Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda

Gabriel Chamie, Dalsone Kwarisiima, Tamara D Clark, Jane Kabami, Vivek Jain, Elvin Geng, Maya L Petersen, Harsha Thirumurthy, Moses R Kamya, Diane V Havlir, Edwin D Charlebois, SEARCH Collaboration, Gabriel Chamie, Dalsone Kwarisiima, Tamara D Clark, Jane Kabami, Vivek Jain, Elvin Geng, Maya L Petersen, Harsha Thirumurthy, Moses R Kamya, Diane V Havlir, Edwin D Charlebois, SEARCH Collaboration

Abstract

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 non-communicable 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.

Methods: A five-day, multi-disease campaign, offering diagnostic, preventive, treatment and referral services, was performed in May 2011. Services included point-of-care screening for HIV, malaria, TB, hypertension and diabetes. Finger-prick diagnostics eliminated the need for phlebotomy. HIV-infected adults met clinic staff and peer counselors on-site; those with CD4 ≤ 100/µL underwent intensive counseling and rapid referral for antiretroviral therapy (ART). Community participation, case-finding yield, and linkage to care three months post-campaign were analyzed.

Results: Of 6,300 residents, 2,323/3,150 (74%) adults and 2,020/3,150 (69%) children participated. An estimated 95% and 52% of adult female and male residents participated respectively. Adult HIV prevalence was 7.8%, with 46% of HIV-infected adults newly diagnosed. Thirty-nine percent of new HIV diagnoses linked to care. In a pilot subgroup with CD4 ≤ 100, 83% linked and started ART within 10 days. Malaria was identified in 10% of children, and hypertension and diabetes in 28% and 3.5% of adults screened, respectively. Sixty-five percent of hypertensives and 23% of diabetics were new diagnoses, of which 43% and 61% linked to care, respectively. Screening identified suspected TB in 87% of HIV-infected and 19% of HIV-uninfected adults; 52% percent of HIV-uninfected TB suspects linked to care.

Conclusions: In an integrated campaign engaging 74% of adult residents, we identified a high burden of undiagnosed HIV, hypertension and diabetes. Improving male attendance and optimizing linkage to care require new approaches. The campaign demonstrates the feasibility of integrating hypertension, diabetes and communicable diseases into HIV initiatives.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Map of Kakyerere Parish.
Figure 1. Map of Kakyerere Parish.
Location of Campaign Sites and the Relationship Between Prevalence of Undiagnosed Disease among Adult Parish Residents and Increasing Distance from the Local Health Centre.

References

    1. (2009) World Health Organization. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector : progress report 2009.
    1. Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA (2006) Laboratory medicine in Africa: a barrier to effective health care. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 42: 377–382.
    1. Sendagire I, Schim Van der Loeff M, Mubiru M, Konde-Lule J, Cobelens F (2010) Long delays and missed opportunities in diagnosing smear-positive pulmonary tuberculosis in Kampala, Uganda: a cross-sectional study. PLoS ONE 5: e14459.
    1. Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, et al. (2011) HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS and behavior 15: 1111–1120.
    1. Bovet P, Gervasoni JP, Mkamba M, Balampama M, Lengeler C, et al. (2008) Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study. BMC Public Health 8: 407.
    1. Buregyeya E, Kulane A, Colebunders R, Wajja A, Kiguli J, et al. (2011) Tuberculosis knowledge, attitudes and health-seeking behaviour in rural Uganda. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease 15: 938–942.
    1. Rosen S, Fox MP (2011) Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med 8: e1001056.
    1. Beran D, Yudkin JS (2006) Diabetes care in sub-Saharan Africa. Lancet 368: 1689–1695.
    1. Uganda. Ministry of Health. 2005. Uganda national policy guidelines for HIV voluntary counselling and testing. Kampala: Ministry of Health.
    1. Uganda Bureau of Statistics: Population Projections 2008–2012. December, 2008.
    1. (2009) National Antiretroviral Treatment Guidelines for Adults, Adolescents, and Children. Ministry of Health, Uganda. 3rd edition, June 2009.
    1. Menzies N, Abang B, Wanyenze R, Nuwaha F, Mugisha B, et al. (2009) The costs and effectiveness of four HIV counseling and testing strategies in Uganda. Aids 23: 395–401.
    1. Lugada E, Millar D, Haskew J, Grabowsky M, Garg N, et al. (2010) Rapid Implementation of an Integrated Large-Scale HIV Counseling and Testing, Malaria, and Diarrhea Prevention Campaign in Rural Kenya. PloS ONE 5: e12435.
    1. Kahn JG, Harris B, Mermin JH, Clasen T, Lugada E, et al. (2011) Cost of community integrated prevention campaign for malaria, HIV, and diarrhea in rural Kenya. BMC health services research 11: 346.
    1. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K (2007) The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 370: 1929–1938.
    1. Maher D, Waswa L, Baisley K, Karabarinde A, Unwin N (2011) Epidemiology of hypertension in low-income countries: a cross-sectional population-based survey in rural Uganda. J Hypertens 29: 1061–1068.
    1. Addo J, Smeeth L, Leon DA (2007) Hypertension in sub-saharan Africa: a systematic review. Hypertension 50: 1012–1018.
    1. Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST (2010) Diabetes in sub-Saharan Africa. Lancet 375: 2254–2266.
    1. WHO Projections of mortality and burden of disease, 2004–22030.
    1. (2011) United Nations high-level meeting on noncommunicable disease prevention and control.
    1. Faal M, Naidoo N, Glencross DK, Venter WD, Osih R (2011) Providing immediate CD4 count results at HIV testing improves ART initiation. Journal of acquired immune deficiency syndromes 58: e54–59.
    1. Jani IV, Sitoe NE, Alfai ER, Chongo PL, Quevedo JI, et al. (2011) Effect of point-of-care CD4 cell count tests on retention of patients and rates of antiretroviral therapy initiation in primary health clinics: an observational cohort study. Lancet 378: 1572–1579.
    1. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Lancet 356: 103–112.
    1. Clark CM, Fradkin JE, Hiss RG, Lorenz RA, Vinicor F, et al. (2000) Promoting early diagnosis and treatment of type 2 diabetes: the National Diabetes Education Program. JAMA : the journal of the American Medical Association 284: 363–365.
    1. Marques-Vidal P, Tuomilehto J (1997) Hypertension awareness, treatment and control in the community: is the ‘rule of halves’ still valid? Journal of human hypertension 11: 213–220.
    1. Bwambale FM, Ssali SN, Byaruhanga S, Kalyango JN, Karamagi CA (2008) Voluntary HIV counselling and testing among men in rural western Uganda: implications for HIV prevention. BMC Public Health 8: 263.
    1. Mills EJ, Ford N, Mugyenyi P (2009) Expanding HIV care in Africa: making men matter. Lancet 374: 275–276.
    1. (2010) WHO Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings; Department of HIV/AIDS, Stop TB Department.
    1. Kranzer K, Houben RM, Glynn JR, Bekker LG, Wood R, et al. (2010) Yield of HIV-associated tuberculosis during intensified case finding in resource-limited settings: a systematic review and meta-analysis. Lancet Infect Dis 10: 93–102.
    1. Boehme C, Nabeta P, Hillemann D, Nicol MP, Shenai S, et al.. (2010) Rapid Molecular Detection of Tuberculosis and Rifampin Resistance. N Engl J Med.
    1. Lawn SD, Brooks SV, Kranzer K, Nicol MP, Whitelaw A, et al. (2011) Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: a prospective study. PLoS Med 8: e1001067.
    1. (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: Report of a WHO/IDF Consultation. WHO Document Production Services, Geneva, Switzerland.
    1. Whitworth JA (2003) 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21: 1983–1992.
    1. (2006) Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults : recommendations for a public health approach. World Health Organization.
    1. WHO. Guideline: Vitamin A supplementation in infants and children 6–59 months of age. Geneva, World Health Organization, 2011.
    1. (2004) World Health Organization (WHO) & Unicef: “How to add de-worming to Vitamin A distribution”.

Source: PubMed

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