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Aluisio AR, Bergam SJ, Sugut J, Kinuthia J, Bosire R, Ochola E, Ngila B, Guthrie KM, Liu T, Mugambi M, Katz DA, Farquhar C, Mello MJ. HIV self-testing acceptability among injured persons seeking emergency care in Nairobi, Kenya. Glob Health Action 2023; 16:2157540. [PMID: 36628574 PMCID: PMC9848354 DOI: 10.1080/16549716.2022.2157540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emergency department-based HIV self-testing (ED-HIVST) could increase HIV-testing services to high-risk, under-reached populations. OBJECTIVES This study sought to understand the injury patient acceptability of ED-HIVST. METHODS Injury patients presenting to the Kenyatta National Hospital Accident and Emergency Department were enrolled from March to May 2021. Likert item data on HIVST assessing domains of general acceptability, personal acceptability, and acceptability to distribute to social and/or sexual networks were collected. Ordinal regression was performed yielding adjusted odds ratios (aOR) to identify characteristics associated with high HIVST acceptability across domains. RESULTS Of 600 participants, 88.7% were male, and the median age was 29. Half reported having primary care providers (PCPs) and 86.2% reported prior HIV testing. For each Likert item, an average of 63.5% of the participants reported they 'Agree Completely' with positive statements about ED-HIVST in general, for themselves, and for others. In adjusted analysis for general acceptability, those <25 (aOR = 1.67, 95%CI:1.36-2.08) and with prior HIV testing (aOR = 1.68, 95%CI:1.27-2.21) had greater odds of agreeing completely. For personal acceptability, those with a PCP (aOR = 3.31, 95%CI:2.72-4.03) and prior HIV testing (aOR = 1.83, 95%CI:1.41-2.38) had greater odds of agreeing completely. For distribution acceptability, participants with a PCP (aOR = 2.42, 95%CI:2.01-2.92) and prior HIV testing (aOR = 1.79, 95%CI: 1.38-2.33) had greater odds of agreeing completely. CONCLUSIONS ED-HIVST is perceived as highly acceptable, and young people with prior testing and PCPs had significantly greater favourability. These data provide a foundation for ED-HIVST programme development in Kenya.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Scarlett J. Bergam
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Janet Sugut
- Department of Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Ochola
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Beatrice Ngila
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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Aluisio A, Bergam S, Ogory A, Ngila B, Sugut J, Bosire R, Bukusi D, Kinuthia J, Guthrie K, Katz D, Farquhar C, Mello M. 1178. Opportunities and Challenges to Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya. Open Forum Infect Dis 2022. [PMCID: PMC9752706 DOI: 10.1093/ofid/ofac492.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking and needed to understand opportunities and barriers for HIV testing and care, and inform program implementation. Methods Between December 2021 and March 2022, 32 in-depth interviews (IDIs) were conducted with 16 male and 16 female patients who had been treated in the Kenyatta National Hospital (KNH) ED, half of whom had been HIV-tested. Six focus-group discussions (FGDs) were also conducted with 50 nurses, doctors, HIV testing counselors, and administrators working in the ED. All transcripts were double-coded and thematically analyzed using Dedoose software and a parallel inductive and deductive coding approach which allowed for capture of both a priori and emergent themes. Results Patients and providers agreed that ED-HTS are facilitated by friendly staff, patient education, high perceived HIV risk, and confidentiality. However, ED-HTS is limited by burdens on staff, resources, time, and space, as well as severity of patient injuries limiting ability to consent to or prioritize HIV testing. These limitations provide opportunities for ED-HIVST: particularly the ability to test at a comfortable time and place, especially when provided alongside sufficient HIV and testing education, contact with healthcare providers, and psychosocial support. Barriers for ED-HIVST where identified and as patients’ concerns about HIVST accuracy and mental health impacts of a positive test, as well providers’ identified barriers on their concerns for loss to follow up and inability to complete confirmatory testing. COM-B Model
![]() Application of the COM-B Model of Behavior Change to ED-HIVST Acceptability in Kenya Conclusion ED stakeholders are receptive to HTS and HIVST, and patients desire the opportunity to use HIVST. Potential challenges—such as psychological effects of testing positive, worries about access to follow-up care, and confusion about how to self-administer testing, may be addressed through programming designed to promote education, access and ensure follow-up mechanisms. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Adam Aluisio
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Scarlett Bergam
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Agot Ogory
- Kenyatta National Hospital, Nairobi, Nairobi Area, Kenya
| | - Beatrice Ngila
- Kenyatta National Hospital, Nairobi, Nairobi Area, Kenya
| | - Janet Sugut
- Kenyatta National Hospital, Nairobi, Nairobi Area, Kenya
| | - Rose Bosire
- Kenya Medical Research Institute, Nairobi, Nairobi Area, Kenya
| | - David Bukusi
- Kenya Medical Research Institute, Nairobi, Nairobi Area, Kenya
| | - John Kinuthia
- Kenyatta National Hospital, Nairobi, Nairobi Area, Kenya
| | - Kate Guthrie
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - David Katz
- University of Washington, Seattle, Washington
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Aluisio AR, Sugut J, Kinuthia J, Bosire R, Ochola E, Ngila B, Ojuka DK, Lee JA, Maingi A, Guthrie KM, Liu T, Mugambi M, Katz DA, Farquhar C, Mello MJ. Assessment of standard HIV testing services delivery to injured persons seeking emergency care in Nairobi, Kenya: A prospective observational study. PLOS Glob Public Health 2022; 2:e0000526. [PMID: 36962519 PMCID: PMC10021732 DOI: 10.1371/journal.pgph.0000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Emergency departments (EDs) in Africa are contact points for key groups for HIV testing services (HTS) but understanding of ED-testing delivery is limited which may impeded program impacts. This study evaluated the offering and uptake of standard HTS among injured persons seeking ED care at Kenyatta National Hospital (KNH) in Nairobi, Kenya. An ED population of adult injured persons was prospectively enrolled (1 March-25 May 2021) and followed through ED disposition. Participants requiring admission were followed through hospital discharge and willing participants were contacted at 28-days for follow up. Data on population characteristics and HTS were collected by personnel distinct from clinicians responsible for standard HTS. Descriptive analyses were performed and prevalence values with 95% confidence intervals (CI) were calculated for HIV parameters. The study enrolled 646 participants. The median age was 29 years with the majority male (87.8%). Most ED patients were discharged (58.9%). A prior HIV diagnosis was reported by 2.3% of participants and 52.7% reported their last testing as >6 months prior. Standard ED-HTS were offered to 49 or 8.6% of participants (95% CI: 5.8-9.9%), among which 89.8% accepted. For ED-tested participants 11.4% were newly diagnosed with HIV (95% CI: 5.0-24.0%). Among 243 participants admitted, testing was offered to 6.2% (95% CI: 3.9-9.9%), with 93.8% accepting. For admitted participants tested 13.3% (95% CI: 4.0-35.1%) were newly diagnosed (all distinct from ED cases). At 28-day follow up an additional 22 participants reported completing testing since ED visitation, with three newly diagnosed. During the full follow-up period the HIV prevalence in the population tested was 10.3% (95% CI: 5.3-19.0%); all being previously undiagnosed. Offering of standard HTS was infrequent, however, when offered, uptake and identification of new HIV diagnoses were high. These data suggest that opportunities exist to improve ED-HTS which could enhance identification of undiagnosed HIV.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Janet Sugut
- Department of Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Ochola
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Beatrice Ngila
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel K. Ojuka
- Department of Surgery, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - J. Austin Lee
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Alice Maingi
- Department of Dermatology, Kenyatta National Hospital, Nairobi, Kenya
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States of America
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | | | - David A. Katz
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
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