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

Abstract

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 2674 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.

Conflict of interest statement

Competing Interests: Elvin Geng, a co-author on this manuscript, serves on the editorial board for PLOS ONE. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Population distribution of Kakyerere parish as determined from a twelve-day study census (open blue and red bars), and Community Health Campaign participation over five days among residents (solid blue and red bars), by age and sex.

Figure 2. Change in male and female participation from a 2011 to a 2012 community health campaign (CHC) in Kakyerere parish, a rural Ugandan community.

Shown are the age and sex distribution of CHC participants, including non-residents of the community, by year. The dashed arrow indicates the low proportion of adult male participants in the 2011 CHC.

Figure 3. Proportion of residents attending the 2012 community health campaign (CHC) according to sex and age group among residents ≥15 years old.

The dashed vertical lines indicate 95% confidence intervals.