance linkage to care? A case study of HIVST Challenge Fund Project in Kenya

BACKGROUND: Globally, only 81% of people living with HIV know their status (UNAIDS, 2019). In Kenya, 27.5% of men aged 15 to 64 living with HIV do not know their status compared to 17.3% among their female counterparts (KENPHIA, 2018). Knowledge of HIV status is critical to entry and initiation of lifelong ART which ensures quality of care for individuals who are HIV positive. In 2016, WHO published guidelines on HIV self-testing.There is limited data to demonstrated methods that optimize linkage to care. These abstract compares linkage to treatment and care clients who tested on-site and those tested off-site.
METHODS: In 2019, HIVST Challenge Fund Project trained young women and men aged 20 to 34 years as peer educators to distribute HIVST. During the distribution recipients can either opt to test at the point of distribution or take away the kits. Clients willing to test onsite are offered private spaces to test themselves. Clients who test through on-site strategy and report reactive results are immediately offered confirmatory testing by trained HTS providers. For those who are confirmed HIV positive, linkage to ART treatment is facilitated through real-time escort by HTS providers to facilities of choice.
RESULTS: Between April 2020 to October 2020, 18467 people tested onsite. Of these 288 (1.6%) reported positive results, 270 (94%) were confirmed positive and 237 (88 %) were initiated on treatment and care. 7349 opted to test off -site. Of these, 289 (4.0%) reported positive results, 66 (23%) confirmed their results and 44 (67%) were initiated on treatment and care. Persons testing on site were more likely to be initiated on treatment as compared to testing off site (P-Value <0.005).
CONCLUSIONS: On-site HIV self-testing is a promising approach as it enhancing linkage to care and treatment among HIV positive clients. The approach can be tested in a wider scale in rigorous studies.