Achieving Universal Access for Human Immunodeficiency Virus and Tuberculosis: Potential Prevention Impact of an Integrated Multi-Disease Prevention Campaign in Kenya

Abstract

In 2009, Government of Kenya with key stakeholders implemented an integrated multi-disease prevention campaign for water-borne diseases, malaria and HIV in Kisii District, Nyanza Province. The three day campaign, targeting 5000 people, included testing and counseling (HTC), condoms, long-lasting insecticide-treated bednets, and water filters. People with HIV were offered on-site CD4 cell counts, condoms, co-trimoxazole, and HIV clinic referral. We analysed the CD4 distributions from a district hospital cohort, campaign participants and from the 2007 Kenya Aids Indicator Survey (KAIS). Of the 5198 individuals participating in the campaign, all received HTC, 329 (6.3%) tested positive, and 255 (5%) were newly diagnosed (median CD4 cell count 536 cells/μL). The hospital cohort and KAIS results included 1,284 initial CD4 counts (median 348/L) and 306 initial CD4 counts (median 550/μL), respectively (campaign and KAIS CD4 distributions P = 0.346; hospital cohort distribution was lower P < 0.001 and P < 0.001). A Nyanza Province campaign strategy including ART <350 CD4 cell count could avert approximately 35,000 HIV infections and 1,240 TB cases annually. Community-based integrated public health campaigns could be a potential solution to reach universal access and Millennium Development Goals.

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

“…The percentage of men out of total persons tested was reported in 25 home HTC studies 5,14,18,29,31,32,37,38,41–45,63,64,66,68–72,88–90 , two home with self-testing 11,75 , 10 mobile 10,13,68,72,91–99 , 3 index partner 47,49,88 , 3 campaign 46,47,76 , 2 workplace 100,101 , 20 facility VCT 52,54,61,64,81,88,89,92,93,95,96,98,102–107 , and 13 facility PITC 58,60,82–84,86,99,108–113 (Fig. 2).…”

“…Uptake was reported in 31 home HTC studies 5,14,15,18,27,29–38,40–45,53,62–74 , two home with self-testing 11,75 , two mobile 10,68 , three index partner or family member 48–50 , four campaign 46,47,76,77 , three workplace 78–80 , three facility VCT 54,56,81 , and 11 facility PITC studies 56,57,59,60,81–87 . Overall, community modalities had high uptake (Fig.…”

“…Yield of HIV positive individuals (HIV positivity) was reported in 29 home studies 14,15,18,27,29–32,34,36,38,41–45,63,65,66,68,70–73,88,89 , one home with self-testing 11 , 12 mobile 10,13,68,72,92–95,97,98,103,107,114 , five campaign 46,47,76,77,120 , three workplace 79,80,121 , four key population 12,115,116,122 , four index partner 48–50,88 , 27 facility VCT 54–56,64,81,84,88,91–93,95,98,102,104–107,114,118–120,123–127 , and 17 facility PITC 56,57,59,60,81,83–88,99,110–113,126 studies. Community-based strategies for the general population had lower HIV positivity (6–11%) than facility HTC (18–20%), whereas targeted community HTC for key populations and sexual partners of index patients had the highest HIV yield (Fig.…”

“…The proportion of individuals with CD4 count of less than 350 cells μL −1 at HIV diagnosis was reported in 7 home 14,38,42,43,65,72,73 , 3 mobile 91,94,114 , 3 campaign 46,47,76 , 8 facility VCT 60,81,107,126,127,129–131 and 5 facility PITC studies 61,81,99,126,130 . Community-based strategies identified HIV-positive individuals at higher CD4 counts than facility HTC, with campaign having the lowest proportion with CD4 count less than 350 cells μL −1 (26%, 95% CI = 22–30%) (Fig.…”

“…Linkage was reported for ten home 14,15,29,34,41–43,65,72,132 , six mobile 72,91,92,94,133–135 , two campaign 76,77 , eight facility VCT 56,81,84,91,92,123,126,136 and five facility PITC studies 60,84,87,111,126 . Home and campaign interventions achieved a high proportion of individuals linked (95%, 95% CI = 87–98%) when paired with facilitated linkage to care strategies (for example lay-counsellor follow up to encourage clinic visit); interventions without facilitated linkage achieved lower proportions of HIV positive individuals visiting a clinic (26%, 95% CI = 18–36%) (Fig.…”