Health Ministry set to roll out new HIV testing model in July

Blood sample for HIV test. [iStockphoto] The government targets to end HIV by 2030, a time when more than1.3 million Kenyans are living with the disease, with 22,154 new infections reported last year. As Kenya races against time to eradicate HIV infections, access to treatment in early years has been identified as key in ensuring better health outcome. The Ministry of Health is now seeking to enhance HIV testing to end the disease. Director of Kenya AIDS Vaccine Initiative - Institute of Clinical Research (KAVI), Prof Omu Anzala, emphasizes that testing enhances prevention and treatment. But Prof Anzala, a virologist, says vaccination is a sure way of ending HIV although science is yet to yield fruits. "There is need to eliminate the disease to stop circulation, and then have it eradicated," says Kavi director who has been part of a team of experts researching on HIV vaccines and treatment. Kenya has adopted three-test algorithms or testing method, for general and antenatal populations (pregnant and lactating mothers), with a target for site-level, overseen by the National Aids and STI Control Program (Nascop). The new testing model is set for roll out in July This approach repeals the two test algorithms that has been in use for the last 15 years. A senior laboratory expert at Nascop, Christabel Ogola, explains that with this testing strategy, the first test, which is a highly sensitive one, can reliably detect the presence of antibodies to the virus after the window period. If the first test is negative, an individual is linked to preventive services. On the other hand, a reactive result on the first test is confirmed using two other test kits which also have to be reactive for an individual to be declared HIV positive. The same testing process is then repeated by another HIV testing services provider before an individual is put on Antiretroviral Therapy (ART) to suppress the virus. WHO also recommends the dual testing of HIV and syphilis as the first test in pregnant women in antenatal care. "Kits used in algorithm are rapid tests that detect antibodies to the virus. During the window period, the antibody levels may not be detected by all the test kits. This is a rare occurrence and such results are termed as inconclusive," explains Ogola. "In HIV, we at times record testing errors that can lead to inconclusive results. Proper protocols should therefore be followed as per the kit manufacturers' instructions," she adds. She says if the result is inconclusive (or not clear), and individual would require further testing after 14 days to give a definite diagnosis. In 2019, WHO recommended states to adopt the new HIV testing tool to guarantee quality services in achieving UNAIDS' targets of 95-95-95. This target ensures that at least 95 per cent of the population know their HIV status, 95 per cent are put on treatment and 95 percent of people living with the disease have their viral load suppressed. Scientific studies reveal that the new testing technology enhances diagnostic precision, and introduces a dual HIV/Syphilis rapid diagnostic test. A review of Kenya's current two test algorithm did not yield a positive predictive value of at least 99 per cent. In view of the current testing method, a taskforce recommended shift to the three test algorithm to improve proficiency and enhance accuracy of HIV testing results in line with WHO recommendations. The taskforce formed in March 2022, comprises of government officials, technical partners and research scientists tasked to review the evidence and file a technical report. With a three test algorithm, the first test in HIV testing should have the highest sensitivity, with the second and third being of highest in terms of being specific and accurate. The algorithm, according to WHO, should guarantee high-quality and accurate testing. Kenya will be joining other African countries in adopting this new approach. They include South Sudan, Zambia, Chad, Cameroon, Mali, Burkina Faso, Philipis, Armenia and Ukrain. Piloting of the new testing method was done in six facilities in Kisumu, Garissa, Kiambu and Mombasa counties. It was meant to assess feasibility and acceptability of the newly verified HIV testing algorithms and identify any operational issues before the national rollout. Nascop Chief Executive Officer Ruth Wafula says that recent scientific evidence shows that using the two test algorithm has a limitation at population level, where there could be some cases that are not correctly classified for appropriate interventions. "The principal around HIV is correctly identifying a sick person, putting them on treatment to have them viral load suppressed so that as they engage with other persons who are negative, the risk of infection is not there," says Dr Wafula. The new three test algorithm therefore increases the opportunity of correctly classifying somebody at the point of service within a shorter time, with accurate results, and linking them to the correct treatment. It also allows correct classification of negative persons who are at higher risk because some of the drivers of infection is people not knowing their status, while preventing the risk of one acquiring the virus. "When you have an algorithm that correctly classifies somebody at the point of service, you have the highest chance of putting the person on treatment that gives you suppression, and therefore reducing the risks of transmission to the other person," says Wafula. She says Kenya is set to roll out the testing technology in July, whose guidelines are given in a tool christened a 'protocol' and a tool kit. Wafula notes that from the analysis, progress on UNAIDS targets is on track in terms of identifying those who are positive, identifying those who need treatment and following up on viral suppression. The tool will first be rolled out in Asal communities where uptake of HIV services - including testing, treatment and suppression of viral load - remains low. The first phase will see the testing adopted in Wajir, Mandera, Marsabit, Isiolo, Lamu and Tana River counties. In the second phase, West Pokot, Embu, Laikipia, Kiambu, Bungoma, Meru, Murang'a, Bomet Kirinyaga and Tana River, with the third cluster being Kilifi, Makueni, Nandi, Narok, Kwale, Nyeri, Machakos, Turkana and Kericho counties. The fourth group to adopt the new testing approach will be Taita Taveta, Kitui, Nakuru, Tarns Nzoia, Nairobi, Kajiado, Nyamira, Kakamega, Uasin Gishu, whereas the fifth group is Vihiga, Samburu, Kisii, Mombasa, Busia, Migori, Siaya Kisumu and Homa Bay counties. The roll-out program is spearheaded by Nascop in collaboration with other stakeholders, including Global Fund and PEPFAR. "In terms of the roll-out of the three test algorithm, (it) is a phase in phase approach where not all sites will start at the same time but while program ensuring there is no service interruption across the country," says Wafula. "We are also supporting the Asal to achieve their targets because compared to other counties, they are much behind in terms of achieving their targets. Prioritising them in this new science is a critical tool to move together," she adds. The Nascop CEO emphasises that the science of testing is more of addressing the quality and correct diagnosis, but there is much more for HIV testing programme than just the algorithm. "The science requires correct messaging because it requires the public to take up the interventions. There is a lot of communication that has to go out there about the benefits of testing not necessarily for positives, but also for negatives because we have packages for combination prevention," she says. "You do not need to test because you are worried of positive status, but the opportunity to confirm that you are still negative as you partake in prevention interventions," she adds. The ministry's HIV coverage shows that Kenya conducts 8 million HIV tests in 8,851 testing sites annually. According to the 2023 Kenya Population-based HIV Impact Assessment (KENPHIA HIV estimstes, 89.5 per cent of males population have their HIV status identified, as compared to only 73 per cent reported in 2018 as per the). Kenya Demographic Health Survey (KDHS) 2022 data states that 85 per cent of women and 72 per cent of men had been tested for HIV/Aids respectively. At least 95 per cent of women aged 15 and 49 who gave birth in the two years before the survey were tested during antenatal clinic (ANC), or labour. "Taking an HIV test enables a person to know their status and take appropriate action, including preventive behaviour such as using condoms and seeking treatment," reads the report. However, seeking an HIV test is likely to be more difficult among young people because most lack experience and autonomy in accessing health services. But with information, youth and young adults access HIV services. Brian Amboko, 23, a student at Presbyterian University in Kiambu, tells The Standard that he regularly tests for HIV, as advised by his father. "I test for HIV annually to know my status. This is a must do for all my family members. I am happy because testing enables me to take precautions to avoid acquiring the virus," says Amboko. The student did the test during the recent Safari Rally held in Mombasa, where sensitisation of HIV was done among young adults. Hankins Adolwa says he tests for HIV to know his status. "I test because anything could have happened, leading to acquiring the virus. Testing helps in decision making," says Adolwa adding that he encourages his peers to test for HIV regularly.

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