Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya

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Abstract

Objective:

We sought to increase adolescent HIV testing across rural communities in east Africa and identify predictors of undiagnosed HIV.

Design:

Hybrid mobile testing.

Methods:

We enumerated 116 326 adolescents (10–24 years) in 32 communities of Uganda and Kenya (SEARCH:NCT01864603): 98 694 (85%) reported stable (≥6 months of prior year) residence. In each community we performed hybrid testing: 2-week multidisease community health campaign that included HIV testing, followed by home-based testing of community health campaign nonparticipants. We measured adolescent HIV testing coverage and prevalence, and determined predictors of newly diagnosed HIV among HIV-infected adolescents using multivariable logistic regression.

Results:

A total of 86 421 (88%) stable adolescents tested for HIV; coverage was 86, 90, and 88% in early (10–14), mid (15–17), and late (18–24) adolescents, respectively. Self-reported prior testing was 9, 26, and 55% in early, mid, and late adolescents tested, respectively. HIV prevalence among adolescents tested was 1.6 and 0.6% in Ugandan women and men, and 7.1 and 1.5% in Kenyan women and men, respectively. Prevalence increased in mid-adolescence for women and late adolescence for men. Among HIV-infected adolescents, 58% reported newly diagnosed HIV. In multivariate analysis of HIV-infected adolescents, predictors of newly diagnosed HIV included male sex [odds ratio (OR) = 1.97 (95% confidence interval (CI): 1.42–2.73)], Ugandan residence [OR = 2.63 (95% CI: 2.08–3.31)], and single status [OR = 1.62 (95% CI: 1.23–2.14) vs. married)].

Conclusions:

The SEARCH hybrid strategy tested 88% of stable adolescents for HIV, a substantial increase over the 28% reporting prior testing. The majority (57%) of HIV-infected adolescents were new diagnoses. Mobile HIV testing for adults should be leveraged to reach adolescents for HIV treatment and prevention.

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