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July 23, 2012

Integrated Community HIV Testing Campaigns: Leveraging HIV infrastructure for non- communicable diseases . July 23, 2012

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July 23, 2012

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  1. Integrated Community HIV Testing Campaigns:Leveraging HIV infrastructure for non- communicable diseases July 23, 2012 Gabriel Chamie, DalsoneKwarisiima, Tamara D. Clark, Jane Kabami, VivekJain, Elvin Geng, Maya L. Petersen, HarshaThirumurthy, Moses R. Kamya,Diane V. Havlir, Edwin D. Charlebois, and the SEARCH Collaboration

  2. Background • 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?

  3. SEARCH Community Health Campaign • Sustainable East African Research on Community Health • A broader approach to test and treat • Health (HIV, NCDs, and other diseases) • Education • Economics

  4. Objectives • 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

  5. Campaign Procedures 5 day campaign (May 16-21, 2011)

  6. Community Mobilization • 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

  7. CHC Sites: Kakyerere, Uganda Bwizibwera Health Centre IV H Nyakayojo Primary School May 21, 2011 Karuyenje Primary School May 19, 20, 2011 RwanyamahembeSubcountyHeadquarters May 16, 17, 2011 3 km

  8. Site 3 Site 1 Site 2

  9. 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

  10. Study Population § 2011 Ugandan Bureau of Statistics Population Projection, Kakyerere Parish * <18 years old

  11. Patient Transit Time Through Campaign • 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)

  12. HIV Prevalence Adults: Age ≥ 15: 6.9% Ages 15-49: 8.0% Children: Age < 15: 0.5% women: 8.2% men: 4.5% women: 9.4% men: 5.3%

  13. Prior HIV Testing & New Diagnoses Campaign adult population (n=2,323): • Never HIV tested = 802 (35%) HIV-infected adults (n=179): • New diagnoses = 82 (46%) • Known positive = 97 (54%)

  14. 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)

  15. CD4+ T Cell Counts in New Diagnoses Median CD4 = 449 (IQR: 281-592), n=77 • CD4 <200: 12% • CD4 >350: 64%

  16. 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 noton anti-hypertensive treatment

  17. Diabetes • Prevalence: • Random BG > 200, or reported prior dx of DM • 80 adults: 3.5% • New diagnoses: • 18 adults: 23% • On treatment: • 38/62 (61%)

  18. Linkage to Care Linkage to care at 3 months • HIV: 82/139 (59%) • Active Referral: 58% linked to care • Enhanced Referral: 75% linked & started ART

  19. Summary • 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

  20. 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 • Campaign Participants • Kakyerere Parish LC Leaders • SEARCH Community Campaign Staff • Uganda Ministry of Health • NIH/NIAID

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