2. Knowledge of HIV Status in Kenya
Proportion aware of HIV+ status, KAIS 2007 and 2012
>50% PLWH unaware of HIV+ status in 2012
HIV testing gap greater among men than women

3. Cluster RCT on Assisted Partner Notification Services (aPNS) in Kenya
Main study conducted
18 rural and urban areas in central and western Kenya
Intervention arm: Immediate aPNS
Control arm: Delayed aPNS by 6 weeks
Results:
Partner testing rates increased 5-fold
Rates of first-time HIV testing increased 15-fold
Rates of testing HIV positive increased 5-fold
No intimate partner violence (IPV) cases were attributable to intervention
This study was one of the four RCTs that have informed the WHO recommendation
Dr. Peter Cherutich, Deputy Medical Director, Kenya MoH
Cherutich et al. Lancet HIV 2017

4. Do Index Characteristics Modify aPNS Efficacy?
For 1119 index clients, characteristics included:
High vs. low HIV prevalence region (range 3.8% to 23.7%)
Rural/peri-urban vs. urban location
Gender (62% female)
Age (median 30 years)
Knowledge of HIV status (new dx for 82%)
For 1286 partners (~1.3 per index), outcomes included:
Partner testing rates
Rates of first-time HIV testing
Rates of testing HIV positive
Linkage to care
Generalized Estimating Equations (GEE) used to calculate incidence rate ratios

5. HIV Testing Outcomes for Partners
Higher rates of HIV testing for index who are:
In high HIV prevalence region
In rural or peri-urban facilities
Female
Newly diagnosed
Identifying new HIV positives was more likely if aPNS offered to female index compared to male index.
we demonstrate that aPS efficacy varies across key index characteristics and achieves higher HIV testing rates for some hard-to-reach
populations, such as men in rural areas. Specifically, we found rates of HIV testing were significantly higher when offered to index participants in the high HIV prevalence Nyanza region versus lower prevalence regions in Kenya, in rural or periurban facilities rather than urban facilities. HIV testing rates were also higher when offered to female rather than male index participants, and to those who were newly diagnosed with HIV compared to those with known HIV.
HIV case finding rates were significantly higher only for female index compared to male index participants.

6. Why are there differences?
Increased aPNS efficacy for index client location and gender may be attributed to:
Reduced access to HIV testing in rural areas and western Kenya
Low baseline testing rates among men in all locations

7. Why should we care?
Reach those who have remained undiagnosed in the setting of existing HIV testing services
Identify and map areas and populations with low testing rates and high HIV prevalence
Use to plan health policy and set more granular and realistic aPNS targets
Develop appropriate strategies for aPNS scale-up, monitoring and evaluation

8. Conclusion
aPNS can reduce the gap in HIV testing, diagnosis and linkage to care gap between men and women
Target populations must have access to HIV treatment and prevention services for these populations, including resources for IPV

9. Acknowledgements UW, KNH and NASCOP Study Team members
Sarah Masyuko, Peter Cherutich, Mathew Golden, Beatrice Wamuti, Felix Abuna, Betsy Sambai, Peter Maingi, David Bukusi, Paul Macharia, Matt Dunbar, Barbara Richardson, Ann Ng’ang’a
Ministry of Health, Kenya
Mary Mugambi, Martin Sirengo
All Health Advisors and study participants
US National Institutes of Health for funding: NIAID R01 A and Fogarty International Center D43 TW

10. Graçias! Asante Sana! Thank you!