McKenna C Eastment 1, George Wanje 2, Barbra A Richardson 2 3 4, Faiza Nassir 5, Emily Mwaringa 6, Ruanne V Barnabas 7 2 8, Kenneth Sherr 2, Kishorchandra Mandaliya 2, Walter Jaoko 9, R Scott McClelland 7 2 8
Affiliations
- 1Department of Medicine, University of Washington, Seattle, WA, USA. mceast@uw.edu.
- 2Department of Global Health, University of Washington, Seattle, WA, USA.
- 3Department of Biostatistics, University of Washington, Seattle, WA, USA.
- 4Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, WA, USA.
- 5Department of Obstetrics and Gynecology, Coast General Hospital, Mombasa, Kenya.
- 6Mombasa County Department of Health, Mombasa, Kenya.
- 7Department of Medicine, University of Washington, Seattle, WA, USA.
- 8Department of Epidemiology, Seattle, WA, USA.
- 9University of Nairobi, Medical Microbiology, Nairobi, Kenya.
PMID: 31521157 PMCID: PMC6744633
DOI: 10.1186/s12913-019-4519-x
Abstract
Background: A high proportion of African women utilize family planning (FP) services. Accordingly, incorporating HIV testing into FP services may strategically target the first WHO 90-90-90 goal of 90% of people living with HIV knowing their status.
Methods: The objective of this analysis was to determine the proportion of new FP clients counseled and tested for HIV, as well as correlates of HIV testing, in a random sample of 58 FP clinics in Mombasa County, Kenya. Structured interviews of FP clinic managers collected data on characteristics of FP clinics and staff. Study staff performed a 3-month review of FP registers, summarizing new client HIV testing and counseling (HTC). Because overall rates of HTC were quite low, a binary variable was created comparing clinics performing any HIV counseling and/or testing to clinics performing none. Generalized linear models were used to calculate prevalence ratios (PR) and identify correlates of HTC. Factors associated with any HTC with a p-value < 0.10 in univariate analysis were included in a multivariate analysis.
Results: Of the 58 FP clinics, 26 (45%) performed any counseling for HIV testing, and 23 (40%) performed any HIV testing. Counseling for HIV testing was conducted for 815/4389 (19%) new clients, and HIV testing was performed for 420/4389 (10%). Clinics without trained HIV testing providers uniformly did not conduct HIV counseling and/or testing (0/12 [0%]), while 27/46 (59%) of clinics with ≥1 provider performed some HTC (p < 0.001). In the subset of 46 clinics with ≥1 trained HIV testing provider, correlates of performing HTC included being a public versus non-public clinic (PR 1.70 95%CI 1.01-2.88), and having an HIV comprehensive care center (CCC) onsite (PR 2.05, 95%CI 1.04-4.06).
Conclusion: Trained HIV testing providers are crucial for FP clinics to perform any HTC. Approaches are needed to increase routine HTC in FP clinics including staffing changes and/or linkages with other testing services (in standalone VCT services or lab facilities) in order to improve the implementation of existing national guidelines. A future cluster randomized trial is planned to test an implementation strategy, the Systems Analysis and Improvement Approach (SAIA) to increase HTC in FP clinics.
Keywords: Family planning clinics; HIV testing.
Conflict of interest statement
RSM received research funding, paid to the University of Washington from hologic.
Link
https://pubmed.ncbi.nlm.nih.gov/31521157/
