Routine program data indicates positivity rates under 2 from HIV testing services HTS at sites supported by Centre for Health Solutions-Kenya in Central Kenya. Achieving the UNAIDS 95:95:95 goals requires continuous identification of people living with HIV in an environment of diminishing resources.
We assessed non-clinical and clinical characteristics of persons who tested HIV-positive aimed at improving the process of HTS through Provider-Initiated HIV Testing Counseling PITC.
We conducted a retrospective analysis of routine PITC program data collected between October 2018 and September 2019 from six health facilities located in three counties in central Kenya. Stratification was based on county and facility volume. A multivariable logistic regression model clustered adjusted for facility using robust standard errors was used to determine predictors of a positive HIV result.
The total sample was 80693 with an overall positivity rate of 1.2. Most 65.5 were female and 6.1 were15 years. Most clients 55464 68.7 had previously tested for HIV. Client characteristics associated with a higher odds of positivity on multivariable analysis included: being female adjusted odds ratio aOR 1.27 95 confidence interval CI 1.031.57 adults 15 years and above compared to children15 years divorced and married polygamous compared to married monogamous aOR 3.98 95 CI 2.127.29 and aOR 2.41 95 CI 1.483.94 respectively clients testing for the first time compared to repeat testers in less than 12 months aOR 1.39 95 CI 1.271.51. Similarly repeat testers in more than 12 months compared to repeat testers in less than 12 months aOR 1.90 95 CI 1.552.32 presumptive TB clients compared to those without signs of TB aOR 16.25 95 CI 10.6324.84. Clients tested at inpatient departments IPD were more likely to get a positive HIV result compared to those tested at outpatient departments OPD and other departments.
We found that client characteristics such as age maritalrnstatus HIV test entry point frst-time test repeat testrnafter 12 months and TB status are potentially predictivernof the outcome of HIV case fnding in PITC settings inrncentral Kenya. Te factors highlighted as determinants ofrna positive HIV test in this study can be used to developrna screening tool to target high-risk clients for HTS inrnsimilar settings. To the best of our knowledge no similarrnstudy using a large dataset from the three central Kenyarncounties has been done. Te researchers intend to buildrna prognostic risk model based on the multivariate modelrnthat will be trained tested calibrated and validated tornhave a predictive capability to classify HTS clients asrneither low medium or high risk in low HIV prevalencernsettings.