Preferred HIV Testing Modalities Among Adolescent Girls and Young Women in Kenya

Abstract

Purpose: To improve testing coverage, it is imperative to determine adolescent girls and young women (AGYW) preferences about HIV testing modality and where they prefer receiving services.

Methods: Participants were enrolled between May 2017 and April 2018 from three sites in Homa Bay County, Nyanza region, western Kenya. We explored two recruitment approaches (home-based vs. mobile-event based) and three HIV testing options (oral self-test, staff-administered, or referral to health facility). Exact logistic regression compared yield of newly diagnosed HIV and high-risk HIV-negatives from the recruitment and testing option strategies.

Results: A total of 1,198 participants were enrolled, 1,046 (87.3%) at home and 152 (12.7%) at mobile events. Most participants (928, 77.5%) chose staff-aided testing either at home or at a mobile event; 268 (22.4%) chose self-testing; and only 2 (.2%) chose facility referral. Prevalence of newly diagnosed HIV-positives was 2.7% (32/1,198) and 36.8% (429/1,166) of HIV-negative AGYW were identified as high risk. We identified more newly diagnosed HIV infection among AGYW recruited at mobile events than at home (OR = 3.11; 95% CI: 1.33-6.74; p = .02). High-risk status was related to neither recruitment strategy nor testing modality. Older age was associated with increased odds of selecting an oral self-test (OR = 1.85; 95% CI: 1.06-3.22).

Conclusions: More than one-third of AGYW were at elevated risk of HIV infection, and those unaware of their HIV infection were more likely to be identified at a mobile outreach. Though self-testing was not the dominant preferred strategy, self-tests were performed accurately and with high confidence. These findings can help inform efficient identification of undiagnosed HIV infection and high risk for seroconversion among AGYW in similar settings.