517. A comparison of HIV prevalence estimates based on rapid testing and central lab testing in Kenya: results from the 2012 Kenya AIDS Indicator Survey
Session: Poster Abstract Session: HIV Testing and Diagnosis
Thursday, October 27, 2016
Room: Poster Hall
Background: National HIV serologic surveys increasingly rely on home-based testing and counseling (HBTC) in lieu of central laboratory testing to ensure immediate return of results.

Methods: The 2012 Kenya AIDS Indicator Survey used a two-stage stratified cluster design to obtain a representative sample of persons aged 15–64 years. Demographic information was collected, and both HBTC and central laboratory (enzyme immunoassays, EIA) testing were offered. If HIV-positive, testing for antiretroviral (ARV) drug metabolites was conducted. Prevalence was estimated for EIA, HBTC, and an adjusted method accounting for HBTC refusers that self-reported positive and/or had ARV metabolites. Models predicting HBTC refusal were developed, and estimates were weighted to account for sampling design and nonresponse.

Results: Of 11,626 EIA participants, 1,947 (16.7%) refused HBTC. HIV prevalence for EIA participants was 5.6% (95% confidence interval [CI] 4.9–6.3), vs. 4.1% (CI 3.3–4.9) for HBTC. After accounting for HBTC refusers who self-reported positive, tested for ARVs, or both, HIV prevalence was 5.3% (CI 4.5–6.0), 5.3% (CI 4.5–6.1), and 5.9 % (CI 5.1–6.7), respectively. HBTC refusers had significantly higher adjusted odds of being older (> 24 years, AOR 1.2, CI 1.0–1.6); being wealthier (AOR 1.3, CI 1.0–1.6); having completed primary education (AOR 1.6, CI 1.3–1.9); having previously tested for HIV (AOR 1.2, CI 1.0–1.3); and being HIV positive (AOR 3.0, CI 2.3–3.9).

Conclusion: In Kenya, prevalence estimates based on HBTC is underestimated due to high refusal among HIV-infected individuals. Future studies may need to investigate and adjust for this bias.

Sarah Anne Guagliardo, PhD, MPH1, Andrew Voetsch, PhD, MPH2, Peter Young, MPH3, Joyce Wamicwe, MBChB4, Lily Muthoni, MBChB4 and Andrea Kim, PhD, MPH2, (1)Division of Global HIV/ AIDS and Tuberculosis, CDC, Association of Schools and Programs of Public Health, Atlanta, GA, (2)Division of Global HIV/ AIDS and Tuberculosis, CDC, Atlanta, GA, (3)Division of Global HIV/AIDS and Tuberculosis, CDC, Nairobi, Kenya, (4)Kenya National AIDS and STI Control Program, Nairobi, Kenya


S. A. Guagliardo, None

A. Voetsch, None

P. Young, None

J. Wamicwe, None

L. Muthoni, None

A. Kim, None

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