Uptake of Community-Based HIV Testing during a Multi-Disease Health Campaign in Rural Uganda (original) (raw)
Related papers
Leveraging Rapid Community-Based HIV Testing Campaigns for Non-Communicable Diseases in Rural Uganda
PLoS ONE, 2012
Background: The high burden of undiagnosed HIV in sub-Saharan Africa limits treatment and prevention efforts. Community-based HIV testing campaigns can address this challenge and provide an untapped opportunity to identify noncommunicable diseases (NCDs). We tested the feasibility and diagnostic yield of integrating NCD and communicable diseases into a rapid HIV testing and referral campaign for all residents of a rural Ugandan parish.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2020
Introduction: HIV self-testing (HIVST) is an alternative strategy for reaching population subgroups underserved by available HIV testing services. We assessed individual factors associated with ever HIVST within a community-based programme. Setting: Malawi. Methods: We conducted secondary analysis of an endline survey administered under a cluster-randomised trial of community-based distribution of HIVST kits. We estimated prevalence differences and prevalence ratios (PR) stratified by sex for the outcome: selfreported ever HIVST. Results: Prevalence of ever HIVST was 45.0% (475/1,055) among men and 40.1% (584/1,456) among women. Age was associated with ever HIVST in both men and women, with evidence of a strong declining trend across categories of age. Compared with adults aged 25-39 years, HIVST was lowest among adults aged 40 years and older for both men (34.4%, 121/352; PR 0.74, 95% CI 0.62-0.88) and women (30.0%, 136/454; PR 0.71, 95% CI 0.6-0.84). Women who were married, had children, had higher levels of education or were A C C E P T E D wealthier were more likely to self-test. Men who had condomless sex in the last three months (47.9%, 279/582) reported higher HIVST prevalence compared with men who did not have recent condomless sex (43.1%, 94/218; aPR 1.37, 95% CI: 1.06-1.76). Among men and women, the level of previous exposure to HIV testing and household HIVST uptake were associated with HIVST. Conclusions: Community-based HIVST reached men, younger age groups, and some at-risk individuals. HIVST was lowest among older adults and individuals with less previous exposure to HIV testing, suggesting the presence of ongoing barriers to HIV testing.
The Lancet HIV, 2021
Background Some countries are struggling to reach the UNAIDS target of 90% of all individuals with HIV knowing their HIV status, especially among men and youth. To identify individuals who are unaware of their HIV-positive status and achieve testing saturation, we implemented a hybrid HIV testing approach in an urban informal settlement in western Kenya. In this study, we aimed to describe the uptake of HIV testing and linkage to care and treatment during this programme. Methods The Community Health Initiative involved community mapping, household census, multidisease community health campaigns, and home-based tracking in the informal settlement of Obunga in Kisumu, Kenya. 52 multidisease community health campaigns were held throughout the programme coverage area, at which HIV testing by certified testing service counsellors was one of the health services available. Individuals aged 15 years or older who were not previously identified as HIV-positive, children younger than 15 years who reported being sexually active or for whom testing was requested by a parent or guardian, and individuals who tested HIV-negative within the past 3 months but who reported a recent risk were all eligible for testing. Health and counselling services were tailored for men and youth to encourage their participation. Individuals identified during the census who did not attend a community health campaign were tracked using global positioning system data and offered home-based HIV testing services. We calculated the previously unidentified fraction, defined as the number of individuals who were newly identified as HIV-positive as a proportion of all individuals previously identified and newly identified as HIV-positive. Findings Between Jan 11 and Aug 29, 2018, the Community Health Initiative programme reached 23 584 individuals, of whom 11 526 (48•9%) were men and boys and 5635 (23•9%) were aged 15-24 years. Of 12 769 individuals who were eligible for HIV testing, 12 407 (97•2%) accepted testing, including 3917 (31•6%) first-time testers. 101 individuals were newly identified as HIV-positive out of 1248 total individuals who were HIV-positive, representing an 8•1% previously unidentified fraction. The previously unidentified fraction was highest among men (9•8%) and among people aged 15-24 years (15•3%). Interpretation Community-based hybrid HIV testing was successfully implemented in an urban setting. Innovative approaches that make HIV testing more accessible and acceptable, particularly to men and young people, are crucial for achieving testing and treatment saturation. Focusing on identifying individuals who are unaware of their HIV-positive status in combination with monitoring the previously unidentified fraction has the potential to achieve the UNAIDS Fast Track commitment to end AIDS by 2030.
PLoS Medicine, 2014
Background: The success of HIV programs relies on widely accessible HIV testing and counseling (HTC) services at health facilities as well as in the community. Home-based HTC (HB-HTC) is a popular community-based approach to reach persons who do not test at health facilities. Data comparing HB-HTC to other community-based HTC approaches are very limited. This trial compares HB-HTC to mobile clinic HTC (MC-HTC).
African Journal of Reproductive Health, 2013
Home-based HIV counselling and testing (HBHCT) and community mobilization have been proven to be effective in increasing the number of people linked to HIV care and treatment. An assessment was conducted in 18 health facilities in Uganda to evaluate the availability and extent of home based testing services and community mobilization activities in underserved communities. The performance of the health facilities was assessed using a checklist with indicators of HBHCT and community mobilization. While most of the health facilities (72.2%) had active community mobilization, only 12.2% had HBHCT services and this might have affected universal access to HIV prevention, care and treatment. The health facilities did not accompany their intensive community mobilization activities with HBHCT yet this provided the ideal entry point and opportunity to improve linkage to HIV treatment and care.
Non-enrollment for free community HIV care: findings from a population-based study in Rakai, Uganda
AIDS Care, 2011
Improved understanding of HIV-related health-seeking behavior at a population level is important in informing the design of more effective HIV prevention and care strategies. We assessed the frequency and determinants of failure to seek free HIV care in Rakai, Uganda. HIV-positive participants in a community cohort who accepted VCT were referred for free HIV care (cotrimoxazole prophylaxis, CD4 monitoring, treatment of opportunistic infections, and, when indicated, antiretroviral therapy). We estimated proportion and adjusted Prevalence Risk Ratios (adj. PRR) of non-enrollment into care six months after receipt of VCT using log-binomial regression. About 1145 HIV-positive participants in the Rakai Community Cohort Study accepted VCT and were referred for care. However, 31.5% (361/1145) did not enroll into HIV care six months after referral. Non-enrollment was significantly higher among men (38%) compared to women (29%, p=0.005). Other factors associated with non-enrollment included: younger age (15-24 years, adj. PRR=2.22; 95% CI: 1.64, 3.00), living alone (adj. PRR=2.22; 95% CI: 1.57, 3.15); or in households with 1-2 co-residents (adj. PRR=1.63; 95% CI: 1.31, 2.03) compared to three or more co-residents, or a CD4 count >250 cells/ul (adj. PRR=1.81; 95% CI: 1.38, 2.46). Median (IQR) CD4 count was lower among enrolled 388 cells/ul (IQR: 211,589) compared to those not enrolled 509 cells/ul (IQR: 321,754). About one-third of HIV-positive persons failed to utilize community-based free services. Non-use of services was greatest among men, the young, persons with higher CD4 counts and the more socially isolated, suggesting a need for targeted strategies to enhance service uptake.
BMC Health Services Research, 2011
Background In Uganda, public human immunodeficiency virus (HIV) Voluntary Counseling and Testing (VCT) services are mainly provided through the facility based model, although the home based approach is being promoted as a strategy for improving access to VCT. However the uptake of VCT varies according to service delivery model and is influenced by a number of factors. The aim of this study therefore, was to compare predictors for uptake of facility and home based VCT in a rural context. Methods A longitudinal study with cross-sectional investigative phases was conducted at two sites (Rugando and Kabingo) in southwestern Uganda between November 2007 (baseline) and March 2008 (follow up). During the baseline visit, facility based VCT was offered at the main health centre in Rugando while home based VCT was offered at the household level in Kabingo and a mixed survey questionnaire administered to the respondents. The results presented in this paper are derived from only the baseline data. Results Nine hundred ninety four (994) respondents were interviewed, of whom 500 received facility based VCT in Rugando and 494 home based VCT in Kabingo during the baseline visit. The respondents had a mean age of 32.2 years (SD 10.9) and were mainly female (68 percent). Clients who received facility based VCT were less likely to be residents of the more rural households (adjusted Odds Ratio (aOR) = 0.14, 95% CI 0.07, 0.22). The clients who received home based VCT were less likely to report having an STI symptom (aOR = 0.63, 95% CI 0.46, 0.86), and more likely to be worried about discrimination if they contracted AIDS (aOR = 1.78, 95% CI 1.22, 2.61). Conclusion The uptake of VCT provided through either the facility or home based models is influenced by client characteristics such as proximity to service delivery points, HIV related symptoms, and fear of discrimination in rural Uganda. Interventions that seek to improve uptake of VCT should provide potential clients with both facility and home based VCT options within a given setting. The clients are then able to select a model for VCT that best fits their characteristics. This is likely to have positive implications for both service coverage and uptake by different sub-groups within particular communities.
African Journal of Reproductive Health, 2013
Home-based HIV counselling and testing (HBHCT) and community mobilization have been proven to be effective in increasing the number of people linked to HIV care and treatment. An assessment was conducted in 18 health facilities in Uganda to evaluate the availability and extent of home based testing services and community mobilization activities in underserved communities. The performance of the health facilities was assessed using a checklist with indicators of HBHCT and community mobilization. While most of the health facilities (72.2%) had active community mobilization, only 12.2% had HBHCT services and this might have affected universal access to HIV prevention, care and treatment. The health facilities did not accompany their intensive community mobilization activities with HBHCT yet this provided the ideal entry point and opportunity to improve linkage to HIV treatment and care.
Uptake of HIV Testing: Assessing the Impact of a Community-Based Intervention in Rural Nigeria
HEALTH SCIENCES AND DISEASES, 2020
Background. Voluntary counselling and testing (VCT) are the entry point for HIV/AIDS prevention and control for many community-based intervention programs. These VCT services are usually provided by Health care facilities. This study aims to assess the uptake of testing as a result of community-based intervention programs in a Nigerian rural community. Methodology. Quantitative survey that using a structured questionnaire among a sample of the general population aged 15 – 49 years. Demographic data (age, sex, education, occupation, marital status) and information related to HIV testing were sought. Data were analyzed using SPSS 25.0. Results. There were more male’s respondents (53.3%, baseline and 54.2%, post-intervention survey). The level of awareness of the availability of VCT services increased from 65.1% and 63.8% in males and females at the baseline survey to 89% and 87% in the post-intervention survey. The willingness to have HIV tests was relatively high in both surveys. ov...
BMC Infectious Diseases
Background Prevention of new HIV infections is a critical public health issue. The highest HIV testing gaps are in men, adolescents 15–19 years old, and adults 40 years and older. Community-based HIV testing services (HTS) can contribute to increased testing coverage and early HIV diagnosis, with HIV self-testing (HIVST) strategies showing promise. Community-based strategies, however, are resource intensive, costly and not widely implemented. A community-led approach to health interventions involves supporting communities to plan and implement solutions to improve their health. This trial aims to determine if community-led delivery of HIVST can improve HIV testing uptake, ART initiation, and broader social outcomes in rural Malawi. Methods The trial uses a parallel arm, cluster-randomised design with group village heads (GVH) and their defined catchment areas randomised (1:1) to community-led HIVST or continue with the standard of the care (SOC). As part of the intervention, informa...