Impact of a Comprehensive Adolescent-Focused Case Finding Intervention on Uptake of HIV Testing and Linkage to Care Among Adolescents in Western Kenya

Abstract

Background: Low HIV testing uptake prevents identification of adolescents living with HIV and linkage to care and treatment. We implemented an innovative service package at health care facilities to improve HIV testing uptake and linkage to care among adolescents aged 10-19 years in Western Kenya.

Methods: This quasi-experimental study used preintervention and postintervention data at 139 health care facilities (hospitals, health centers, and dispensaries). The package included health worker capacity building, program performance monitoring tools, adolescent-focused HIV risk screening tool, and adolescent-friendly hours.The study population was divided into early (10-14 years) and late (15-19 years) age cohorts. Implementation began in July 2016, with preintervention data collected during January-March 2016 and postintervention data collected during January-March 2017. Descriptive statistics were used to analyze the numbers of adolescents tested for HIV, testing HIV-positive, and linked to care services. Preintervention and postintervention demographic and testing data were compared using the Poisson mean test. χ testing was used to compare the linkage to care rates.

Results: During the preintervention period, 25,520 adolescents were tested, 198 testing HIV-positive (0.8%) compared with 77,644 adolescents tested with 534 testing HIV-positive (0.7%) during the postintervention period (both P-values <0.001). The proportion of HIV-positive adolescents linked to care increased from 61.6% to 94.0% (P < 0.001). The increase in linkage to care was observed among both age cohorts and within each facility type (both P-values <0.001).

Conclusions: The adolescent-focused case finding intervention package led to a significant increase in both HIV testing uptake and linkage to care services among adolescents in Western Kenya.

Figure 1.

Illustration of the comprehensive intervention package of services implemented at all 139 sites. The capacity building element for HCF providers included training by nationally approved trainers on the new national HIV testing algorithm, and training by program staff on the new program-specific tools, including an adolescent-focused HIV risk screening tool, as well as individual-level follow-up mentorship and supervision. Second, newly developed program-specific tools, which collected data stratified by sex, age, and entry point, were introduced at HIV testing service points in the HCFs. Third, a newly developed, adolescent-focused HIV screening tool designed to identify eligibility for HIV testing, including assessment of HIV risk, among adolescents aged 10–19 years was implemented. Finally, extended evening (5–7 pm) and/or weekend hours (Saturdays and Sundays) were implemented at most HCFs to accommodate adolescents. In some high-volume HCFs (those with >2000 outpatient clients per month and multiple entry points), additional HIV testing service providers were allocated including linkage officers and triage staff.

Figure 2.

Change in proportion of adolescents testing HIV-positive linked to care and treatment services by age and sex during the preintervention (January–March 2016) and postintervention (January–March 2017) periods in Western Kenya. Linkage to care and treatment is a key challenge in adolescent HIV case finding. The comprehensive intervention package aimed to improve the rate of linkage to care for adolescents testing HIV-positive in the postintervention period. The linkage to care rate was assessed by age cohort (10–14 years and 15–19 years) and sex. The proportion of adolescents testing HIV-positive and linked to care improved from 61.6% in the preintervention period to 94% in the postintervention period.