Upload
inigo
View
32
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Integrated Community HIV Testing Campaigns: Leveraging HIV infrastructure for non- communicable diseases . July 23, 2012 - PowerPoint PPT Presentation
Citation preview
Integrated Community HIV Testing Campaigns:
Leveraging HIV infrastructure for non- communicable diseases
July 23, 2012Gabriel Chamie, Dalsone Kwarisiima, Tamara D. Clark, Jane Kabami, Vivek Jain, Elvin Geng, Maya L. Petersen, Harsha Thirumurthy, Moses R. Kamya, Diane V. Havlir, Edwin D. Charlebois, and the SEARCH Collaboration
• HIV “test and treat” is under intense scrutiny as a global strategy
• Large unmet need in addressing non-communicable diseases (NCDs)
• Key first step in addressing both HIV and NCDs is diagnosis – many shared obstacles
• Implementation science questions– How do we test large numbers of people in a
sustainable way? – How do we leverage HIV investment to address NCDs?
Background
• Sustainable East African Research on Community Health
• A broader approach to test and treat– Health (HIV, NCDs, and other diseases)– Education– Economics
SEARCH Community Health Campaign
• Community health campaign objectives– Rapid implementation of multi-disease diagnosis and
linkage to care across a community– Reach community members not previously tested– Achieve high-throughput testing (1,000/day)– Integration of NCDs and other communicable
diseases– Rapid assessment of community socio-economics
Objectives
Campaign ProceduresDemographic/SES Household SurveyTesting HIV (Ab, CD4, VL) Malaria RDT DM HTNTB Screening in HIV+ GeneXpertPrevention TMP/SMX Condoms Vitamin A Counseling ITNs
Treatment Coartem Albendazole
Linkage to Care HIV, TB, DM, HTN Immediate ART: CD4<100
5 day campaign(May 16-21, 2011)
• Local Council (LC) leaders from all villages designed and executed community mobilization during the month prior to campaign– Church (Easter) & Mosque
announcements– Posters & pamphlets
distributed widely– Radio announcements
Community Mobilization
Rwanyamahembe Subcounty HeadquartersMay 16, 17, 2011
Karuyenje Primary SchoolMay 19, 20, 2011
H
Bwizibwera Health
Centre IV
Nyakayojo Primary SchoolMay 21, 2011
3 km
CHC Sites: Kakyerere, Uganda
Site 3
Site 2
Site 1
Campaign Field Laboratory• 18 Lab technicians• Rapid HIV Ab testing/confirmation• Point-of-care CD4+ T cell count• Finger-prick HIV viral load• Malaria rapid diagnostic test• Blood glucose• Blood pressure
CHC Uganda Census CHC Coverage
Adults 2,323 3,150 74%
Women 1,523 1,600 95%
Men 800 1,550 52%
Children 2,020 3,150 64%
Girls* 1,066 1,600 67%
Boys* 954 1,550 62%
Total 4,343 6,300§ 69%
Female 2,589 3,200§ 81%
Male 1,754 3,100§ 57%
§ 2011 Ugandan Bureau of Statistics Population Projection, Kakyerere Parish* <18 years old
Study Population
• Overall – Median of 95 minutes (IQR: 71-129)– HIV-negative• Median: 1 hour, 33 minutes (93 min, IQR: 70-125)
– HIV-positive• Median: 2 hours, 51 minutes (171 min, IQR: 136-216)
Patient Transit Time Through Campaign
Adults: Age ≥ 15: 6.9% Ages 15-49: 8.0% Children: Age < 15: 0.5%
HIV Prevalence
women: 8.2%
men: 4.5%
women: 9.4%
men: 5.3%
Campaign adult population (n=2,323):• Never HIV tested = 802 (35%)
HIV-infected adults (n=179):• New diagnoses = 82 (46%)• Known positive = 97 (54%)
Prior HIV Testing & New Diagnoses
CD4+ T cell Counts in Adults
Median CD4 = 415 (IQR: 281-568), n=167
• Substantial population was diagnosed with CD4 above Uganda ART initiation threshold (>350 cells/μL)
0-200 201-350 >3500%
10%
20%
30%
40%
50%
60%
70%
CD4+ Count
• CD4 <200: 12%• CD4 >350: 64%
0-200 201-350 >3500%
10%
20%
30%
40%
50%
60%
70%
CD4+ Count
CD4+ T Cell Counts in New Diagnoses
Median CD4 = 449 (IQR: 281-592), n=77
Hypertension• Prevalence (adults)
– BP > 140/90: 23%– BP > 150/100: 12%
• New vs. prior diagnoses– 69% of BP>150/100 group unaware of their diagnosis– 61% with known HTN were not on anti-hypertensive treatment
0-14 15-24 25-34 35-44 45-54 55-64 65-74 >750
5
10
15
20
25
30
35
40
45Prevalence of Hypertension by Age
Age (years)
Prev
alen
ce H
TN
• Prevalence:– Random BG > 200, or reported prior dx of DM– 80 adults: 3.5%
• New diagnoses:– 18 adults: 23%
• On treatment:– 38/62 (61%)
Diabetes
Linkage to care at 3 months• HIV: 82/139 (59%)– Active Referral: 58% linked to care– Enhanced Referral: 75% linked & started ART
Linkage to Care
• High burden of undiagnosed HIV and non-communicable diseases in rural east Africa
• Shared obstacles, but also shared solutions• HIV testing and referral can be leveraged in
rural Africa to find and engage patients with undiagnosed NCDs
• Community Health Campaigns can drive universal HIV testing & offers opportunity and an immediate way forward for addressing NCDs in resource-limited settings
Summary
• Campaign Participants• Kakyerere Parish LC Leaders• SEARCH Community Campaign Staff• Uganda Ministry of Health• NIH/NIAID
Thank you – SEARCH Team• SEARCH Advisory Board• MU-UCSF Research Collaboration• Mbarara-Mulago Joint AIDS Program • Mbarara University of Science &
Technology• PEPFAR WHO World Bank