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Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya
Kevin Kadede1, Theodore Ruel, Jane Kabami
1aCentre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya bDivision of Infectious Disease and Global Health, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA cMakerere University-University of California Research Collaboration, Kampala, Uganda dDepartment of Obstetrics, Gynecology and Reproductive Sciences eDivision of HIV, Infectious Diseases and Global Medicine fCenter for AIDS Prevention Studies, University of California San Francisco (UCSF), San Francisco gUniversity of California Berkeley School of Public Health, Berkeley, California, USA hDepartment of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Objective:
We sought to increase adolescent HIV testing across rural communities in east Africa and identify predictors of undiagnosed HIV.
Design:
Hybrid mobile testing.
Methods:
We enumerated 116 326 adolescents (10-24 years) in 32 communities of Uganda and Kenya (
Search:
NCT01864603): 98 694 (85%) reported stable (≥6 months of prior year) residence. In each community we performed hybrid testing: 2-week multidisease community health campaign that included HIV testing, followed by home-based testing of community health campaign nonparticipants. We measured adolescent HIV testing coverage and prevalence, and determined predictors of newly diagnosed HIV among HIV-infected adolescents using multivariable logistic regression.
Results:
A total of 86 421 (88%) stable adolescents tested for HIV; coverage was 86, 90, and 88% in early (10-14), mid (15-17), and late (18-24) adolescents, respectively. Self-reported prior testing was 9, 26, and 55% in early, mid, and late adolescents tested, respectively. HIV prevalence among adolescents tested was 1.6 and 0.6% in Ugandan women and men, and 7.1 and 1.5% in Kenyan women and men, respectively. Prevalence increased in mid-adolescence for women and late adolescence for men. Among HIV-infected adolescents, 58% reported newly diagnosed HIV. In multivariate analysis of HIV-infected adolescents, predictors of newly diagnosed HIV included male sex [odds ratio (OR) = 1.97 (95% confidence interval (CI): 1.42-2.73)], Ugandan residence [OR = 2.63 (95% CI: 2.08-3.31)], and single status [OR = 1.62 (95% CI: 1.23-2.14) vs. married)].
Conclusions:
The SEARCH hybrid strategy tested 88% of stable adolescents for HIV, a substantial increase over the 28% reporting prior testing. The majority (57%) of HIV-infected adolescents were new diagnoses. Mobile HIV testing for adults should be leveraged to reach adolescents for HIV treatment and prevention.
