Study protocol for the: HIV enhanced access testing in emergency department program using a systems analysis and...

Area of Science:

• Public Health
• Implementation Science
• HIV Prevention

Background:

• Undiagnosed HIV infections in Kenya disproportionately affect hard-to-reach populations like men, adolescents, and substance users.
• These populations frequently utilize emergency care, yet emergency departments are underutilized for HIV testing and prevention services (HTS).
• Existing guidelines recommend HTS during emergency encounters, but implementation remains limited.

Purpose of the Study:

• To evaluate the Systems Analysis and Improvement Approach (SAIA) as an implementation strategy.
• To improve HIV screening, testing, and linkage to treatment and prevention from emergency care settings in Kenya.
• To assess the effectiveness, feasibility, and scalability of SAIA for public health programming.

Main Methods:

• A cluster randomized trial involving ten public health facilities in Kenya's Coast region.
• Half of the facilities will be exposed to the SAIA strategy, while the other half will follow usual procedures.
• Evaluation across Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) domains using quantitative, qualitative, and micro-costing data.

Main Results:

• The trial will compare inter-arm HIV testing and prevention services (HTS) cascade outcomes using Poisson regression and mixed-effect models.
• Determinants of program success will be analyzed using framework matrix and coincidence analyses.
• Cost-effectiveness will be assessed using incremental cost-effectiveness ratios and scale-up modeling.

Conclusions:

• Emergency care presents a significant, yet underutilized, opportunity for HIV testing and prevention.
• The SAIA strategy has the potential to improve and expand HTS delivery in emergency settings.
• This trial will provide crucial data on SAIA's effectiveness, feasibility, and scalability in Kenya to inform future public health initiatives.