Preliminary Baseline Findings From the Girls Study: Recruitment Venue and Testing Option Preferences

Sunday, 22 July 2018

Ann E. Kurth, PhD, CNM, MPH1
Irene Inwani, MD, MPH2
Kawango Agot, PhD, MPH3
Charles M. Cleland, PhD4
Nok Chhun, MS, MPH1
Mark Anam, BS3
Samwel Rao, MS3
John Kinuthia, MD, MPH2
Peter Cherutich, MD, PhD, MPH5
Ruth Nduati, MD, MPH6
(1)Yale University School of Nursing, New Haven, CT, USA
(2)Kenyatta National Hospital, Nairobi, Kenya
(3)Impact Research and Development Organization, Kisumu, Kenya
(4)NYU Rory Meyers College of Nursing, New York, NY, USA
(5)Kenya Ministry of Health, Nairobi, Kenya
(6)University of Nairobi, Nairobi, Kenya

Purpose: Adolescent girls and young women (AGYW) ages 15-24 years are twice as likely as their male peers to be infected, making females in sub-Saharan Africa the most at-risk group for HIV infection (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2013). Given the disproportionate risk faced by AGYW, nurses and other providers need to be aware of AGYW preferences to ensure that this vulnerable population can receive effective primary prevention, HIV testing, and linkage to care services (World Health Organization [WHO], 2013; UNAIDS, 2014; Kurth, Lally, Choko, Inwani, & Fortenberry, 2015).

Methods: Within a framework of implementation science, we evaluate prevention-treatment continuum interventions (Lester et al., 2010; Choko et al, 2015; Handa, Halpern, Pettifor, & Thirumurthy, 2014) to increase uptake of HIV testing, linkage to and retention in care, and prevention among AGYW. We are comparing two “seek” recruitment strategies, three “test” strategies, and pilot “linkage” to care interventions (SMART design) among AGYW in Homa Bay County, western Kenya. Participants are recruited from Homa Bay, Mbita, and Ndhiwa subcounties representing urban, rural and fishing communities. AGYW are recruited via home-based or community-based strategies that run concurrently until the sample size is reached. AGYW are offered three testing options: (1) oral fluid HIV self-testing, (2) immediate staff-aided rapid HIV testing or (3) referral to a health care facility for standard HIV testing services. Newly diagnosed HIV positives are enrolled in a cohort to pilot the most effective way to support AGYW with initial linkage to care (Lei, Nahum-Shani, Lynch, Oslin, & Murphy, 2012). We also evaluate a primary prevention messaging intervention to support high risk HIV-negative AGYW to reduce their HIV risk behavior and adhere to HIV retesting recommendations.

Results: We have enrolled 554 participants, 425 (76.7%) in the home, and 129 (23.3%) at mobile health events. Mean age was 19.7 (SD:2.4); 99 (17.9%) are 15-17 years old. Eighty-seven percent reported ever having sex, with sexual debut mean age of 16 years (SD:1.97). Only 35.5% reported condom use at last sex. Most, 445 (80.3%) chose staff-aided testing, with 105 (19.0%) choosing self-testing, and 4 (0.7%) health care facility referral. Twenty participants newly diagnosed HIV-positive all enrolled in the pilot, and 13 have linked to care. Out of 534 HIV negative, 96 (18%) were identified as high risk and 63 were enrolled to the HIV negative cohort.

Conclusion: The GIRLS Study will inform best practices to increase young women’s uptake of HIV prevention, testing, and linkage to care services in a high-burden African setting. Lessons learned will directly guide and inform the Government of Kenya about appropriate scale up of multiple seek, test, link, retain, and prevention strategies for adolescent girls and young women. Preliminary findings indicate that AGYW prefer home-based recruitment strategy and staff-aided HIV testing regardless of recruitment site. For those who selected the self-testing option, no invalid results were reported; reactive results, and a proportion of non-reactive results were confirmed per Government of Kenya guidelines. No serious adverse events have been reported.