Effect of an opt-out point-of-care HIV-1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: The Tambua Mapema Plus Study

Effect of an opt-out point-of-care HIV-1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: The Tambua Mapema Plus Study
Up to 69% of adults who acquire HIV in Kenya seek care before seroconversion, providing 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. Using a stepped-wedge trial design, we enrolled 1,374 eligible participants during the observation period to assess standard care, and 1,500 in the HIV testing intervention at 6 health facilities in Kenya, then estimated the potential impact of TMP on the Kenyan HIV epidemic using a stochastic agent-based model. Cost-effectiveness analysis was used to evaluate the incremental cost-effectiveness ratio of standard care, scaled up rapid HIV testing alone, and the TMP intervention, if scaled up in Kenya.