Expanded HIV Testing Eligibility Increases Detection of HIV Infections

Three counties in western Kenya with the highest HIV burden (Homa Bay, Siaya, and Kisumu) have struggled with identifying new HIV infections. To increase HIV testing services and the detection of HIV infections, 7 high-volume health facilities in western Kenya expanded HIV testing eligibility to now include clients who reported having a negative HIV test:

• In the past 3 to 12 months, or
• In the past 3 months or less if the negative test could not be verified by available health records.

These criteria expand the Kenya MOH guideline, which recommends annual HIV testing for the general population. CDC Kenya conducted a study to determine if the expanded eligibility criteria lead to increased detection of HIV infections.

Data collected and analyzed by CDC Kenya from PEPFAR-supported testing facilities between March and July 2017 showed that of the 68,513 clients who received an HIV test, 740 (1.1%) had a HIV positive test result. Although the rate of positive tests was twice as high among those meeting MOH guidelines versus those meeting expanded criteria (1.9% vs. 0.8%), more than half of all infections were found among clients meeting the expanded criteria — individuals who normally would be ineligible under the current guidelines. The results of this study suggest that expanding HIV testing eligibility (i.e., to include clients tested in the past 3 – 12 months) in high HIV-burden areas could increase access to HIV testing services and timely diagnosis, and accelerate epidemic control. The findings of this analysis was presented at the international 2018 Conference on Retroviruses and Opportunistic Infections and represents CDC Kenya’s continued efforts to identify new ways to intervene effectively.