Predictors of first time and repeat HIV testing among HIV positive individuals in Kenya

Abstract

Introduction: Kenya’s coverage of HIV testing has doubled over the last decade, yet approximately half of HIV positive individuals were unaware of their infection in 2012. HIV testing in resource-limited settings can be most effective in diagnosing unknown HIV positive individuals through frequent and strategic testing in populations at high risk of infection. An assessment of the frequency of testing and the predictors of first time and repeat testing is critical for monitoring the effectiveness of testing strategies in hard-to-reach populations. Methods: We conducted a cross-sectional analysis of adults aged ≥18 who tested HIV-positive at 4 HIV testing and counseling clinics in Kenya from February 2015 to February 2016, we categorized individuals based on testing history and used Wilcoxon rank-sum test to assess differences in, intervals between the most recent and current HIV test among repeat testers (intertest interval), and logistic regression to determine characteristics associated with first-time and repeat testing. Results: Among 1136 people testing HIV-positive, 336 (30%) had never tested for HIV and 70% had tested before, of whom 208 (26%) had previously tested positive. Among previously negative repeat testers, the median intertest interval was 414 days for key populations (IQR=179-1072) and 538 days for the general population (IQR=228-1299) [p=0.0936]. Compared to previously negative repeat testers, being a first-time tester was associated with being age ≥40 years (vs. 18-24 years; adjusted odds ratio [aOR]=2.36, 95% confidence interval [CI]=1.5-3.68), male (vs. female; 1.89, IQR=1.43-2.51), and being tested through provider-initiated testing and counseling (vs. client-initiated; 0.73, IQR=0.55-0.97). Conclusions: Our results confirm that there is need to increase HIV testing among older individuals and men in Kenya, increase the frequency of testing in key populations, and maintain efforts to offer provider-initiated and facility-based testing to reach first-time testers.