Sunday, March 13, 2016

The Status of HIV Testing and Counseling in Kenya: Results from a Nationally Representative Population-Based Survey

HIV testing and counseling (HTC) is essential for successful HIV prevention and treatment programs. The national target for HTC is 80% of the adult population in Kenya. Population-based data to measure progress towards this HTC target are needed to assess the country’s changing needs for HIV prevention and treatment.

In 2012–2013, we conducted a national HIV survey among Kenyans aged 18 months to 64 years. Respondents aged 15–64 years were administered a questionnaire that collected information on demographics, HIV testing behavior, and self-reported HIV status. Blood samples were collected for HIV testing in a central laboratory. Participants were offered home-based testing and counseling to learn their HIV status in the home and point-of-care CD4 testing if they tested HIV-positive.

Of 13,720 adults who were interviewed, 71.6% [95% confidence interval (CI): 70.2 to 73.1] had been tested for HIV. Among those, 56.1% (95% CI: 52.8 to 59.4) had been tested in the past year, 69.4% (95% CI: 68.0 to 70.8) had been tested more than once, and 37.2% (95% CI: 35.7 to 38.8) had been tested with a partner. Fifty-three percent (95% CI: 47.6 to 58.7) of HIV-infected persons were unaware of their infection. Overall 9874 (72.0%) of participants accepted home-based HIV testing and counseling; 4.1% (95% CI: 3.3 to 4.9) tested HIV-positive, and of those, 42.5% (95% CI 31.4 to 53.6) were in need of immediate treatment for their HIV infection but not receiving it.

HIV testing rates have nearly reached the national target for HTC in Kenya. However, knowledge of HIV status among HIV-infected persons remains low. HTC needs to be expanded to reach more men and couples, and strategies are needed to increase repeat testing for persons at risk for HIV infection.

Unawareness of HIV Infection Among HIV-Infected Persons Aged 15–64 Years by Select Characteristics, Kenya AIDS Indicator Survey 2012
Unaware of HIV

Select Characteristics Weighted % (95% CI)Unweighted, NInfection Unweighted, n
Total64834353.1 (47.6 to 58.7)
 Male19312062.0 (53.4 to 70.5)
 Female45522347.8 (42.1 to 53.4)
Age category, yrs
 15–24755982.0 (72.3 to 91.7)
 25–3420912158.9 (50.5 to 67.4)
 35–441988942.2 (33.4 to 51.0)
 45–541265345.1 (34.6 to 55.6)
 55–64*402148.5 (31.2 to 65.8)
Marital status
 Never married/never cohabited584477.7 (66.4 to 88.9)
 Ever widowed1655231.5 (24.1 to 39.0)
 Divorced/separated835364.6 (51.8 to 77.4)
 Married/cohabiting34219456.1 (47.9 to 64.3)
Highest educational attainment
 No primary*432661.1 (44.1 to 78.2)
 Incomplete primary*462349.1 (32.9 to 65.4)
 Complete primary22312356.0 (47.2 to 64.7)
 Secondary or higher33517051.2 (44.5 to 57.9)
Wealth index
 Poorest975149.1 (36.8 to 61.5)
 Second1537549.8 (37.4 to 62.2)
 Middle1376846.8 (36.0 to 57.5)
 Fourth1588455.7 (46.0 to 65.3)
 Richest1026465.2 (54.9 to 75.4)
 Rural37319251.0 (43.6 to 58.3)
 Urban27515156.0 (47.5 to 64.5)
 Nairobi674060.0 (47.5 to 72.4)
 Central603256.3 (41.2 to 71.4)
 Coast664059.1 (44.2 to 74.0)
 Eastern754153.6 (37.6 to 69.7)
 Nyanza24211649.7 (40.1 to 59.3)
 Rift Valley794756.0 (40.1 to 72.0)
 Western592746.7 (31.2 to 62.2)
Ever pregnant
 No*322682.5 (70.1 to 95.0)
 Yes40018645.7 (39.7 to 51.7)
Currently pregnant
 No37419149.9 (43.6 to 56.2)
Lifetime number of partners
 11287151.0 (40.3 to 61.6)
 2–323612554.8 (47.9 to 61.6)
 4–51054849.1 (37.8 to 60.4)
 6–9*452453.7 (36.4 to 71.0)
 10 or more582950.7 (36.7 to 64.8)
 Do not know623451.2 (36.4 to 66.0)
Condom use with most recent sexual partner in the past 12 mo§
 No29120267.7 (60.3 to 75.1)
 Yes1796137.1 (29.1 to 45.2)
Symptoms of sexually transmitted infections in past 12 mo
 No57431354.4 (48.6 to 60.3)
 Yes743042.9 (30.0 to 55.9)
Ever been tested for HIV
 Yes57426946.3 (40.5 to 52.1)
When was the last HIV test?
 <3 mo ago1365639.0 (28.9 to 49.2)
 3–5 mo ago914850.5 (37.5 to 63.5)
 6–11 mo ago784458.0 (44.1 to 71.9)
 1–2 yrs ago1156253.7 (42.9 to 64.4)
 >2 yrs ago1445236.8 (27.2 to 46.4)
Participants with missing values were removed from this analysis.
*Denominator between 25 and 49 observations; estimates may be unreliable.
Among women only.
Due to small denominator (<25 observations), estimates are unreliable and have been suppressed.
§Among persons who had sex in the past 12 months.

Full article at:

By:  Anne Ng’ang’a, BDS, MSc,* Wanjiru Waruiru, MBA, MPH, Carol Ngare, BA,* Victor Ssempijja, MS, Thomas Gachuki, MSc,§ Inviolata Njoroge, BS,|| Patricia Oluoch, MPH, Davies O. Kimanga, MBChB, MMed,* William K. Maina, MBChB, MPH,* Rex Mpazanje, MD, and Andrea A. Kim, PhD, MPH, for the KAIS Study Group
*National AIDS and Sexually Transmitted Infection (STI) Control Programme, Ministry of Health, Nairobi, Kenya
Global Health Sciences, University of California, San Francisco, San Francisco, CA
Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
§National Public Health Laboratory Services, Ministry of Health, Kenya
||Liverpool Voluntary Counselling and Testing, Nairobi, Kenya
National Public Health Laboratory Services, Ministry of Health, Nairobi, Kenya
World Health Organization, Nairobi, Kenya
Correspondence to: Anne Ng’ang’a, BDS, MSc, National AIDS and Sexually Transmitted Infection Control Programme, Ministry of Health, Kenyatta National Hospital Grounds, 19361-00202 Nairobi, Kenya 

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