- HIV screening at health facilities and community pharmacies in Kenya
- Enhancing test uptake and early diagnosis
T.F. Rinke de Wit
- Award date
- 3 October 2017
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
Despite a tremendous scale-up of antiretroviral therapy, as many as 54% of HIV-infected persons globally remain undiagnosed hence are not on treatment. This thesis presents findings from a series of studies conducted in Coastal Kenya aiming to enhance HIV test uptake and early diagnosis.
We found that most adults with urethritis seek care at pharmacies and private clinics, highlighting the need to enhance HIV test access in the private healthcare sector. We subsequently showed that HIV self-testing through community pharmacies is feasible and may be in high demand. With regard to early diagnosis, we found that while acute HIV infection may be present in 1-3% of patients presenting with fever in outpatient healthcare settings, it is rarely considered in medical curricula, clinical guidelines and clinical practice. We demonstrated that an acute HIV infection detection strategy targeting young febrile adults seeking care at pharmacies and health facilities is feasible. Further, we showed that low-cost mobile phone and in-person appointment reminders can increase uptake of repeat HIV testing by as much as 70%.
Test uptake and early diagnosis can be enhanced through implementation of HIV testing services in the private healthcare sector, by incorporating targeted acute HIV infection screening in clinical management and other HIV testing services, and through reminders for repeat testing appointments. In an era of decreasing donor funding, the coordination of public and private efforts to enhance test coverage and identify HIV-infected individuals will be crucial.
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