Background We analyzed HIV testing rates, prevalence of undiagnosed HIV, and predictors of testing in the Kenya AIDS Indicator Survey (KAIS) 2007. Methods KAIS was a nationally representative sero-survey that included demographic and behavioral indicators and testing for HIV, HSV-2, syphilis, and CD4 cell counts in the population aged 15–64 years. We used gender-specific multivariable regression models to identify factors independently associated with HIV testing in sexually active persons. Results Of 19,840 eligible persons, 80% consented to interviews and blood specimen collection. National HIV prevalence was 7.1% (95% CI 6.5–7.7). Among ever sexually active persons, 27.4% (95% CI 25.6–29.2) of men and 44.2% (95% CI 42.5–46.0) of women reported previous HIV testing. Among HIV-infected persons, 83.6% (95% CI 76.2–91.0) were unaware of their HIV infection. Among sexually active women aged 15–49 years, 48.7% (95% CI 46.8–50.6) had their last HIV test during antenatal care (ANC). In multivariable analyses, the adjusted odds ratio (AOR) for ever HIV testing in women ≥35 versus 15–19 years was 0.2 (95% CI: 0.1–0.3; p<0.0001). Other independent associations with ever HIV testing included urban residence (AOR 1.6, 95% CI: 1.2–2.0; p = 0.0005, women only), highest wealth index versus the four lower quintiles combined (AOR 1.8, 95% CI: 1.3–2.5; p = 0.0006, men only), and an increasing testing trend with higher levels of education. Missed opportunities for testing were identified during general or pregnancy-specific contacts with health facilities; 89% of adults said they would participate in home-based HIV testing. Conclusions The vast majority of HIV-infected persons in Kenya are unaware of their HIV status, posing a major barrier to HIV prevention, care and treatment efforts. New approaches to HIV testing provision and education, including home-based testing, may increase coverage. Targeted interventions should involve sexually active men, sexually active women without access to ANC, and rural and disadvantaged populations.
References
[1]
Crepaz N, Lyles CM, Wolitski RJ, Passin WF, Rama SM, et al. (2006) Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS 20: 143–157.
[2]
Bunnell R, Opio A, Musinguzi J, Kirungi W, Ekwaru P, et al. (2008) HIV transmission risk behavior among HIV-infected adults in Uganda: results of a nationally representative survey. AIDS 22: 617–624.
[3]
Allen S, Serufilira A, Bogaerts J, Van de Perre P, Nsengumuremyi F, et al. (1992) Confidential HIV testing and condom promotion in Africa: Impact on HIV and gonorrhea rates. (23): JAMA 268. pp. 3338–43.
[4]
Denison J, O'Reilly K, Schmid G, Kennedy C, Sweat , M (2008) HIV counseling and testing and behavioral risk reduction in developing countries: A meta-analysis, 1990–2005. AIDS and Behavior 12: 363–373.
[5]
Matovu JK (2010) Preventing HIV transmission in married and cohabiting HIV-discordant couples in sub-Saharan Africa through combination prevention. Curr HIV Res 8(6): 430–40.
[6]
Kellerman S, Essajee S (2010) HIV Testing for Children in Resource-Limited Settings: What Are We Waiting For? PLoS Med 7(7): e1000285. doi:10.1371/journal.pmed.1000285.
[7]
Kamb ML, Fishbein M, Douglas JM , Rhodes F, Rogers J, et al. (1998) Efficacy of risk-reduction counseling to prevent Human Immunodeficiency Virus and sexually transmitted diseases: a randomized controlled trial. JAMA 280(13): 1161–1167.
[8]
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365(6): 493–505.
[9]
Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG (2009) Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 373(9657): 48–57.
[10]
Harries AD, Zachariah R, Corbett EL, Lawn SD, Santos-Filho ET, et al. (2010) The HIV-associated tuberculosis epidemic–when will we act? Lancet 375(9729): 1906–19.
[11]
WHO – UNAIDS – UNICEF (2009) Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector. Progress Report 2009. Geneva: World Health Organization.
[12]
Nakanjako D, Kamya M, Kyabayinze D, Mayanja-Kizza H, Freers J, et al. (2006) Acceptance of routine testing for HIV among adult patients at the medical emergency unit at a national referral hospital in Kampala, Uganda. AIDS and Behavior 11, 753–758:
[13]
Kalichman SC, Simbayi LC (2003) HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sexually Transmitted Infections 79, 442–447:
[14]
Creek TL, Ntumy R, Seipone K, Smith M, Mogodi M, et al. (2007) Successful introduction of routine opt-out HIV testing in antenatal care in Botswana. Journal of Acquired Immune Deficiency Syndrome 45, 102–107:
[15]
Wanyenze R, Kamya M, Liechty CA, Ronald A, Guzman DJ, et al. (2006) HIV counseling and testing practices at an urban hospital in Kampala, Uganda. AIDS Behav 10: 361–367.
[16]
Marum E, Taegtmeyer M, Chebet K (2006) Scale-up of voluntary HIV testing and counseling in Kenya. JAMA 296: 859–862.
[17]
Negin J, Wariero J, Mutuo P, Jan S, Pronyk P (2009) Feasibility, acceptability and cost of home-based HIV testing in rural Kenya. Trop Med Int Health 14(8): 849–855.
[18]
NASCOP (2009) 2007 Kenya AIDS Indicator Survey: Final Report. Nairobi: National AIDS/STI Control Programme (NASCOP).
[19]
Rutstein SO, Johnson K (2004) The DHS wealth index, DHS Comparative Reports No. 6, CalvertonMD: ORC Macro.
[20]
KNBS (2006) Revised Population Projections for Kenya 2000–2010, Nairobi: Kenya National Bureau of Statistics.
[21]
NASCOP (2008) National Guidelines for HIV Testing and Counselling in Kenya. Nairobi: National AIDS/STI Control Programme (NASCOP).
[22]
NASCOP (2001) National Guidelines for HIV Testing and Counselling in Kenya. Nairobi: National AIDS/STI Control Programme (NASCOP).
[23]
CBS Kenya, ORC Macro (2004) Kenya Demographic and Health Survey 2003. Calverton, Maryland: Central Bureau of Statistics, Kenya Ministry of Health and ORC Macro.
[24]
Fox MA (2010) The social determinants of HIV serostatus in Sub-Saharan Africa: an inverse relationship between poverty and HIV? Public Health Reports Suppl. 4, 125: 16–24.
[25]
Were W, Mermin J, Bunnell R, Ekwaru JP, Kaharuza F (2003) Home-based model for HIV voluntary counselling and testing. Lancet. 361: 611.
[26]
Menzies N, Abang B, Wanyenze R, Nuwaha F, Mugisha B, et al. (2009) The costs and effectiveness of four HIV counseling and testing strategies in Uganda. AIDS 23(3): 395–401.
[27]
KNBS , ICF Macro (2010) Kenya Demographic and Health Survey 2008–09. Calverton, Maryland: Kenya National Bureau of Statistics and ICF Macro.
[28]
Kim AA, Hallet T, Stover J, Gouws E, Musinguzi J, et al. (2011) Estimating HIV Incidence among Adults in Kenya and Uganda: A Systematic Comparison of Multiple Methods. PLoS ONE 6(3): e17535. doi:10.1371/journal.pone.
[29]
WHO – UNAIDS – UNICEF (2010) Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector. Progress Report 2010. Geneva: World Health Organization. 15: Available: http://www.who.int/hiv/pub/2010progressr？eport/report/en/index.html. Accessed 2012 Apr.
[30]
UNAIDS , WHO (2007) AIDS Epidemic Update 2007. Geneva: Joint United Nations Programme on HIV/AIDS and World Health Organization. 15: Available http://www.unaids.org/en/media/unaids/co？ntentassets/dataimport/pub/epislides/200？7/2007_epiupdate_en.pdf Accessed 2012 Apr.
