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[Preprint]. 2024 Apr 4:2024.04.03.24305277.
doi: 10.1101/2024.04.03.24305277.

Implementation and Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) Program in Nairobi, Kenya: A Quasi-Experimental Prospective Study

Adam R Aluisio  1 , Joshua Smith-Sreen  2 , Agatha Offorjebe  1 , Wamutitu Maina  3 , Sankei Pirirei  3 , John Kinuthia  4 , David Bukusi  3 , Harriet Waweru  3 , Rose Bosire  4 , Daniel K Ojuka  5 , McKenna C Eastment  6   7 , David A Katz  6 , Michael J Mello  1 , Carey Farquhar  6   7
Affiliations

Implementation and Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) Program in Nairobi, Kenya: A Quasi-Experimental Prospective Study

Adam R Aluisio et al. medRxiv. .

Update in

Abstract

Background: Persons seeking emergency injury care are often from underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons.

Methods: This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed using setting specific data and utilizes resource reorganization, services integration and HIV sensitization to promote ED-HTS. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and those never previously HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains.

Results: All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR=1.31, 95% CI:1.21-1.43; p<0.001) with a 62.9% relative increase in HIV self-test kit provision. Among 605 patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR=11.2, 95%CI:6.9-18.1; p<0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR=13.8, 95%CI:5.5-28.7, p<0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16-weeks post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation.

Conclusions: The HEATED program increased ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons, already in contact with health systems.

Keywords: Emergency Care; HIV testing; Health systems; Kenya; Key populations; Testing.

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Figures

Figure 1:
Figure 1:
Study Population
Figure 2.
Figure 2.
HIV Services With Implementation of the HIV Enhanced Access Testing in the Emergency Department Program 1Risk ratios outcomes based on comparison of data aggregating post-implementation periods 1&2 with the pre-implementation period as the baseline. 2Eligible People Living With HIV included those not currently on antiretroviral treatments and discharged from the hospital alive 3HIV Testing Delivery aggregates both facility-based HIV testing and distribution of HIVST kits 4Key populations include sex workers, men who have sex with men, gay persons, transgender persons, and persons who inject drugs. Priority populations include persons 18–24 years of age, victims of interpersonal violence, persons who screened positive for hazardous alcohol use on the Alcohol Use Disorders Identification Test, persons never previously HIV tested
Figure 3.
Figure 3.
HIV Testing Cascade Pre- and Post-implementation of the HIV Enhanced Access Testing in the Emergency Department Program Stratified by Key and Priority Populations
Figure 4.
Figure 4.
Systems Level HIV Testing Services Delivery Across Study Periods1 1Biweekly average proportion of persons who received HIV testing services with associated 95% confidence intervals
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