Evaluating the feasibility and uptake of a community‐led HIV testing and multi‐disease health campaign in rural Uganda

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).Conclusions: 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.

Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review

“…This has revealed the poor quality of diabetes care, especially in insulin-dependent patients, and has helped to build a database of diabetics in the area. In Uganda [ 76 , 77 ] and South Africa [ 67 ], community-based HIV testing campaigns also included screening and diagnosis for diabetes and other NCDs, which also, parenthetically, helped to reduce the stigma associated with persons who had HIV. This intervention identified new diabetic patients and the intervention in Uganda [ 76 ] achieved a 63% linkage of care to newly diagnosed diabetic patients.…”

Feasibility of integrated, multilevel care for cardiovascular diseases (CVD) and HIV in low- and middle-income countries (LMICs): A scoping review

“…Additionally, only 5% of selected studies (n = 1) was a randomized controlled trial (RCT)—a pragmatic cluster RCT [19]. Most studies were either descriptive, cross sectional studies (n = 8) [20, 21, 22, 23, 24, 25, 26, 27] or observational cohort studies (n = 6) [21, 28, 29, 30, 31] (See S1 Dataset )…”

“… 1 Reference numbers [22], [26], [38] 2 Reference numbers [22], [24], [25], [26], [27], [29], [30], [31], [32], [33], [34], [35], [37] 3 Reference numbers [27] 4 Reference numbers [22], [24], [30], [32], [33], [35] 5 Reference numbers [22], [26], [30], [32], [34] 6 Reference numbers [23], [30], [32], [33], [34], [39] 7 Reference numbers [19], [20], [21], [23], [25], [31], [33], [38] 8 Reference numbers [25], [26], [36], [37], [39] 9 Reference numbers [25], [26], [34], [36], [37], [39] 10 Reference numbers [34], [39]…”

“…Reporting of feasibility catered to the settings and/or scale-up of the interventions, helping identify unique facilitators and barriers to implementing integrated CVD-HIV care interventions (screening, referral/linkage to care and treatment) in LMIC settings. Barriers include lack of tracking of linkage to care after cases are referred (setting and scale-up specific) [22, 24, 29] loss to follow-up (setting-specific) [20], lacking time to make clinic visits during the weekdays (setting-specific) [30], using non-standard BP cutoffs (setting-specific) [33], insufficient funding (setting and scale-up specific) [28], cumbersome curriculum for training (scale-up specific) [19], and challenges in staffing and equipment (setting-specific) [37].…”

District-level differentiated HIV testing strategies are needed to achieve the 1st 90 in Zimbabwe

“…Despite them being unpopular, for these districts with a high prevalence but struggling to meet ART coverage targets it's still worth to invest in wide spread mopup community HIV testing campaigns with a leading role for health care workers [17]. These HIV testing campaigns can be conducted as part of health fairs or multi-disease screening campaigns/events to reduce stigma associated with HIV testing [18,19]. Studies have shown a high interest in HIV self-testing from a wide range of subgroups, including sero-discordant couples, men, young people, sex workers and their partners [20].…”