Chamie Gabriel, Kwarisiima Dalsone, Clark Tamara D, Kabami Jane, Jain Vivek, Geng Elvin, Balzer Laura B, Petersen Maya L, Thirumurthy Harsha, Charlebois Edwin D, Kamya Moses R, Havlir Diane V
HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, United States of America ; Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Uganda ; The Sustainable East Africa Research in Community Health (SEARCH) Consortium.
Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Uganda ; The Sustainable East Africa Research in Community Health (SEARCH) Consortium ; Mulago-Mbarara Joint AIDS Program, Kampala and Mbarara, Uganda.
PLoS One. 2014 Jan 2;9(1):e84317. doi: 10.1371/journal.pone.0084317. eCollection 2014.
The high burden of undiagnosed HIV in sub-Saharan Africa is a major obstacle for HIV prevention and treatment. Multi-disease, community health campaigns (CHCs) offering HIV testing are a successful approach to rapidly increase HIV testing rates and identify undiagnosed HIV. However, a greater understanding of population-level uptake is needed to maximize effectiveness of this approach.
After community sensitization and a census, a five-day campaign was performed in May 2012 in a rural Ugandan community. The census enumerated all residents, capturing demographics, household location, and fingerprint biometrics. The CHC included point-of-care screening for HIV, malaria, TB, hypertension and diabetes. Residents who attended vs. did not attend the CHC were compared to determine predictors of participation.
Over 12 days, 18 census workers enumerated 6,343 residents. 501 additional residents were identified at the campaign, for a total community population of 6,844. 4,323 (63%) residents and 556 non-residents attended the campaign. HIV tests were performed in 4,795/4,879 (98.3%) participants; 1,836 (38%) reported no prior HIV testing. Of 2674 adults tested, 257 (10%) were HIV-infected; 125/257 (49%) reported newly diagnosed HIV. In unadjusted analyses, adult resident campaign non-participation was associated with male sex (62% male vs. 67% female participation, p = 0.003), younger median age (27 years in non-participants vs. 32 in participants; p<0.001), and marital status (48% single vs. 71% married/widowed/divorced participation; p<0.001). In multivariate analysis, single adults were significantly less likely to attend the campaign than non-single adults (relative risk [RR]: 0.63 [95% CI: 0.53-0.74]; p<0.001), and adults at home vs. not home during census activities were significantly more likely to attend the campaign (RR: 1.20 [95% CI: 1.13-1.28]; p<0.001).
CHCs provide a rapid approach to testing a majority of residents for HIV in rural African settings. However, complementary strategies are still needed to engage young, single adults and achieve universal testing.
撒哈拉以南非洲地区未诊断出的艾滋病毒负担沉重，这是艾滋病毒预防和治疗的主要障碍。开展提供艾滋病毒检测的多病种社区健康活动（CHC）是迅速提高艾滋病毒检测率并识别未诊断出的艾滋病毒感染者的成功方法。然而，需要更深入了解人群层面的参与情况，以最大限度地提高这种方法的有效性。
在社区宣传和人口普查之后，2012年5月在乌干达一个农村社区开展了为期五天的活动。人口普查对所有居民进行了登记，记录了人口统计学信息、家庭住址和指纹生物特征。社区健康活动包括对艾滋病毒、疟疾、结核病、高血压和糖尿病进行即时检测。对参加和未参加社区健康活动的居民进行比较，以确定参与的预测因素。
在12天内，18名人口普查工作人员登记了6343名居民。活动期间又识别出501名居民，社区总人口达到6844人。4323名（63%）居民和556名非居民参加了活动。4879名参与者中有4795名（98.3%）接受了艾滋病毒检测；1836名（38%）报告此前未进行过艾滋病毒检测。在接受检测的2674名成年人中，257名（10%）感染了艾滋病毒；257名感染者中有125名（49%）报告为新诊断出的艾滋病毒感染者。在未经调整的分析中，成年居民未参加活动与男性性别（参加比例为62%男性对67%女性，p = 0.003）、年龄中位数较低（未参与者为27岁，参与者为32岁；p<0.001）以及婚姻状况（单身者参加比例为48%，已婚/丧偶/离异者参加比例为71%；p<0.001）有关。在多变量分析中，单身成年人参加活动的可能性显著低于非单身成年人（相对风险[RR]：0.63[95%置信区间：0.53 - 0.74]；p<0.001），人口普查活动期间在家的成年人比不在家的成年人参加活动的可能性显著更高（RR：1.20[95%置信区间：1.13 - 1.28]；p<0.001）。
社区健康活动为在非洲农村地区对大多数居民进行艾滋病毒检测提供了一种快速方法。然而，仍需要补充策略来吸引年轻单身成年人并实现全面检测。
