title: Lack of knowledge of HIV status a major barrier to HIV prevention, care and treatment efforts in Kenya: results from a nationally representative study.
abstract: BACKGROUND
  We analyzed HIV testing rates, prevalence of undiagnosed HIV, and predictors of testing in the Kenya AIDS Indicator Survey (KAIS) 2007.
  
  
  METHODS
  KAIS was a nationally representative sero-survey that included demographic and behavioral indicators and testing for HIV, HSV-2, syphilis, and CD4 cell counts in the population aged 15-64 years. We used gender-specific multivariable regression models to identify factors independently associated with HIV testing in sexually active persons.
  
  
  RESULTS
  Of 19,840 eligible persons, 80% consented to interviews and blood specimen collection. National HIV prevalence was 7.1% (95% CI 6.5-7.7). Among ever sexually active persons, 27.4% (95% CI 25.6-29.2) of men and 44.2% (95% CI 42.5-46.0) of women reported previous HIV testing. Among HIV-infected persons, 83.6% (95% CI 76.2-91.0) were unaware of their HIV infection. Among sexually active women aged 15-49 years, 48.7% (95% CI 46.8-50.6) had their last HIV test during antenatal care (ANC). In multivariable analyses, the adjusted odds ratio (AOR) for ever HIV testing in women ≥35 versus 15-19 years was 0.2 (95% CI: 0.1-0.3; p<0.0001). Other independent associations with ever HIV testing included urban residence (AOR 1.6, 95% CI: 1.2-2.0; p = 0.0005, women only), highest wealth index versus the four lower quintiles combined (AOR 1.8, 95% CI: 1.3-2.5; p = 0.0006, men only), and an increasing testing trend with higher levels of education. Missed opportunities for testing were identified during general or pregnancy-specific contacts with health facilities; 89% of adults said they would participate in home-based HIV testing.
  
  
  CONCLUSIONS
  The vast majority of HIV-infected persons in Kenya are unaware of their HIV status, posing a major barrier to HIV prevention, care and treatment efforts. New approaches to HIV testing provision and education, including home-based testing, may increase coverage. Targeted interventions should involve sexually active men, sexually active women without access to ANC, and rural and disadvantaged populations.
authors.affiliation: National AIDS/STI Control Programme (NASCOP), Nairobi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kaiser
authors.forename: Jennifer
authors.initials: J
authors.lastname: Galbraith
authors.forename: John
authors.initials: J
authors.lastname: Williamson
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shiraishi
authors.forename: Carol
authors.initials: C
authors.lastname: Ngare
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Marum
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003625:Data Collection; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006285:Health Planning; D006801:Humans; D007630:Kenya; D007753:Laboratories; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011634:Public Health / Q000706:statistics & numerical data; D057566:Self Report; D012725:Sexual Behavior / Q000706:statistics & numerical data; D055815:Young Adult