Evaluation of Kenya’s readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance

BACKGROUND: Sentinel surveillance for HIV among women attending antenatal clinics using unlinked anonymous testing is a cornerstone of HIV surveillance in sub-Saharan Africa. Increased use of routine antenatal HIV testing allows consideration of using these programmatic data rather than sentinel surveillance data for HIV surveillance. METHODS: To gauge Kenya’s readiness to discontinue sentinel surveillance, we evaluated whether recommended World Health Organization standards were fulfilled by conducting data and administrative reviews of antenatal clinics that offered both routine testing and sentinel surveillance in 2010. RESULTS: The proportion of tests that were HIV-positive among women aged 15–49 years was 6.2 % (95 % confidence interval [CI] 4.6–7.7 %] in sentinel surveillance and 6.5 % (95 % CI 5.1–8.0 %) in routine testing. The agreement of HIV test results between sentinel surveillance and routine testing was 98.0 %, but 24.1 % of specimens that tested positive in sentinel surveillance were recorded as negative in routine testing. Data completeness was moderate, with HIV test results recorded for 87.8 % of women who received routine testing. CONCLUSIONS: Additional preparation is required before routine antenatal HIV testing data can supplant sentinel surveillance in Kenya. As the quality of program data has markedly improved since 2010 a repeat evaluation of the use of routine antenatal HIV testing data in lieu of ANC sentinel surveillance is recommended

Leveraging electronic medical records for HIV testing, care, and treatment programming in Kenya—the national data warehouse project

Abstract Background Aggregate electronic data repositories and population-level cross-sectional surveys play a critical role in HIV programme monitoring and surveillance for data-driven decision-making. However, these data sources have inherent limitations including inability to respond to public health priorities in real-time and to longitudinally follow up clients for ascertainment of long-term outcomes. Electronic medical records (EMRs) have tremendous potential to bridge these gaps when harnessed into a centralised data repository. We describe the evolution of EMRs and the development of a centralised national data warehouse (NDW) repository. Further, we describe the distribution and representativeness of data from the NDW and explore its potential for population-level surveillance of HIV testing, care and treatment in Kenya. Main body Health information systems in Kenya have evolved from simple paper records to web-based EMRs with features that support data transmission to the NDW. The NDW design includes four layers: data warehouse application programming interface (DWAPI), central staging, integration service, and data visualization application. The number of health facilities uploading individual-level data to the NDW increased from 666 in 2016 to 1,516 in 2020, covering 41 of 47 counties in Kenya. By the end of 2020, the NDW hosted longitudinal data from 1,928,458 individuals ever started on antiretroviral therapy (ART). In 2020, there were 936,869 individuals who were active on ART in the NDW, compared to 1,219,276 individuals on ART reported in the aggregate-level Kenya Health Information System (KHIS), suggesting 77% coverage. The proportional distribution of individuals on ART by counties in the NDW was consistent with that from KHIS, suggesting representativeness and generalizability at the population level. Conclusion The NDW presents opportunities for individual-level HIV programme monitoring and surveillance because of its longitudinal design and its ability to respond to public health priorities in real-time. A comparison with estimates from KHIS demonstrates that the NDW has high coverage and that the data maybe representative and generalizable at the population-level. The NDW is therefore a unique and complementary resource for HIV programme monitoring and surveillance with potential to strengthen timely data driven decision-making towards HIV epidemic control in Kenya. Database link ( https://dwh.nascop.org/ )

Effect of the SARS-CoV-2 pandemic, defined as the period after the first documented case when compared to the period prior to the pandemic, on virologic non-suppression amongst HIV infected individuals >15 years starting combination antiretroviral therapy using data from the national data warehouse sampling framework in Kenya (April 01^st 2018 to March 31^st 2021, N = 7,406)^b'*'.

Effect of the SARS-CoV-2 pandemic, defined as the period after the first documented case when compared to the period prior to the pandemic, on virologic non-suppression amongst HIV infected individuals >15 years starting combination antiretroviral therapy using data from the national data warehouse sampling framework in Kenya (April 01st 2018 to March 31st 2021, N = 7,406)b'*'.</p

Distribution of HIV infected individuals >15 years old, starting combination antiretroviral therapy, included in the national data warehouse sampling framework and randomly sampled, by COVID-19 exposure status in Kenya (April 2018 to March 2021, N = 7,046).

Distribution of HIV infected individuals >15 years old, starting combination antiretroviral therapy, included in the national data warehouse sampling framework and randomly sampled, by COVID-19 exposure status in Kenya (April 2018 to March 2021, N = 7,046).</p

Overall effect of the COVID-19 pandemic, defined as period after the first documented case when compared to the period prior to the pandemic, on initial virologic non-suppression (VnS) amongst HIV infected individuals aged >15 years using data from the national data warehouse sampling framework in Kenya (April 2018 to March 2021, N = 7,046).

Overall effect of the COVID-19 pandemic, defined as period after the first documented case when compared to the period prior to the pandemic, on initial virologic non-suppression (VnS) amongst HIV infected individuals aged >15 years using data from the national data warehouse sampling framework in Kenya (April 2018 to March 2021, N = 7,046).</p

Fig 4 -

(a) Graph showing six-months retention after ART initiation by COVID-19 exposure calendar period when compared to the period prior to the pandemic, and (b) by high infection zone counties, amongst HIV infected individuals >15 years using data from the national data warehouse sampling framework in Kenya (April 01st 2018 to March 31st 2021, N = 7,046).</p

Effect of the COVID-19 pandemic, defined as the period after the first documented case when compared to the period prior to the pandemic, on time from a HIV diagnosis to combination antiretroviral therapy start (Same-day HIV diagnosis and ART initiation) amongst HIV infected individuals aged >15 years using data from the national data warehouse sampling framework in Kenya (April 01^st 2018 to March 31^st 2021, N = 7,046)^b'*'.

Effect of the COVID-19 pandemic, defined as the period after the first documented case when compared to the period prior to the pandemic, on time from a HIV diagnosis to combination antiretroviral therapy start (Same-day HIV diagnosis and ART initiation) amongst HIV infected individuals aged >15 years using data from the national data warehouse sampling framework in Kenya (April 01st 2018 to March 31st 2021, N = 7,046)b'*'.</p

A comparison of the general eligible and randomly sampled population of HIV infected individuals aged >15 years at the start of combination antiretroviral therapy using data from the national data warehouse (April 01^st 2018 to March 31^st 2021, N = 352,322).

A comparison of the general eligible and randomly sampled population of HIV infected individuals aged >15 years at the start of combination antiretroviral therapy using data from the national data warehouse (April 01st 2018 to March 31st 2021, N = 352,322).</p