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Cited by 4HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskBlood donation and transfusion practices

Predictors of testing history and new HIV diagnosis among adult outpatients seeking care for symptoms of acute HIV infection in coastal Kenya: a cross-sectional analysis of intervention participants in a stepped-wedge HIV testing trial

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Agutu, Clara A., Oduor, Tony H., Hassan, Amin S., Mugo, Peter M., Chege, Wairimu, de Wit, Tobias F. Rinke, Sanders, Eduard J., Graham, Susan M.·2022·BMC Public Health
DOI 10.1186/s12889-022-12711-1PMC PMC8832653
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Abstract

Background: HIV testing is the first step to stop transmission. We aimed to evaluate HIV testing history and new diagnoses among adult outpatients in Kenya aged 18–39 years seeking care for symptoms of acute HIV infection (AHI). Methods: The Tambua Mapema Plus study, a stepped-wedge trial, enrolled patients presenting to care at six primary care facilities with symptoms of AHI for a targeted HIV-1 nucleic acid (NA) testing intervention compared with standard provider-initiated testing using rapid antibody tests. Intervention participants underwent a questionnaire and NA testing, followed by rapid tests if NA-positive. Multinomial logistic regression was used to analyse factors associated with never testing or testing > 1 year ago (“late retesting”) relative to testing ≤ 1 year ago (“on-time testers”). Logistic regression was used to analyse factors associated with new diagnosis. All analyses were stratified by sex. Results: Of 1,500 intervention participants, 613 (40.9%) were men. Overall, 250 (40.8%) men vs. 364 (41.0%) women were late retesters, and 103 (16.8%) men vs. 50 (5.6%) women had never tested prior to enrolment. Younger age, single status, lower education level, no formal employment, childlessness, sexual activity in the past 6 weeks, and > 1 sexual partner were associated with testing history among both men and women. Intimate partner violence > 1 month ago, a regular sexual partner, and concurrency were associated with testing history among women only. New diagnoses were made in 37 (2.5%) participants (17 men and 20 women), of whom 8 (21.6%) had never tested and 16 (43.2%) were late retesters. Newly-diagnosed men were more likely to have symptoms for > 14 days, lower education level and no religious affiliation and less likely to be young, single, and childless than HIV-negative men; newly-diagnosed women were more likely to report fever than HIV-negative women. Among men, never testing was associated with fivefold increased odds (95% confidence interval 1.4–20.9) of new diagnosis relative to on-time testers in adjusted analyses. Conclusion: Most new HIV diagnoses were among participants who had never tested or tested > 1 year ago. Strengthening provider-initiated testing targeting never testers and late retesters could decrease time to diagnosis among symptomatic adults in coastal Kenya. Trial registration: ClinicalTrials.gov Identifier: NCT03508908 registered on 26/04/2018.

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  • Primary care facilities were often chosen as clusters in low-resource settings.

    “Primary care facilities were often chosen as clusters in low-resource settings (37, 52, 55, 56, 62, 70, 91, 92, 101, 108).”

    From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [37]

  • The ability of SWD to address time-related confounding is particularly relevant where secular trends, seasonal variation, or concurrent programs may influence outcomes.

    “This feature is particularly relevant where secular trends, seasonal variation, or concurrent programs may influence outcomes (36, 37).”

    From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [37]

    The Methods > Study design passage (page not provided) says the trial used a modified stepped-wedge design, but does not discuss its ability to address time-related confounding. Searches for secular trends, seasonal variation, concurrent programs, and adjustment for time effects found no passage addressing that claim. (LLM, conf=0.74)

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Cited by

Sorted by citations

Authors
Agutu, C. A., Oduor, T. H., Hassan, A. S., Mugo, P. M., Chege, W., de Wit, T. F. R., Sanders, E. J., & Graham, S. M.
Affiliations
  • Kenya Medical Research Institute (KE)
  • National Institutes of Health (US)
  • University of Washington (US)
Corresponding author
Agutu, Clara A.
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2022-02-11
Volume
22
Issue
1
Pages
280-280
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-022-12711-1
PMC
PMC8832653
OpenAlex
W4211070179
Cited by
4
References
3
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1
FWCI
0.37
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (acceptedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Sub-Saharan African Network for TB/HIV Research Excellence (DEL-15-006)
  • National Institutes of Health (R01AI124968)
  • University of Washington/Fred Hutch Center for AIDS Research (AI027757)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Social Sciences › Business, Management and Accounting › Management of Technology and Innovation › Blood donation and transfusion practices
Keywords
HIV testing history, acute HIV infection, provider-initiated HIV testing, rapid antibody test, predictors of HIV testing, intimate partner violence, sexual concurrency, sexual partners, sex differences, young adults, primary care outpatients, coastal Kenya, HIV prevention
MeSH terms
HIV Testing, Adult, Cross-Sectional Studies, Female, Humans, Infant, Kenya, Male, Outpatients, HIV Infections

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