Lessons learned from a multi-disease community health campaign, to increase testing and knowledge of HIV status

Uptake of community-based HIV testing during a multi-disease health campaign in rural Uganda.

Chamie G, Kwarisiima D, Clark TD, Kabami J, Jain V, Geng E, Balzer LB, Petersen ML, Thirumurthy H, Charlebois ED, Kamya MR, Havlir DV. PLoS One 2014 Jan 2;9(1):e84317. doi: 10.1371/journal.pone.0084317.

Background: The high burden of undiagnosed HIV in sub-Saharan Africa is a major obstacle for HIV prevention and treatment. Multi-disease, community health campaigns (CHCs) offering HIV testing are a successful approach to rapidly increase HIV testing rates and identify undiagnosed HIV. However, a greater understanding of population-level uptake is needed to maximize effectiveness of this approach.

Methods: After community sensitization and a census, a five-day campaign was performed in May 2012 in a rural Ugandan community. The census enumerated all residents, capturing demographics, household location, and fingerprint biometrics. The CHC included point-of-care screening for HIV, malaria, TB, hypertension and diabetes. Residents who attended vs. did not attend the CHC were compared to determine predictors of participation.

Results: Over 12 days, 18 census workers enumerated 6 343 residents. 501 additional residents were identified at the campaign, for a total community population of 6 844. 4 323 (63%) residents and 556 non-residents attended the campaign. HIV tests were performed in 4 795/4 879 (98.3%) participants; 1 836 (38%) reported no prior HIV testing. Of 2 674 adults tested, 257 (10%) were HIV-infected; 125/257 (49%) reported newly diagnosed HIV. In unadjusted analyses, adult resident campaign non-participation was associated with male sex (62% male vs. 67% female participation, p = 0.003), younger median age (27 years in non-participants vs. 32 in participants; p<0.001), and marital status (48% single vs. 71% married/widowed/divorced participation; p<0.001). In multivariate analysis, single adults were significantly less likely to attend the campaign than non-single adults (relative risk [RR]: 0.63 [95% CI: 0.53-0.74]; p<0.001), and adults at home vs. not home during census activities were significantly more likely to attend the campaign (RR: 1.20 [95% CI: 1.13-1.28]; p<0.001).

Conclusions: CHCs provide a rapid approach to testing a majority of residents for HIV in rural African settings. However, complementary strategies are still needed to engage young, single adults and achieve universal testing.

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Editor’s notes: There are several subtle but important lessons to be learned from this paper by Chamie et al. It describes the uptake of HIV testing as part of a multi-disease community health campaign which included prior community sensitisation, a baseline community census followed by testing days at well-known public places, two schools, a government building and a market place. Regional and village political leaders were engaged in advance, announcements were made and promotional material was prepared to adequately sensitise the community. T-shirts were provided for males to increase participation. Women, older people and individuals who were or had previously been married (non-singles) were more frequently encountered at home during the census. The campaign held at the market-place on a weekend day was more effective than those held at other venues, presumably on weekdays, at engaging the individuals who were more difficult to reach at home during the census - males, singles and younger individuals. It is noteworthy that males were not less likely to participate, after adjusting for marital status and presence at home during the census. An important consideration in interpreting the results on HIV test uptake in this campaign is that it was a multi-disease effort and participation might be different in a number of complex ways, from community engagement with HIV focused ventures.

Africa
Uganda
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