A Hybrid Mobile Approach for Population-Wide HIV Testing in Rural East Africa: An Observational Study

Citation

Chamie, Gabriel; Clark, Tamara D.; Kabami, Jane; Kadede, Kevin; Ssemmondo, Emmanuel; Steinfeld, Rachel L.; Lavoy, Geoff; Kwarisiima, Dalsone; Sang, Norton Mutai; & Jain, Vivek, et al. (2016). A Hybrid Mobile Approach for Population-Wide HIV Testing in Rural East Africa: An Observational Study. Lancet HIV, 3(3), e111-9. PMCID: PMC4780220

Abstract

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 muL (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.

URL

http://dx.doi.org/10.1016/s2352-3018(15)00251-9

Reference Type

Journal Article

Year Published

2016

Journal Title

Lancet HIV

Author(s)

Chamie, Gabriel
Clark, Tamara D.
Kabami, Jane
Kadede, Kevin
Ssemmondo, Emmanuel
Steinfeld, Rachel L.
Lavoy, Geoff
Kwarisiima, Dalsone
Sang, Norton Mutai
Jain, Vivek
Thirumurthy, Harsha
Liegler, Teri J.
Balzer, Laura B.
Petersen, Maya L.
Cohen, Craig R.
Bukusi, Elizabeth A.
Kamya, Moses R.
Havlir, Diane V.
Charlebois, Edwin D.

PMCID

PMC4780220

ORCiD

Thirumurthy - 0000-0002-3308-7603