HIV Testing

HIV Testing

Rapid implementation of an integrated large-scale HIV counselling and testing, malaria, and diarrhoea prevention campaign in rural Kenya.

Integrated disease prevention in low resource settings can increase coverage, equity and efficiency in controlling high burden infectious diseases. A public-private partnership with the Ministry of Health, Centers for Disease Control, Vestergaard Frandsen and CHF International implemented a one-week integrated multi-disease prevention campaign. Residents of Lurambi, Western Kenya were eligible for participation. The aim was to offer services to at least 80% of those aged 15-49. 31 temporary sites in strategically dispersed locations offered: HIV counselling and testing, 60 male condoms, an insecticide-treated bednet, a household water filter for women or an individual filter for men, and for those testing positive, a 3-month supply of cotrimoxazole and referral for follow-up care and treatment. Over 7 days, 47,311 people attended the campaign with a 96% uptake of the multi-disease preventive package. Of these, 99.7% were tested for HIV (87% in the target 15-49 age group); 80% had previously never tested. 4% of those tested were positive, 61% were women (5% of women and 3% of men), 6% had median CD4 counts of 541 cell/µL (IQR; 356, 754). 386 certified counsellors attended to an average 17 participants per day, consistent with recommended national figures for mass campaigns. Among women, HIV infection varied by age, and was more likely with an ended marriage (e.g. widowed vs. never married, OR.3.91; 95% CI. 2.87-5.34), and lack of occupation. In men, quantitatively stronger relationships were found (e.g. widowed vs. never married, OR.7.0; 95% CI. 3.5-13.9). Always using condoms with a non-steady partner was more common among HIV-infected women participants who knew their status compared to those who did not (OR.5.4 95% CI. 2.3-12.8). Through integrated campaigns it is feasible to efficiently cover large proportions of eligible adults in rural underserved communities with multiple disease preventive services simultaneously achieving various national and international health development goals.

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Editors’ note: Talk about integration and meeting people’s needs! This exciting 7-day programme in an area of high malaria incidence, poor sanitation and high diarrhoeal disease, and a low knowledge of HIV serostatus elicited high demand. The population consisted of 51,178 people aged 15-49 years living in 157 villages covering an area of 194 square kilometres. Over 87% of them showed up (along with almost 2800 non-residents) for the MPP (multi-disease prevention package) that consisted of a long-lasting impregnated bednet to prevent night-time mosquito bites, a water purification system, 60 condoms, and testing and counselling for HIV. Uptake was higher for the MPP than had ever been seen for social marketing campaigns for its individual components. Following individual pre-test counselling, fully 99.7% consented to have a test for HIV and receive the results. Unique client numbers delinked from personal identifiers protected confidentiality and micro-planning exercises projected daily demand and matched it to personnel and logistics requirements for 30 service delivery sites. A pre-campaign survey identified appropriate media messages and channels for a health education/community mobilisation programme which began one month before and continued during the 7-day campaign. More ‘outside the facility’ multi-disease integrated campaigns such as this have the potential to achieve rapid, high, equitable coverage to address multiple health challenges on the road to the Millennium Development Goals.