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HIV Testing Uptake and Prevalence Among Adolescents and Adults in a Large Home-Based HIV Testing Program in Western Kenya

Wachira, Juddy PhD, MPH*; Ndege, Samson MBChB, MPH*,†; Koech, Julius MS*; Vreeman, Rachel C. MD, MS*,‡; Ayuo, Paul MBChB, MPH*,§; Braitstein, Paula PhD*,§,‖,¶,#

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2014 - Volume 65 - Issue 2 - p e58–e66
doi: 10.1097/QAI.0b013e3182a14f9e
Implementation and Operational Research: Epidemiology and Prevention
IOR articles

Objective: To describe HIV testing uptake and prevalence among adolescents and adults in a home-based HIV counseling and testing program in western Kenya.

Methods: Since 2007, the Academic Model Providing Access to Healthcare program has implemented home-based HIV counseling and testing on a large scale. All individuals aged ≥13 years were eligible for testing. Data from 5 of 8 catchments were included in this analysis. We used descriptive statistics and multivariate logistic regression to examine testing uptake and HIV prevalence among adolescents (13–18 years), younger adults (19–24 years), and older adults (≥25 years).

Results: There were 154,463 individuals eligible for analyses as follows: 22% adolescents, 19% younger adults, and 59% older adults. Overall mean age was 32.8 years and 56% were female. HIV testing was high (96%) across the following 3 groups: 99% in adolescents, 98% in younger adults, and 94% in older adults (P < 0.001). HIV prevalence was higher (11.0%) among older adults compared with younger adults (4.8%) and adolescents (0.8%) (P < 0.001). Those who had ever previously tested for HIV were less likely to accept HIV testing (adjusted odds ratio: 0.06, 95% confidence interval: 0.05 to 0.07) but more likely to newly test HIV positive (adjusted odds ratio: 1.30, 95% confidence interval: 1.21 to 1.40). Age group differences were evident in the sociodemographic and socioeconomic factors associated with testing uptake and HIV prevalence, particularly, gender, relationship status, and HIV testing history.

Conclusions: Sociodemographic and socioeconomic factors were independently associated with HIV testing and prevalence among the age groups. Community-based treatment and prevention strategies will need to consider these factors.

*USAID-Academic Model Providing Access to Healthcare (AMPATHPlus) Partnership, Eldoret, Kenya;

Department of Epidemiology, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya;

Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN;

§Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;

Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN;

Regenstrief Institute, Inc, Indianapolis, IN; and

#Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Correspondence to: Paula Braitstein, PhD, Department of Medicine, Indiana University School of Medicine, 1001 West 10th Street, OPW-M200, Indianapolis, IN 46202 (e-mail:

Supported in part by a grant to the United States Agency for International Development (USAID)–Academic Model Providing Access to Healthcare (AMPATH) Partnership from the USAID as part of the President's Emergency Plan for AIDS Relief (PEPFAR). The USAID-AMPATH partnership is grateful for the support of the USAID. The home-based HIV counseling and testing program was supported by grants from Abbott Laboratories, the Purpleville Foundation, and the Global Business Coalition. USAID-PEPFAR supported care for those found to be HIV positive; and Abbott Laboratories provided test kits and logistical support. The contents of this study are the sole responsibility of AMPATH and do not necessarily reflect the views of USAID or the United States Government.

The authors have no conflicts of interest to disclose.

Received March 19, 2013

Accepted June 12, 2013

© 2014 by Lippincott Williams & Wilkins