Routinely offered opt-out testing for acute and chronic HIV infection could identify twice as many undiagnosed cases of HIV as standard care in Kenya, according to a recent study. The Tambua Mapema Plus (TMP) Trial was conducted in Kilifi and Mombasa County, Kenya from 2017 to 2020.

Using an opt-out point-of-care (POC) HIV-1 nucleic acid amplification testing (NAAT) intervention, researchers led by Dr. Susan Graham from the UW Department of Global Health (DGH) and Dr. Eduard Sanders from Oxford and the Kenya Medical Research Institute set out to determine the number of new HIV diagnoses among symptomatic participants seeking care at outpatient clinics.

Through a stepped-wedge trial, a type of randomized control trial that evaluates outcomes before and after the intervention is implemented over a number of waves, researchers found that the POC NAAT identified HIV in 2.4% of intervention participants versus 0.9% of standard care participants; 5.4% of intervention participants had acute HIV infection. These results indicate that regular testing for both acute and chronic HIV infection could detect more cases of HIV among adult symptomatic outpatients, ultimately leading to improvements in health and quality of life for countless individuals.

UW CSDE Senior Research Scientist Deven Hamilton and faculty member Steve Goodreau, as well as former DGH faculty member Joseph Babigumira, played key roles in this study by modeling the potential impact that a scaled-up TMP intervention could have on preventing further HIV transmission, as more people living with HIV would be aware of their HIV status and earlier treatment would decrease transmission. A cost-effectiveness evaluation based on this model also demonstrated the value of investing in POC NAAT testing. “Tambua Mapema Plus shows us one way we can be more aggressive in stopping HIV in its tracks” said Dr. Graham, professor of global health and medicine at UW.

UW researchers including Drs. Graham, Hamilton, Goodreau, Babigumira, and Dr. Carey Farquhar worked alongside partners from the KEMRI-Wellcome Trust Research Programme, the University of Oxford, and the Kenya National AIDS & STI Control Programme in this work. Funding was provided by the National Institute of Allergy and Infectious Diseases.

View the one-page brief here.


By Sophie Li