Clinic-Based Routine Voluntary HIV Testing in a Refugee Settlement in Uganda

Kn, OLaughlin; Kasozi, Julius; Walensky, Rochelle P.; Ra, Parker; Zm, Faustin; Doraiswamy, Sathyanarayanan; Co, Owino; Bassett,

doi:10.1097/qai.0000000000000317

Cited by 21 publications

(34 citation statements)

References 13 publications

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“…The percentage of men out of total persons tested was reported in 25 home HTC studies 5,14,18,29,31,32,37,38,41–45,63,64,66,68–72,88–90 , two home with self-testing 11,75 , 10 mobile 10,13,68,72,91–99 , 3 index partner 47,49,88 , 3 campaign 46,47,76 , 2 workplace 100,101 , 20 facility VCT 52,54,61,64,81,88,89,92,93,95,96,98,102–107 , and 13 facility PITC 58,60,82–84,86,99,108–113 (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…The percentage of testers who were young adults testers <age 25 or <30 years) was reported in 17 home HTC studies 5,18,29–31,35,37,38,45,63,64,68–70,73,74,90,117 , one home with self-testing 11 , 13 mobile 10,12,13,68,91,93,95–97,103,107,114 , two index partner 48,88 , two campaign 47,77 , 20 facility VCT 12,51,52,54,64,88,89,91–93,95,104–107,114,118–120 , and six facility PITC 58,82,86,88,110,113 . Results varied considerably by study (Supplementary Figures S29–S35).…”

Section: Resultsmentioning

confidence: 99%

“…Yield of HIV positive individuals (HIV positivity) was reported in 29 home studies 14,15,18,27,29–32,34,36,38,41–45,63,65,66,68,70–73,88,89 , one home with self-testing 11 , 12 mobile 10,13,68,72,92–95,97,98,103,107,114 , five campaign 46,47,76,77,120 , three workplace 79,80,121 , four key population 12,115,116,122 , four index partner 48–50,88 , 27 facility VCT 54–56,64,81,84,88,91–93,95,98,102,104–107,114,118–120,123–127 , and 17 facility PITC 56,57,59,60,81,83–88,99,110–113,126 studies. Community-based strategies for the general population had lower HIV positivity (6–11%) than facility HTC (18–20%), whereas targeted community HTC for key populations and sexual partners of index patients had the highest HIV yield (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

455

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

455

532

View full text Add to dashboard Cite

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“…Patients were tested if they requested an HIV test or presented with signs and symptoms that led a clinician to refer them for a test. Though broader data on the prevalence of HIV/AIDS in the Nakivale settlement during the study period are not available, a subsequent study showed a prevalence of 3.3–4.5% (O'Laughlin et al, 2014). Prevalence rates in the refugees' countries of origin range from 1.1–6.3% (UNAIDS 2010).…”

Section: Methodsmentioning

confidence: 99%

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

Rouhani

O’Laughlin

Faustin

et al. 2016

Global Public Health

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Little is known about the factors that encourage or discourage refugees to test for HIV, or to access and adhere to HIV care. In non-refugee populations, social support has been shown to influence HIV testing and utilization of services. The present study enrolled HIV-infected refugees on anti-retroviral therapy (ART) in Uganda, who participated in qualitative interviews on HIV testing, treatment, and adherence. Interviews were analyzed for themes about four types of social support: emotional, informational, instrumental and appraisal support. A total of 61 interviews were analyzed. Four roles for these types of social support were identified: (1) informational support encouraged refugees to test for HIV; (2) emotional support helped refugees cope with a diagnosis of HIV; (3) instrumental support facilitated adherence to ART and (4) after diagnosis, HIV-infected refugees provided informational and emotional support to encourage other refugees to test for HIV. These results suggest that social support influences HIV testing and treatment among refugees. Future interventions should capitalize on social support within a refugee settlement to facilitate testing and treatment.

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“…We conducted a clinic-based HIV screening intervention study at Nakivale Health Center [7]. Our primary objective for this analysis was to evaluate the correlates of HIV infection of those tested during this screening intervention.…”

Section: Introductionmentioning

confidence: 99%

Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement

O’Laughlin

Rabideau

Kasozi³

et al. 2016

BMC Infect Dis

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BackgroundThe instability faced by refugees may place them at increased risk of exposure to HIV infection. Nakivale Refugee Settlement in southwestern Uganda hosts 68,000 refugees from 11 countries, many with high HIV prevalence. We implemented an HIV screening program in Nakivale and examined factors associated with new HIV diagnosis.MethodsFrom March 2013-November 2014, we offered free HIV screening to all clients in the Nakivale Health Center while they waited for their outpatient clinic visit. Clients included refugees and Ugandan nationals accessing services in the settlement. Prior to receiving the HIV test result, participants were surveyed to obtain demographic information including gender, marital status, travel time to reach clinic, refugee status, and history of prior HIV testing. We compared variables for HIV-infected and non-infected clients using Pearson’s chi-square test, and used multivariable binomial regression models to identify predictors of HIV infection.ResultsDuring the HIV screening intervention period, 330 (4%) of 7766 individuals tested were identified as HIV-infected. Refugees were one quarter as likely as Ugandan nationals to be HIV-infected (aRR 0.27 [0.21, 0.34], p < 0.0001). Additionally, being female (aRR 1.43 [1.14, 1.80], p = 0.002) and traveling more than 1 h to the clinic (aRR 1.39 [1.11, 1.74], p = 0.003) increased the likelihood of being HIV-infected. Compared to individuals who were married or in a stable relationship, being divorced/separated/widowed increased the risk of being HIV-infected (aRR 2.41 [1.88, 3.08], p < 0.0001), while being single reduced the risk (aRR 0.60 [0.41, 0.86], p < 0.0001). Having been previously tested for HIV (aRR 0.59 [0.47, 0.74], p < 0.0001) also lowered the likelihood of being HIV-infected.ConclusionsIn an HIV screening program in a refugee settlement in Uganda, Ugandan nationals are at higher risk of having HIV than refugees. The high HIV prevalence among clients seeking outpatient care, including Ugandan nationals and refugees, warrants enhanced HIV screening services in Nakivale and in the surrounding region. Findings from this research may be relevant for other refugee settlements in Sub-Saharan Africa hosting populations with similar demographics, including the 9 other refugee settlements in Uganda.

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Clinic-Based Routine Voluntary HIV Testing in a Refugee Settlement in Uganda

Cited by 21 publications

References 13 publications

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement

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