Early access to voluntary HIV counseling and testing, bednets and water filters through an integrated mass implementation campaign in Kenya
Presented by Reuben Granich (Switzerland).
R. Granich1, N. Muraguri2, A. Doyen3, M. Vitoria1, S. Crowley1, B. Williams4
1World Health Organization, Geneva, Switzerland, 2Ministry of Public Health and Sanitation, Government of Kenya, Nairobi, Kenya, 3Vestergaard-Frandsen, Inc, Nairobi, Kenya, 4South African Centre for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
Background: Early access to HIV counseling and testing is essential, however, an estimated 60% of people living with HIV are unaware of their HIV status. Using CD4 counts, we examined how a campaign-based approach to voluntary HIV counseling and testing could improve early access to HIV services including screening for TB.
Methods: To assess feasibility, in September of 2009 the Government of Kenya, a non-governmental organization, a bilateral agency and a private sector company worked together in Kisii District, Nyanza Province, to deliver an integrated prevention campaign. The campaign included voluntary HIV counseling and testing, condoms, a long lasting insecticide-treated bednets, household water filters, and for those testing HIV positive, a 3-month supply of cotrimoxazole and referrals. Onsite CD4 cell count was done for all persons found to have HIV. A retrospective review of hospital clinic records was done to establish baseline CD4 counts for persons seeking care at the local hospital.
Findings: The three day campaign reached 5203 individuals with a 100% uptake of the multi-disease preventive package. All participants were tested for HIV and 329 (6.3%) tested HIV positive. Of those HIV positive, 255 (78%) had CD4 count determination with a median of 536 cells/ µL (IQR 350;759;) with 32 (13%) having a CD4 count of < 250 cell/µL and 64 (25%) a CD4 cell count < 350 cells/ µL. A 6 month retrospective review of 1284 first CD4 counts from Kisii Hospital records showed a median of 348 (IQR 185;551) with 437 (34 %) having a CD4 count of < 250 cell/µL and 646 (50%) a CD4 cell count < 350 cells/ µL.
Conclusion: Community-based campaigns likely reach people living with HIV earlier with significant potential prevention and care benefits. Specifically, early access to HIV counseling and testing could be used to offer early WHO-recommended TB screening and isoniazid preventive treatment.
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