A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: Chamie, Gabriel; Clark, Tamara D; Kabami, Jane; Kadede, Kevin; Ssemmondo, Emmanuel; Steinfeld, Rachel; Lavoy, Geoff; Kwarisiima, Dalsone; Sang, Norton; Jain, Vivek; Thirumurthy, Harsha; Liegler, Teri; Balzer, Laura B; Petersen, Maya L; Cohen, Craig R; Bukusi, Elizabeth A; Kamya, Moses R; Havlir, Diane V; Charlebois, Edwin D
• Is Part Of: Lancet. Volume 3:Issue 3(2016)
• Page Start: e111
• Page End: e119
• Publication Date: 2016-03
• Subjects: HIV (Viruses) -- Periodicals; HIV infections -- Periodicals; AIDS (Disease) -- Periodicals; 616.9792
• DOI: 10.1016/S2352-3018(15)00251-9
• Languages: English
• ISSNs: 2405-4704

Abstract

Summary: Background: Despite large investments in HIV testing, only an estimated 45% of HIV-infected people in sub-Saharan Africa know their HIV status. Optimum methods for maximising population-level testing remain unknown. We sought to show the effectiveness of a hybrid mobile HIV testing approach at achieving population-wide testing coverage. Methods: We enumerated adult (≥15 years) residents of 32 communities in Uganda (n=20) and Kenya (n=12) using a door-to-door census. Stable residence was defined as living in the community for at least 6 months in the past year. In each community, we did 2 week multiple-disease community health campaigns (CHCs) that included HIV testing, counselling, and referral to care if HIV infected; people who did not participate in the CHCs were approached for home-based testing (HBT) for 1–2 months within the 1–6 months after the CHC. We measured population HIV testing coverage and predictors of testing via HBT rather than CHC and non-testing. Findings: From April 2, 2013, to June 8, 2014, 168 772 adult residents were enumerated in the door-to-door census. HIV testing was achieved in 131 307 (89%) of 146 906 adults with stable residence. 13 043 of 136 033 (9·6%, 95% CI 9·4–9·8) adults with and without stable residence had HIV; median CD4 count was 514 cells per μL (IQR 355–703). Among 131 307 adults with stable residence tested, 56 106 (43%) reported no previous testing. Among 13 043 HIV-infected adults, 4932 (38%) were unaware of their status. Among 105 170 CHC attendees with stable residence 104 635 (99%) accepted HIV testing. Of 131 307 adults with stable residence tested, 104 635 (80%; range 60–93% across communities) tested via CHCs. In multivariable analyses of adults with stable residence, predictors of non-testing included being male (risk ratio [RR] 1·52, 95% CI 1·48–1·56), single marital status (1·70, 1·66–1·75), age 30–39 years (1·58, 1·52–1·65 vs 15–19 years), residence in Kenya (1·46, 1·41–1·50), and migration out of the community for at least 1 month in the past year (1·60, 1·53–1·68). Compared with unemployed people, testing for HIV was more common among farmers (RR 0·73, 95% CI 0·67–0·79) and students (0·73, 0·69–0·77); and compared with people with no education, testing was more common in those with primary education (0·84, 0·80–0·89). Interpretation: A hybrid, mobile approach of multiple-disease CHCs followed by HBT allowed for flexibility at the community and individual level to help reach testing coverage goals. Men and mobile populations remain challenges for universal testing. Funding: National Institutes of Health and President's Emergency Plan for AIDS Relief.