Abstract
BackgroundThe 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.MethodsAfter 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.ResultsOver 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).ConclusionsCHCs 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.
Highlights
The high burden of undiagnosed HIV represents a major obstacle to implementation of HIV prevention and antiretroviral treatment (ART) strategies in sub-Saharan Africa
Our findings demonstrate the continued yield of multi-disease, community health campaign (CHC)-based HIV testing in identifying persons with no prior testing and with undiagnosed HIV infection in a community with year-round access to facilitybased testing
Using rigorous methods to define community residence, including a baseline census with fingerprint biometric measurements for identification, we found that young, single adults were significantly less likely than older, non-single adults to access HIV-testing via CHCs, suggesting that novel testing approaches are needed to reach this high-risk group
Summary
The high burden of undiagnosed HIV represents a major obstacle to implementation of HIV prevention and antiretroviral treatment (ART) strategies in sub-Saharan Africa. Late HIV diagnosis translates into missed opportunities for HIV prevention and delayed antiretroviral treatment resulting in increased HIVrelated morbidity and mortality, and ongoing HIV transmission. Health facility-based approaches to HIV testing in rural Africa are limited by several factors: cost of patient travel and waiting time when accessing centralized services, stigma, lack of awareness of HIV risk, and the minimal or non-specific symptoms experienced by many patients early in HIV disease [3,4,5]. 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. A greater understanding of population-level uptake is needed to maximize effectiveness of this approach
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