RESUMEN
HIVST has a key role in ensuring countries meet their 95-95-95 goals. For HIVST to be sustainable, we should explore sharing costs with users as well as the overall experience. This research explores why a consumer would use HIVST and willingness to pay for HIVST through surveying 1,021 participants 18-35 living in Nairobi or Kisumu who were not diagnosed as HIV positive and who are not currently taking PrEP for HIV. A majority (89.8%) would pay 100 KSH and 64.7% would pay 300 KSH, at higher prices likelihood of paying dropped sharply. Price reduction or subsidization coupled with interventions to address the identified barriers may increase HIVST uptake. We identified 5 distinct groups based on willingness to pay and drivers/ barriers to HIVST uptake. These were created using dimension reduction, hierarchical clustering, and k-means analysis to group respondents. 79% of participants had ever heard of HIVST, and 24% had ever used HIVST. The 5 groups included active users, unlikely users, and three segments interested in HIVST with different barriers: need for HCP support, need for increased privacy/confidentiality, and fear of positive result/disclosure.
RESUMEN
BACKGROUND: Pregnant and breastfeeding adolescents and young women living with HIV (AYWLH) have lower retention in prevention of mother-to-child transmission (PMTCT) services compared to older women. METHODS: We evaluated a differentiated service model for pregnant and postnatal AYWLH at seven health facilities in western Kenya aimed at improving retention in antiretroviral treatment (ART) services. All pregnant AYWLH < 25 years presenting for antenatal care (ANC) were invited to participate in group ANC visits including self-care and peer-led support sessions conducted by health facility nurses per national guidelines. ART register data were used to assess loss to follow-up (LTFU) among newly-enrolled pregnant adolescent (< 20 years) and young women (20-24 years) living with HIV starting ART in the pre-period (January-December 2016) and post-period (during implementation; December 2017-January 2019). Poisson regression models compared LTFU incidence rate ratios (IRR) in the first six months after PMTCT enrollment and risk ratios compared uptake of six week testing for HIV-exposed infants (HEI) between the pre- and post-periods. RESULTS: In the pre-period, 223 (63.2%) of 353 pregnant AYWLH newly enrolled in ANC had ART data, while 320 (71.1%) of 450 in the post-period had ART data (p = 0.02). A higher proportion of women in the post-period (62.8%) had known HIV-positive status at first ANC visit compared to 49.3% in the pre-period (p < 0.001). Among pregnant AYWLH < 20 years, the incidence rate of LTFU in the first six months after enrollment in ANC services declined from 2.36 per 100 person months (95%CI 1.06-5.25) in the pre-period to 1.41 per 100 person months (95%CI 0.53-3.77) in the post-period. In both univariable and multivariable analysis, AYWLH < 20 years in the post-period were almost 40% less likely to be LTFU compared to the pre-period, although this finding did not meet the threshold for statistical significance (adjusted incidence rate ratio 0.62, 95%CI 0.38-1.01, p = 0.057). Testing for HEI was 10% higher overall in the post-period (adjusted risk ratio 1.10, 95%CI 1.01-1.21, p = 0.04). CONCLUSIONS: Interventions are urgently needed to improve outcomes among pregnant and postnatal AYWLH. We observed a trend towards increased retention among pregnant adolescents during our intervention and a statistically significant increase in uptake of six week HEI testing.