A Case of TASO Tororo Surge Strategy: Using Double Layered Screening to Increase the Rate of Identification of New HIV Positive Clients in the Community

Abstract

Introduction: HIV testing services is the entry point to HIV prevention, care, treatment, and support services. According to Uganda Population HIV impact assessment preliminary report released in 2018, 72.5% of people living with HIV in Uganda knew their status, which is below the UNAIDS target of 90%. We proposed a double layered screening of the population using the Ministry of Health HIV Testing Services (HTS) screening tool to identify more HIV positives and start them on treatment. The objective of this study was to assess the impact of the double layered screening approach on HIV test yield. Methods: A double layered screening approach involved using community and technical teams from TASO Tororo HIV clinic through the surge strategy. The community team (first layer) comprised of expert clients, local council 1, market and church leaders who were trained on how to screen the people in the community using the HTS screening tool. The technical team (second layer) comprised of medical personnel and counselors who subjected all people mobilized and screened by the community team to a second layered screening before offering an HIV test. We compared proportions of HIV test yields before and after the implementation of the double layered HTS strategy using proportions test and we assessed the impact of the double layered screening using a difference in difference (DID) evaluation method. Results; There was a general increase in HIV test yield from 4.75% with single screening (period: January-March 2018) to 12.25% with double screening (period: April-June 2018) (P<0.001). The increase was more in males (from 3.51% to 11.06%) than in females (from 6.36% to 13.31%) and this difference was significant (P=0.035). The increase in HIV test yield did not differ by age (P=0.060), by marital status (P=0.606) or by first time tester (P=0.167), Conclusion: The double layered screening before HIV test could be an effective strategy to maximize HIV test yield in the general population, which if scaled up can save huge resources, time and help focus on actual targets for HIV testing services, leading to early attainment of the UNAIDS 1 st target of 90-90-90.

Treatment outcome of the implementation of HIV test and treat policy at The AIDs Support Organization (TASO) Tororo clinic, Eastern Uganda: A retrospective cohort study

“…In this study, being tested positive at the outreach site was significantly associated with lower odds of failure to take up test and treat. This study finding is contrary to findings from Zimbabwe [8], and could have resulted from TASO's community HTS intervention where they made deliberate efforts to engage community leaders (expert clients/volunteers, local council I chairpersons and church leaders) into sensitization and mobilization for HIV testing services [21]. This finding therefore confirms that clients tested at their convenient places can comfortably be initiated on ART under the test and treat policy.…”

Screening Adults for HIV Testing in the Outpatient Department: An Assessment of Tool Performance in Malawi

“…The global community is thus seeking innovative ways to more efficiently identify people who should be tested for HIV-including new technologies (self-testing) [7], new operational approaches to testing (e.g., index partner testing, community-based contact tracing, and social or risk network testing) [8][9][10], and the use of screening tools to identify those most in need of testing [11]. Clinical HIV guidelines in many African settings currently recommend testing all pregnant women, individuals with newly-diagnosed tuberculosis, and all sexually active adults annually and whenever they seek care for a sexually transmitted infection (STI) [4]-but, risk assessment through screening may be more sensitive and/or specific than this standard of care (SOC).…”

Effect of universal test and treat on retention and mortality among people living with HIV-infection in Uganda: An interrupted time series analysis

“…The decrease in retention each month after full scale-up of UTT in our study setting could be attributed to the increased number of patients started on ART and enrolled in care which could have burdened the available resources. In addition, during UTT many patients were being enrolled in TASO from communities [ 14 ] without proper counselling and linking into care in facilities preferred by the patients, this could have increased LTFU hence decreasing retention. Also, our study emphasizes the findings from South Africa by Arnesen et al .…”

“…Despite the above information on improvement in retention following UTT, the strategies to increase HIV yield and starting patients on treatment while in communities [ 14 ] without proper counselling and linking into care in facilities preferred by the patients can increase loss to follow-up (LTFU) and transfer-outs, which could negatively affect retention. This implies that though UTT decreases mortality [ 7 ], there is a likelihood of increased LTFU and transfer-outs especially during the scale-up period which may negatively affect retention.…”