A Comparison of Home-Based Versus Outreach Event-Based Community HIV Testing in Ugandan Fisherfolk Communities

Bogart, Laura M.; Wagner, Glenn; Musoke, William; Naigino, Rose; Linnemayr, Sebastian; Maistrellis, Emily; Klein, David J.; Jumamil, Riana B.; Mukasa, Barbara; Bassett, Ingrid V.; Giordano, Thomas P.; Wanyenze, Rhoda K.

doi:10.1007/s10461-016-1629-x

Cited by 16 publications

(51 citation statements)

References 52 publications

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“…We also did not vary our input costs in the uncertainty analysis, and the costs of the novel testing modalities that have not been implemented at scale in the public sector (in particular self-test distribution) are currently based on assumptions regarding staff time, linkage and the number of tests that can be performed per day. Rates of linkage to ART after diagnosis are difficult to determine in the context of community-based models of HIV testing, which generally suffer from lower rates of linkage than facility-based testing 18,[49][50][51] . In our uncertainty analyses, we found that in most community-based testing scenarios the cost per life year saved declined substantially as the rate of linkage to ART increased (Table S3.11), and it is therefore important to quantify linkage rates more precisely.…”

Section: Discussionmentioning

confidence: 99%

Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

Johnson

Rensburg

Govathson

et al. 2019

Sci Rep

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Although many African countries have achieved high levels of HIV diagnosis, funding constraints have necessitated greater focus on more efficient testing approaches. We compared the impact and cost-effectiveness of several potential new testing strategies in South Africa, and assessed the prospects of achieving the UNAIDS target of 95% of HIV-positive adults diagnosed by 2030. We developed a mathematical model to evaluate the potential impact of home-based testing, mobile testing, assisted partner notification, testing in schools and workplaces, and testing of female sex workers (FSWs), men who have sex with men (MSM), family planning clinic attenders and partners of pregnant women. In the absence of new testing strategies, the diagnosed fraction is expected to increase from 90.6% in 2020 to 93.8% by 2030. Home-based testing combined with self-testing would have the greatest impact, increasing the fraction diagnosed to 96.5% by 2030, and would be highly cost-effective compared to currently funded HIV interventions, with a cost per life year saved (LYS) of $394. Testing in FSWs and assisted partner notification would be cost-saving; the cost per LYS would also be low in the case of testing MSM ($20/LYS) and self-testing by partners of pregnant women ($130/LYS).

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Section: Discussionmentioning

confidence: 99%

Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

Johnson

Rensburg

Govathson

et al. 2019

Sci Rep

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“…Finally, several of the rural/remote study facilities serve highly mobile patient populations such as fisherfolk living on Lake Victoria and migratory cattle farmers. HIV prevalence among Ugandan fisherfolk is high relative to the general population (15-40%) [ 29 , 30 ] and fisherfolk are known to have poor linkage (e.g., 38% within 3 months of outreach event-based testing) [ 9 ]. Barriers to care in this population include limited healthcare access, quality of care, and social support, high mobility, competing work demands during clinic hours, and stigma [ 9 ], and community-based testing programs appear promising to improve linkage in these communities [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…HIV prevalence among Ugandan fisherfolk is high relative to the general population (15-40%) [ 29 , 30 ] and fisherfolk are known to have poor linkage (e.g., 38% within 3 months of outreach event-based testing) [ 9 ]. Barriers to care in this population include limited healthcare access, quality of care, and social support, high mobility, competing work demands during clinic hours, and stigma [ 9 ], and community-based testing programs appear promising to improve linkage in these communities [ 9 ]. Interventions to improve linkage and retention may need to provide additional support and more patient-centered models of care to women, adolescents, and patients in rural and highly transitory communities.…”

Section: Discussionmentioning

confidence: 99%

Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Boeke

Nabitaka²,

Rowan³

et al. 2018

BMC Infect Dis

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BackgroundWhile antiretroviral therapy (ART) availability for HIV patients has increased dramatically in Uganda, patient linkage to and retention in care remains a challenge. We assessed patterns of engagement in care in 20 Ugandan health facilities with low retention based on national reporting.MethodsWe assessed patient linkage to care (defined as registering for pre-ART or ART care at the facility within 1 month of HIV diagnosis) and 6-month retention in care (having a visit 3-6 months after ART initiation) and associations with patient−/facility-level factors using multivariate logistic regression.ResultsAmong 928 newly HIV-diagnosed patients, only 53.0% linked to care within 1 month. Of these, 83.7% linked within 1 week. Among 678 newly initiated ART patients, 14.5% never returned for a follow-up visit at the facility. Retention was 71.7% according to our primary definition but much lower if stricter definitions were used. Most patients were already falling behind appointment schedules at their first ART follow-up (median: 28 days post-initiation vs. recommended 14 days). 27.3% of newly-initiated patients had follow-up appointments scheduled 45+ days apart rather than monthly per national guidelines. Linkage and retention were not strongly correlated with each other within facilities (rs = 0.06; p = 0.82). Females, adolescents, and patients in rural settings tended to have lower linkage and retention in multivariable-adjusted models.ConclusionsLinkage support may be most critical immediately after testing positive, as patients are less likely to link over time. More information is needed on reasons for appointment schedules by clinicians and implications on retention.Trial registrationThis study was registered in the Pan African Clinical Trial Registry database (#PACTR201611001756166).Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3042-8) contains supplementary material, which is available to authorized users.

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“…Despite this possibility, our study team observed the opposite. Individuals may be less likely to link to HIV clinical care following home-based testing [ 20 , 47 ], as newly diagnosed individuals cannot easily be personally escorted to HIV clinic for immediate linkage as can be achieved during clinic-based testing. Follow-up data collection was beyond the scope of this pilot study; therefore, we were unable to evaluate linkage to care after home-based testing based on these data.…”

Section: Discussionmentioning

confidence: 99%

“…Home-based HIV testing has been effective in many resource limited settings in sub-Saharan Africa [ 8 – 20 ], but may not be a successful testing strategy in a refugee settlement. Many refugees have endured violent conflict and/or sexual violence [ 5 , 21 ], and thus may be less willing to accept strangers into their homes.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda

O’Laughlin

Greenwald

et al. 2018

BMC Infect Dis

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BackgroundRefugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale.MethodsFrom February–March 2014, we visited homes in 3 villages in Nakivale up to 3 times and offered HIV testing. We enrolled adults who spoke English, Kiswahili, Kinyarwanda, or Runyankore; some were refugees and some Ugandan nationals. We surveyed them about their socio-demographic characteristics. We evaluated the proportion of individuals encountered (feasibility) and assessed participation in HIV testing among those encountered (acceptability). We compared characteristics of home-based and clinic-based testers (from a prior study in Nakivale) using Wilcoxon rank sum and Pearson’s chi-square tests. We examined the relationship between a limited number of factors (time of visit, sex, and number of individuals at home) on willingness to test, using logistic regression models with the generalized estimating equations approach to account for clustering.ResultsOf 566 adults living in 319 homes, we encountered 507 (feasibility = 90%): 353 (62%) were present at visit one, 127 (22%) additional people at visit two, and 27 (5%) additional people at visit three. Home-based HIV testing participants totaled 378 (acceptability = 75%). Compared to clinic-based testers, home-based testers were older (median age 30 [IQR 24–40] vs 28 [IQR 22–37], p < 0.001), more likely refugee than Ugandan national (93% vs 79%, < 0.001), and more likely to live ≥1 h from clinic (74% vs 52%, < 0.001). The HIV prevalence was lower, but not significantly, in home-based compared to clinic-based testing participants (1.9 vs 3.4% respectively, p = 0.27). Testing was not associated with time of visit (p = 0.50) or sex (p = 0.66), but for each additional person at home, the odds of accepting HIV testing increased by over 50% (OR 1.52, 95%CI 1.12–2.06, p = 0.007).ConclusionsHome-based HIV testing in Nakivale Refugee Settlement was feasible, with 90% of eligible individuals encountered within 3 visits, and acceptable with 75% willing to test for HIV, with a yield of nearly 2% individuals tested identified as HIV-positive.

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A Comparison of Home-Based Versus Outreach Event-Based Community HIV Testing in Ugandan Fisherfolk Communities

Cited by 16 publications

References 52 publications

Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda

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