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Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial

BACKGROUND: In sub‐Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. METHODS: Adult symptomatic outpatients aged 18–39 years were evaluated by a consensus AHI risk score. Patients w...

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Autores principales: Sanders, Eduard J., Agutu, Clara, van der Elst, Elise, Hassan, Amin, Gichuru, Evanson, Mugo, Peter, Farquhar, Carey, Babigumira, Joseph B., Goodreau, Steven M., Hamilton, Deven T., Ndung'u, Thumbi, Sirengo, Martin, Chege, Wairimu, Graham, Susan M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204714/
https://www.ncbi.nlm.nih.gov/pubmed/34431196
http://dx.doi.org/10.1111/hiv.13157
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author Sanders, Eduard J.
Agutu, Clara
van der Elst, Elise
Hassan, Amin
Gichuru, Evanson
Mugo, Peter
Farquhar, Carey
Babigumira, Joseph B.
Goodreau, Steven M.
Hamilton, Deven T.
Ndung'u, Thumbi
Sirengo, Martin
Chege, Wairimu
Graham, Susan M.
author_facet Sanders, Eduard J.
Agutu, Clara
van der Elst, Elise
Hassan, Amin
Gichuru, Evanson
Mugo, Peter
Farquhar, Carey
Babigumira, Joseph B.
Goodreau, Steven M.
Hamilton, Deven T.
Ndung'u, Thumbi
Sirengo, Martin
Chege, Wairimu
Graham, Susan M.
author_sort Sanders, Eduard J.
collection PubMed
description BACKGROUND: In sub‐Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. METHODS: Adult symptomatic outpatients aged 18–39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped‐wedge trial of opt‐out delivery of point‐of‐care (POC) HIV‐1 nucleic acid testing (NAAT), compared with standard provider‐initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log‐binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908. RESULTS: Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt‐out intervention had a two‐fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39–3.51) after adjustment for factors imbalanced across study periods. CONCLUSIONS: Among symptomatic adults aged 18–39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt‐out testing could diagnose twice as many patients as an approach relying on provider discretion.
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spelling pubmed-92047142022-06-27 Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial Sanders, Eduard J. Agutu, Clara van der Elst, Elise Hassan, Amin Gichuru, Evanson Mugo, Peter Farquhar, Carey Babigumira, Joseph B. Goodreau, Steven M. Hamilton, Deven T. Ndung'u, Thumbi Sirengo, Martin Chege, Wairimu Graham, Susan M. HIV Med Original Research BACKGROUND: In sub‐Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. METHODS: Adult symptomatic outpatients aged 18–39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped‐wedge trial of opt‐out delivery of point‐of‐care (POC) HIV‐1 nucleic acid testing (NAAT), compared with standard provider‐initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log‐binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908. RESULTS: Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt‐out intervention had a two‐fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39–3.51) after adjustment for factors imbalanced across study periods. CONCLUSIONS: Among symptomatic adults aged 18–39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt‐out testing could diagnose twice as many patients as an approach relying on provider discretion. John Wiley and Sons Inc. 2021-08-25 2022-01 /pmc/articles/PMC9204714/ /pubmed/34431196 http://dx.doi.org/10.1111/hiv.13157 Text en © 2021 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Sanders, Eduard J.
Agutu, Clara
van der Elst, Elise
Hassan, Amin
Gichuru, Evanson
Mugo, Peter
Farquhar, Carey
Babigumira, Joseph B.
Goodreau, Steven M.
Hamilton, Deven T.
Ndung'u, Thumbi
Sirengo, Martin
Chege, Wairimu
Graham, Susan M.
Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial
title Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial
title_full Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial
title_fullStr Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial
title_full_unstemmed Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial
title_short Effect of an opt‐out point‐of‐care HIV‐1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial
title_sort effect of an opt‐out point‐of‐care hiv‐1 nucleic acid testing intervention to detect acute and prevalent hiv infection in symptomatic adult outpatients and reduce hiv transmission in kenya: a randomized controlled trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204714/
https://www.ncbi.nlm.nih.gov/pubmed/34431196
http://dx.doi.org/10.1111/hiv.13157
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