Influence of alcohol-serving venue characteristics on yield of HIV status-neutral screening in rural East Africa

Résumé

Alcohol-serving venues are high-risk sites for HIV transmission in East Africa. Understanding how venue characteristics influence HIV screening outcomes may help to target venue-based outreach. In eight rural communities in Kenya and Uganda, we mapped all alcohol-serving venues (N = 530) and invited owners to participate in a cluster-randomized trial to promote biomedical HIV prevention uptake: 527 (99%) owners agreed to participate. We distributed cards recruiting adults (≥18 years) for free HIV testing with rapid initiation of HIV biomedical prevention or treatment. We characterized the yield of venue-based recruitment and evaluated venue-level correlates of being newly diagnosed with HIV, being previously diagnosed but out-of-care, and having self-reported HIV risk. Of 480 participating venues (Kenya = 89, Uganda = 391; 41 closed pre-recruitment and 6 had no one present), 61 (13%) had rooms for sex work; 91 (19%) offered condoms, and the median patrons/venue was 10/weekend-day. Staff distributed 9,375 cards and 7,744 (83%) adults participated in HIV screening. Of those screened, the median age was 34 years (IQR:26-43), 62% were men, and 1,620 (21%) had HIV. Among persons without known HIV, 141/6,265 (2.3%) were newly-diagnosed with HIV. Among persons with known HIV, 78/1,479 (5.3%) were out-of-care. Among persons without HIV, 2,285/6,124 (37%) reported HIV risk. The odds of having newly-diagnosed HIV increased significantly with each additional patron/weekend-day at a given venue (adjusted odds ratio [aOR]=1.03, 95%CI:1.00-1.05, p = 0.025). The odds of being previously diagnosed but out-of-care were significantly lower among attendees at venues with condoms on site (aOR=0.39, 95%CI:0.16-0.99, p = 0.047). The odds of reporting HIV risk were significantly higher among attendees at venues with condoms (aOR=1.25, 95%CI:1.04-1.49, p = 0.015), more patrons/weekday (aOR=1.01, 95%CI:1.00-1.02, p = 0.022), and more barmaids (aOR=1.07, 95%CI:1.01-1.13, p = 0.013). Alcohol-serving venue characteristics were predictive of the yield of persons with untreated HIV or high HIV risk, and could aid programs in targeting venues for HIV prevention and treatment.

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