Evaluating the feasibility and uptake of a community-led HIV testing and multi-disease health campaign in rural Uganda
SEARCH Collaboration, Jane Kabami, Gabriel Chamie, Dalsone Kwarisiima, Edith Biira, Peter Ssebutinde, Maya Petersen, Edwin D Charlebois, Moses R Kamya, Diane V Havlir, Tamara D Clark, SEARCH Collaboration, Jane Kabami, Gabriel Chamie, Dalsone Kwarisiima, Edith Biira, Peter Ssebutinde, Maya Petersen, Edwin D Charlebois, Moses R Kamya, Diane V Havlir, Tamara D Clark
Abstract
Introduction: Multi-disease community health campaigns can be effective for population-wide HIV testing in a research setting (SEARCH: NCT01864603). We sought to evaluate feasibility and uptake of a community-led health campaign (CLHC) planned and implemented by village leaders and local clinic workers in Uganda.
Methods: Over five months in 2014, locally elected village leaders and Ministry of Health (MoH) clinic staff in a rural parish in Uganda planned a census followed by a CLHC, after training by two SEARCH trial consultants and by leaders from a neighbouring parish that had previously participated in a SEARCH health campaign. We defined feasibility as: (1) elected leaders' participation in training and implementation of pre-campaign census and mobilization activities; (2) implementation of all campaign activities by MoH-funded, local clinic staff; and (3) community participation in the campaign, including point-of-care screening for HIV, malaria, hypertension and diabetes, and same-day referral for male circumcision and family planning (FP). Costing of all salaries and supplies was conducted.
Results: Elected leaders from all eight villages in the parish participated in CLHC training. They and local clinic staff met monthly to select and plan CLHC services. Village leaders then leveraged existing volunteer health teams to perform a door-to-door census, enumerating 5,202 parish residents over 2 weeks. 2,753 (53%) residents participated in the 6-day CLHC. Of 1,584 adult participants, 1,474 (93%) tested for HIV: 105/1,474 (7.1%) tested HIV positive. 27% (751/2,753) of participants reported fever and underwent malaria rapid diagnostic testing: 5.3% (40/751) tested positive. Among adults screened, 19% (271/1,452) were hypertensive, and 3% (18/637) had a random blood sugar >11.1 mmol/L. Of 805 men and boys (>10 years), 91 (11%) accepted same-day clinic referral and underwent medical circumcision. Of 900 women offered same-day long-term FP referrals, 25 accepted. The CLHC cost, including census, mobilization and testing services, was $23,597 ($8.57/participant).
Conclusion: Elected village leaders successfully planned and conducted a 6-day multi-disease health campaign with service provision by local clinic staff that reached over half of a rural Ugandan community. These data suggest it is feasible for local leaders and clinics to adopt a multi-disease health campaign approach to scale-up HIV testing in rural Africa.
Keywords: Africa; HIV testing; community health campaign; diabetes; hypertension; mobile testing.
Conflict of interest statement
The authors have no competing interests to declare.
References
- 90-90-90 An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
- Sharma M, Ying R, Tarr G, Barnabas R.. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528(7580):S77–S85.
- Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, et al. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. Plos Med. 2013;10(8):e1001496.
- Lugada E, Millar D, Haskew J, Grabowsky M, Garg N, Vestergaard M, et al. Rapid Implementation of an Integrated Large-Scale HIV Counseling and Testing, Malaria, and Diarrhea Prevention Campaign in Rural Kenya. Plos ONE. 2010;5(8):e12435.
- Chamie G, Clark TD, Kabami J, Kadede K, Ssemmondo E, Steinfeld R, et al. A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study. Lancet HIV. 2016;3(3):e111–e119.
- Chamie G, Kwarisiima D, Clark TD, Kabami J, Jain V, Geng E, et al. Uptake of community-based HIV testing during a multi-disease health campaign in rural Uganda. Plos ONE. 2014;9(1):e84317.
- Chamie G, Kwarisiima D, Clark TD, Kabami J, Jain V, Geng E, et al. Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda. Plos ONE. 2012;7(8):e43400.
- Uganda. Ministry of Health Uganda national policy guidelines for HIV voluntary counselling and testing. Kampala: Ministry of Health; 2005.
- Uganda, Ministry of Health (MOH) Health Sector Strategic & Investment Plan (HSSIP): promoting people’s health to enhance socio-economic development. 2010/11-2014/15. Kampala, Uganda: Ministry of Health; July, 2010.
- Uganda Bureau of Statistics: population projections 2008-2012. Kampala, Uganda: Uganda Bureau of Statistics; 2008.
- Uganda Clinical Guidelines National guidelines for management of common conditions. Republic of Uganda. 2012;5:2012.
- Skarbinski J, Massaga JJ, Rowe AK, Kachur SP. Distribution of free untreated bednets bundled with insecticide via an integrated child health campaign in Lindi Region, Tanzania: lessons for future campaigns. Am J Trop Med Hyg. 2007;76(6):1100–8.
- Schaetti C, Ali SM, Chaignat CL, Khatib AM, Hutubessy R, Weiss MG, et al. Improving community coverage of oral cholera mass vaccination campaigns: lessons learned in Zanzibar. Plos ONE. 2012;7(7):e41527.
- Ali M, Sur D, Lopez AL, Kanungo S, Ochiai RL, Manna B, et al. Community participation in two vaccination trials in slums of Kolkata, India: a multi-level analysis. J Health Popul Nutr. 2010;28(5):450–57.
- Morin SF, Khumalo-Sakutukwa G, Charlebois ED, Routh J, Fritz K, Lane T, et al. Removing barriers to knowing HIV status: same-day mobile HIV testing in Zimbabwe. J Acquir Immune Defic Syndr. 2006;41(2):218–24.
- Ostermann J, Reddy EA, Shorter MM, Muiruri C, Mtalo A, Itemba DK, et al. Who tests, who doesn’t, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania. Plos ONE. 2011;6(1):e16488.
- Musinguzi LK, Turinawe EB, Rwemisisi JT, De Vries DH, Mafigiri DK, Muhangi D, et al. Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital. Hum Resour Health. 2017;15(1):4.
- Chang W, Chamie G, Mwai D, Clark TD, Thirumurthy H, Charlebois ED, et al. Implementation and operational research. J Acquir Immune Defic Syndr. 2016;73:e39–e45.
- Menzies N, Abang B, Wanyenze R, Nuwaha F, Mugisha B, Coutinho A, et al. The costs and effectiveness of four HIV counseling and testing strategies in Uganda. AIDS. 2009;23(3):395–401.
Source: PubMed