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Implementation of a Community-Based Hybrid HIV Testing Services Program as a Strategy to Saturate Testing Coverage in Western Kenya

Truong, Hong-Ha M. PhD, MS, MPHa; Akama, Eliud MPHb; Guzé, Mary A. MPHc; Otieno, Frankline BScb; Obunge, Duncan BScb; Wandera, Esther BScb; Nsengiyumva, Ntwali Placide BScc; Obabo, Sammy BScNb; Bushman, Dena NP, MPHa; Kadede, Kevin MAb; Bukusi, Elizabeth A. MBChB, MMed, MPH, PhDb; Oyaro, Patrick MBChB, MPHd; Cohen, Craig R. MD, MPHc

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2019 - Volume 82 - Issue 4 - p 362–367
doi: 10.1097/QAI.0000000000002160
Implementation Science

Background: Knowledge of HIV status is the entry point for linkage to prevention, care, and treatment, and the first step toward achieving the UNAIDS 90-90-90 targets. Most countries rely on proxies for estimating testing saturation, including periodic population-based sampling and yield (number positive among those tested). We conducted a community-based “Hybrid” HIV testing services (HTS) program to identify persons unaware of their HIV-positive status.

Setting: Homa Bay County, Kenya; July–September, 2016.

Methods: We conducted community mapping, household census, multi-disease community health campaigns (CHCs), and home-based tracking. HIV testing eligibility was based on 2015 national guidelines. The previously unidentified fraction (PUF) was defined as the proportion of newly identified persons living with HIV (PLWH) out of all previously identified and newly identified PLWH.

Results: The Hybrid HTS program reached 28,885 persons in total: 25,340 residents and 3545 nonresidents. There were 19,288 persons reached through CHCs and tracking. Of 11,316 individuals eligible for HIV testing, 9463 (83%) accepted testing, including 1230 (13%) first-time testers. There were 115 newly identified PLWH of 1589 total HIV-positive persons, representing a 7.2% PUF. Of 93 newly identified PLWH at the CHCs, 68% initiated same-day antiretroviral therapy.

Conclusion: The Hybrid HTS program identified persons previously unaware of their HIV-positive status, thereby enabling linkage to care and same-day treatment and reducing onward transmission risk. An approach focused on identifying persons unaware of their HIV-positive status in combination with ascertaining the PUF has the potential to better target testing strategies to identify >90% of PLWH in a community.

aDepartment of Medicine, University of California, San Francisco, CA;

bCentre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya;

cDepartment of Obstetrics, Gynecology and Reproductive Services, University of California, San Francisco, CA; and

dRCTP-FACES NGO, Kisumu, Kenya.

Correspondence to: Hong-Ha M. Truong, PhD, MS, MPH, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158 (e-mail:

Supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) under the terms of U2GPS001913.

Presented in part at: IAS Conference on HIV Science; July 23–26, 2017; Paris, France and Conference on Retroviruses and Opportunistic Infections; March 4–7, 2018; Boston, MA.

The authors have no conflicts of interest to disclose.

The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the official position of the funding agencies.

Received June 06, 2019

Accepted August 05, 2019

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