Role of Support Persons in Adolescent and Young Adult Voluntary HIV Testing and Counseling in Kenya

University of Washington Abstract Role of Support Persons in Adolescent and Young Adult Voluntary HIV Testing and Counseling in Kenya Jillian Neary Chair of the Supervisory Committee: Jennifer Slyker, MSc, PhD Assistant Professor, Global Health Adjunct Assistant Professor, Epidemiology Background: Adolescents and young adults (AYA) are the only age stratum in which HIV incidence and mortality are increasing. A quarter of AYA aged 15-24 in Kenya have been tested for HIV. Understanding how AYA leverage parent, partner, and peer support when testing for HIV can inform policies and programs aimed at improving the uptake and quality of AYA testing. Methods: AYA aged 14-24 who completed voluntary HIV testing and counseling (VCT) at a large urban referral hospital in Nairobi, Kenya completed a post-test, anonymous audio computer assisted self-interview (ACASI) survey. Questions assessed the role of parent, partner and peer support people (SP) in the AYA’s decision to test and the role they played in the AYA’s testing visit. SP were compared between AYA grouped by age (young: 14-19y vs older 20-24y), and cofactors for testing with SP were determined using relative risk regression. Results: Among 227 AYA assessed between October and December 2015, median age was 21 (IQR: 19-23). More than half of AYA presented with a SP (6.2% with a parent, 9.3% with a partner, 35.0% with a peer, 2.7% with others, and 2.1% with multiple types of support persons), and SP participated in all aspects of the testing visit. It was more common for older AYA to present alone (49.1% vs 30.2%, p=0.011) and less common to present with a parent (1.2% vs 19.1%, p<0.001) when compared to younger AYA. Similar proportions of younger and older AYA came with a peer, partner, or in a group (p>0.05 for all comparisons). Younger AYA were more likely than older AYA to be influenced in their decision to test for HIV by parents (22.2% vs 6.1%, p<0.001) (Figure 1). Using age as a continuous variable, older AYA were less likely to come to the VCT with a support person when compared to younger AYA (RR: 0.91 [95%CI: 0.85-0.98]). After controlling for age and previous HIV testing, peer-accompanied AYA were less likely to have correct HIV prevention knowledge (aRR: 0.50 [95%CI: 0.28-0.91] p=0.022) than those who came alone. Accompanied and unaccompanied AYA had similar knowledge regarding HIV transmission (P>0.05), and similar proportions had previously sought family planning services and had been tested for STI (p>0.05). Conclusion: Parent, partner, and peer SP play an important role in Kenyan AYA’s decision to seek HIV testing, and during the test visit itself. Young AYA leverage parental support while older AYA are more likely to come to the VCT unaccompanied. Defining the role of SP in the HIV testing visit and AYA care-seeking behaviors can inform strategies that leverage this support to enhance AYA HIV testing and care.