Modeling the Impact of HIV-1 Nucleic Acid Testing Among Symptomatic Adult Outpatients in Kenya

As many as 69% of adults who acquire HIV in Kenya will visit a health care provider due to their symptoms from HIV before they develop antibodies that can be detected with current rapid tests. These early visits provide an important opportunity for early diagnosis and treatment. The Tambua Mapema Plus (TMP) trial tested a combined HIV-1 nucleic acid testing, linkage, treatment, and partner notification intervention for adults aged 18-39 with symptoms of acute HIV infection presenting to health facilities in coastal Kenya with the goal of taking advantage of this early window. We developed a computer simulation to model HIV-1 transmission using data from the TMP trial and Kenyan statistics to estimate potential population-level impact of targeted facility-based testing over 10 years. We simulated three different scenarios including standard care (current use of provider-initiated testing and counseling [PITC]), standard HIV rapid testing scaled to higher coverage obtained in TMP (scaled-up PITC), and the TMP intervention. The simulation suggested that with standard of care 90.7% of persons living with HIV (PLWH) would know their status, with 67.5% of those diagnosed on treatment. Scaled-up PITC resulted in 94.4% of PLWH knowing their status and 70.4% of those diagnosed on treatment. The TMP intervention achieved 97.5% of PLWH knowing their status and 80.6% of those diagnosed on treatment. Scaled-up PITC also prevented 1.0% of new infections over 10 years while TMP prevented 9.4% of new infections. The simulation study suggests that leveraging new technologies to identify acute HIV infection among symptomatic outpatients is superior to scaled-up PITC in this population, resulting in >95% knowledge of HIV status, and would reduce new HIV infections in Kenya.