HIV Testing Rates, Frequency Leave Room for Improvement in Kenya

As of 2017, 184,718 young adult women and men were living with HIV in Kenya, for an annual prevalence of 2.61% and 1.34%, respectively, with overall numbers showing a 3 times greater risk among young women than young men. Female sex workers are a subset of the population at higher risk of contracting HIV, especially adolescent girls and young women (AGYW) aged 14 to 24 years.

According to study results published last week in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), AGYW are linked to 23.7% of new HIV infections in Kenya—most being undiagnosed—despite accounting for just 18.4% of the adult population in the country. And the city of Mombasa, Kenya, is considered a hotspot in the HIV/AIDS epidemic in sub-Saharan Africa. Together with Nairobi, HIV diagnoses there jumped from 4707 in 2013 to 7145 in 2015—an almost 52% increase in just 2 years.

The JAIDS investigators noted that “the consequence of undiagnosed HIV among AGYW is untreated HIV, thus limiting the individual health and the population-level transmission benefits of effective antiretroviral treatment.” Using data on Mombasa, they looked into how venue-based (ie, location-based) testing might be used to increase the overall HIV testing and detection rate of AGYW who self-classify as sex workers, addressing potential barriers to access to care in the process (eg, stigma, costs, conflict with school/work schedule).

Their surveyed population consisted of 2 groups of cisgender females aged 14 to 24 years: young females who sell sex (n = 365) and those who did not (n = 828), all with at least 1 occurrence of vaginal or anal sex in their lifetime. The hotspots they investigated consisted of locations that female sex workers and non—sex workers frequented, such as schools, shopping malls, and parks. Outreach workers and peer educations conducted, with consent, in-person interviews, as well as on-site HIV testing in the form of collected dried blood specimens, which were used to confirm disease status.

Overall, 89.3% of the AGYW consented to be tested, and their median age was 19 years (interquartile range, 17-21 years). Among the study cohorts, 10.1% of the sex workers and 3.6% of the non—sex workers tested positive for HIV (P <.001), but just 27.0% and 30.0%, respectively, knew their status (P = .79).

For the hotspots studied, the study authors estimated that 627 AGYW (range, 310-1081) remained undiagnosed. Accounting for the AGYW who refused to provide their HIV status when they were approached at a hotspot, the investigators determined that hotspot-based testing could precipitously reduce the undiagnosed population from 71.6% (95% CI, 59.3%-82.0%) to 20.2% (95% CI, 17.6%-23.0%). That’s a close to 72% reduction. However, overall, 74.0% of AGYW sex workers and 84.2% of non—sex workers (P <.001) did not know HIV services were available.

“Our findings suggest hotspot-based testing strategies represent an untapped opportunity to increase HIV diagnoses among AGYW living with HIV,” the authors noted. “Recommendations for testing—across key and other priority populations such as AGYW&mdash;include the provision of a ‘safe space,’ testing free of coercion, and employing approaches that address stigma and discrimination related to sex work in general and to sexual activity among youth.”

One positive outcome is the high rates of those with an HIV diagnosis who claimed to be on HIV treatment at the time they were interviewed: 80.0% of sex workers and 77.8% of non—sex workers. In addition, an overall 71.4% self-reported an HIV test in the previous year, and this number was higher among sex workers than non–sex workers (85.4% vs 65.4%; P <.001).

Reference

Ma H, Wang L, Gichangi P, et al. Venue-based HIV testing at sex work hotspots to reach adolescent girls and young women living with HIV: a cross-sectional study in Mombasa, Kenya [published online April 6, 2020]. J Acquir Immune Defic Syndr. doi: 10.1097/QAI.0000000000002363.