Testing, Testing: Multiple HIV-Positive Tests among Patients Initiating Antiretroviral Therapy in Ethiopia

Summary:
A recent ISPH study concluded that repeat HIV-positive testing (vs single occurrence re-testing), after a receiving a positive result appears to stem from doubt over their HIV status and whether they tested at another facility.  The odds of repeat (versus single) HIV-positive testing were lower among those who initially tested because of symptoms. Repeat HIV testing after a positive result has never been studied systematically and may provide insight into reasons for delayed linkage to care and providers need to be aware of this potential when counseling those who test HIV-positive.  Repeat HIV-positive testing-not a rare occurrence-appears to stem from doubt, seeking care at a facility other than where diagnosed, and testing for a reason other than having symptoms.

Abstract:
Repeat HIV testing after receiving a positive result has never been studied systematically and may give insight into reasons for delayed linkage to care. Among 831 adults in 6 secondary facilities in Oromia, Ethiopia, who completed an interviewer-administered structured questionnaire within 2 weeks of initiating antiretroviral therapy in 2012 to 2013, 110 (13.2%) reported having retested after an HIV-positive result. The odds of repeat (versus single) HIV-positive testing were higher among those who had doubted their HIV status (adjusted odds ratio [AOR]ref=nodoubt = 6.5; 95% confidence interval [CI]: 3.7-11.4) and those who initially tested at another facility, whether another secondary facility (AOR ref=studyfacility = 22.7; 95% CI: 11.0-46.9) or a lower-level facility (AORref=studyfacility = 19.1; 95% CI: 10.5-34.5). The odds of repeat (versus single) HIV-positive testing were lower among those who initially tested because of symptoms (AORref=not a reason = 0.40; 95% CI: 0.24-0.66). Median time between initial diagnosis and enrollment in care was 12.3 versus 1.0 month for repeat and single HIV-positive testers, respectively ( P < .001). Repeat HIV-positive testing-not a rare occurrence-appears to stem from doubt, seeking care at a facility other than where diagnosed, and testing for a reason other than having symptoms. Because repeat HIV-positive testing is associated with delay in linkage to care, providers should be aware of this potential when counseling those who test HIV positive.

Citation:  Kulkarni STymejczyk O, Gadisa T, Lahuerta M, Remien RH, Melaku Z, El-Sadr W, Elul B, Nash D, Hoffman S. “Testing, Testing”: Multiple HIV-Positive Tests among Patients Initiating Antiretroviral Therapy in Ethiopia. J Int Assoc Provid AIDS Care. 2017 Jan 1:2325957417737840. doi: 10.1177/2325957417737840.  Link to PubMed >>

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