Undisclosed HIV infection and art use in the kenya AIDS indicator survey 2012: relevance to targets for HIV diagnosis and treatment in kenya.

OBJECTIVES: To assess the impact of undisclosed HIV infection and antiretroviral (ARV) therapy (ART) on national estimates of diagnosed HIV and ART coverage in Kenya.

METHODS: HIV-positive dried blood spot samples from Kenya's second AIDS Indicator Survey were tested for an ARV biomarker by liquid chromatography-tandem mass spectrometry. Estimates of diagnosed HIV and ART use based on self-report were compared with those corrected for undisclosed HIV infection and ART use based on ARV testing. Multivariate analysis determined factors associated with undisclosed HIV infection and ART use among persons on ART.

RESULTS: Among 559 HIV-positive samples, the ARV biomarker was detected in 42.5% (CI 37.4-47.7). ARV drugs were present in 90.7% (CI 86.1-95.2) reporting HIV-positive status and receiving ART, 66.7% (CI 59.9-73.4) reporting HIV-positive status irrespective of ART use, 21.0% (CI 13.4-28.6) reporting HIV-negative status, and 19.3% (CI 9.0-29.5) reporting no previous HIV test. After correcting for undisclosed HIV infection and ART use, diagnosed HIV increased from 46.9% to 57.2% and ART coverage increased from 31.8% to 42.8%. Undisclosed HIV infection on ART was associated with being aged 25-39 years and not visiting a health provider in the past year, while younger age and higher wealth was associated with undisclosed ART use.

CONCLUSION: Substantial levels of undisclosed HIV infection and ART use while on ART were observed, resulting in diagnosed HIV underestimated by 112,000 persons and ART coverage by 131,000 persons. Supplementing self-reported ART status with objective measures of ART use in national population-based sero-surveys can improve monitoring of treatment targets in countries.