We implemented and evaluated a clinic-based routine voluntary HIV testing intervention in Nakivale Refugee Settlement in Uganda. Comparing the SOC period (40 days) to the Intervention period (168 days), the mean HIV-infected clients identified per week increased from 0.9 to 5.6, and there was no significant difference between the HIV prevalence in the two periods (standard of care: 3.3%, intervention: 4.5%; p > 0.5). Clinic-based routine HIV testing in a refugee settlement is effective and should be considered for implementation in refugee settlements in other high prevalence regions in sub-Saharan Africa.

Objectives Refugees in Uganda come from HIV-afflicted countries, and many remain in refugee settlements for over a decade. Our objective was to evaluate the HIV care cascade and assess correlates of linkage to care. Methods We prospectively enrolled individuals accessing clinic-based HIV testing in Nakivale Refugee Settlement from March 2013-July 2014. Newly HIV-diagnosed clients were followed for three months post-diagnosis. Clients underwent a baseline survey. The following outcomes were obtained from HIV clinic registers in Nakivale: clinic attendance (“linkage to HIV care”), CD4 testing, antiretroviral therapy (ART) eligibility, and ART initiation within 90 days of testing. Descriptive data were reported as frequencies with 95% confidence interval (CI) or medians with interquartile range (IQR). The impact of baseline variables on linkage to care was assessed with logistic regression models. Results Of 6,850 adult clients tested for HIV, 276 (4%; CI 3–5%) were diagnosed with HIV, 148 (54%; CI 47–60%) of those linked to HIV care, 54 (20%; CI 15–25%) had a CD4 test, 22 (8%; CI 5–12%) were eligible for ART, and 17 (6%; CI 3–10%) initiated ART. The proportions of refugees and nationals at each step of the cascade were similar. We identified no significant predictors of linkage to care. Conclusions Less than a quarter of newly HIV-diagnosed clients completed ART assessment, considerably lower than other reports from sub-Saharan Africa. Understanding which factors hinder linkage and engagement in care in the settlement will be important to inform interventions specific for this environment.