Trends in characteristics of HIV diagnosis at a tertiary HIV clinic in Nairobi, Kenya, 2010- 2020

ABSTRACT Background Twenty percent of Kenyans aged 15-64 years did not know their HIV status in 2018. Such gaps in utilization of HIV testing by the population have impeded in-country progress in the HIV response. Understanding the characteristics of newly diagnosed HIV patients can inform the design of targeted interventions to address this gap. We describe trends in sociodemographic and clinical characteristics of individuals who were newly diagnosed with HIV at a large urban referral HIV clinic in Kenya. Methods We conducted a retrospective cohort study of people living with HIV who tested positive or presented with a positive diagnosis for the first time at the Kenyatta National Hospital (KNH) between 1 st January 2010 and 30 th September 2020. We assessed trends in sociodemographic and clinical characteristics using the Cochran-armitage test. Results We included a total of 8,595 patients in our analysis, with females accounting for 62%. A majority (91%) of patients were aged 25 years and above and were married (49%). Compared to females, males were more likely to have advanced HIV disease (AHD) WHO stage III/IV (29% vs 36%); CD4<200 (23% vs 31%) respectively. The proportion of new diagnoses with early disease (WHO stage I and II) increased by 10% from 2010 to 2020 (66%-76%) (p<0.001). Of all newly diagnosed persons, the proportion of 25-34 year olds increased from 6% in 2010 to 21% in 2020 (p<0.001). An upward trend was also observed among 35-44 year olds, while the proportion among children (2-8 years), adolescents (9-14 years) and youth (15-24 years) remained low and stable over the study period. HIV testing in the outpatient department was the most common testing modality in 2010 at 80% but declined to 1% in 2020 (p<0.001). The proportion of persons who were transferred to our hospital having already been tested for HIV increased from 13% to 27% (p<0.001). Fewer persons presented with current or previous opportunistic infections from 2010 to 2020. Conclusion We demonstrated gaps in timely identification of men and an increase in the proportion of those aged 25-34 years and 35-44 years among persons newly diagnosed with HIV between 2010 and 2020. We also noted an overall decline in opportunistic infections and advanced HIV disease presentations. The identified gaps suggest increasing prioritization of interventions targeted at early identification of men, and prevention of HIV infection especially in those aged 25-44 years.