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Title
Where did they go? – An exploration of “silent” and “non-silent” cross-facility geospatial movements of persons on HIV treatment in Kenya, 2020-2021
Presenter
Anthony Waruru
Authors
A. Waruru1, J. Muthusi1, A. Kibisu2, M. Ndisha1, K. King’utu3, K. Muthoka4, E. Okango3, L. Odero5, K. Masamaro1, S. Jonnalaggadda1, J.L. Tobias6, R. Wafula2
Institutions
1US Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Nairobi, Kenya, 2National AIDS and STI Control Program (NASCOP), Nairobi, Kenya, 3University of California San Francisco, Global Programs for Research and Training (GPRT), Nairobi, Kenya, 4Palladium, Nairobi, Kenya, 5The United States Agency for International Development (USAID), Nairobi, Kenya, 6US Centers for Disease Control and Prevention (CDC), Atlanta, United States

BACKGROUND: A superficially “leaky” HIV treatment cascade may result from inaccurate accounting of persons living with HIV (PLHIV). PLHIV may register afresh in a different facility as “silent transfers” soon after initiating antiretroviral therapy (ART) or transfer out officially (“non-silent” transfers). We analyzed longitudinal data from HIV case-based surveillance (CBS) system to describe “silent,” and “non-silent” inter-facility geospatial movements and factors associated with the movements of PLHIV initiated on treatment in 40/47 counties in Kenya from 2020-2021.
METHODS: We selected a few demographic variables and clinic numbers and used Stata’s dtalink package to match and identify duplicate PLHIV who had moved from the facilities where they initiated ART. We mapped interfacility movements and explored factors associated with these movements using logistic regression.
RESULTS: Of the 201,465 PLHIV who initiated ART in this period, 4,859 were duplicate PLHIV. Among duplicate PLHIV 66 (1.4%) had moved from their original facility silently; 2,473 (50.9%) PLHIV were documented as still active in their original facility - 40.9% (27) of the “silent” and 51.0% (2446) of the “non-silent” transfers. Most PLHIV (>50%) moved within 1-3 months, 1,396 (28.7%), and 1,315 (27.1%) within 6-12 months. Half of the movements were within medium HIV burden counties (figure). PLHIV initially registered in county or referral hospitals (levels 5 or 6) had higher odds of moving than those initiating ART in lower-level facilities adjusted odds ratio (aOR) 2.3, (95% CI: 1.1-5.0); and being female compared to male aOR 2.5, (95% CI: 1.2-5.4).
CONCLUSIONS: Individual-level and facility factors influence the movement of PLHIV; of whom half moved across facilities but were still alive and currently on treatment, and should not be double-counted. A functional national unique person’s identifier will help classify inter-facility PLHIV movements better through shared health records and make PLHIV management efficient as they re-engage in care.

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