J Int AIDS Soc. 2017 Mar 30;20(1):21514. doi: 10.7448/IAS.20.1.21514.
INTRODUCTION: Multi-disease community health campaigns can be effective for population-wide HIV testing in a research setting (SEARCH: NCT01864603). We sought to evaluate feasibility and uptake of a community-led health campaign (CLHC) planned and implemented by village leaders and local clinic workers in Uganda. METHODS: Over five months in 2014, locally elected village leaders and Ministry of Health (MoH) clinic staff in a rural parish in Uganda planned a census followed by a CLHC, after training by two SEARCH trial consultants and by leaders from a neighbouring parish that had previously participated in a SEARCH health campaign. We defined feasibility as: (1) elected leaders' participation in training and implementation of pre-campaign census and mobilization activities; (2) implementation of all campaign activities by MoH-funded, local clinic staff; and (3) community participation in the campaign, including point-of-care screening for HIV, malaria, hypertension and diabetes, and same-day referral for male circumcision and family planning (FP). Costing of all salaries and supplies was conducted. RESULTS: Elected leaders from all eight villages in the parish participated in CLHC training. They and local clinic staff met monthly to select and plan CLHC services. Village leaders then leveraged existing volunteer health teams to perform a door-to-door census, enumerating 5,202 parish residents over 2 weeks. 2,753 (53%) residents participated in the 6-day CLHC. Of 1,584 adult participants, 1,474 (93%) tested for HIV: 105/1,474 (7.1%) tested HIV positive. 27% (751/2,753) of participants reported fever and underwent malaria rapid diagnostic testing: 5.3% (40/751) tested positive. Among adults screened, 19% (271/1,452) were hypertensive, and 3% (18/637) had a random blood sugar >11.1 mmol/L. Of 805 men and boys (>10 years), 91 (11%) accepted same-day clinic referral and underwent medical circumcision. Of 900 women offered same-day long-term FP referrals, 25 accepted. The CLHC cost, including census, mobilization and testing services, was $23,597 ($8.57/participant). CONCLUSION: Elected village leaders successfully planned and conducted a 6-day multi-disease health campaign with service provision by local clinic staff that reached over half of a rural Ugandan community. These data suggest it is feasible for local leaders and clinics to adopt a multi-disease health campaign approach to scale-up HIV testing in rural Africa.
引言:在研究环境中,多疾病社区健康运动对于全人群的艾滋病毒检测可能是有效的(SEARCH:NCT01864603)。我们试图评估由乌干达的村长和当地诊所工作人员计划并实施的社区主导健康运动(CLHC)的可行性和接受程度。 方法:2014年的五个多月里,乌干达一个农村教区的当地当选村长和卫生部诊所工作人员在两名SEARCH试验顾问以及先前参与过SEARCH健康运动的邻近教区领导人的培训后,计划了一次普查,随后开展了社区主导健康运动。我们将可行性定义为:(1)当选领导人参与运动前普查和动员活动的培训与实施;(2)由卫生部资助的当地诊所工作人员实施所有运动活动;(3)社区参与运动,包括即时护理筛查艾滋病毒、疟疾、高血压和糖尿病,以及当天转诊进行男性包皮环切术和计划生育(FP)。对所有工资和物资进行了成本核算。 结果:教区所有八个村庄的当选领导人都参加了社区主导健康运动培训。他们和当地诊所工作人员每月会面,以选择和规划社区主导健康运动服务。然后,村长利用现有的志愿者健康团队进行挨家挨户的普查,在两周内对5202名教区居民进行了登记。2753名(53%)居民参加了为期6天的社区主导健康运动。在1584名成年参与者中,1474名(93%)接受了艾滋病毒检测:105/1474(7.1%)检测为艾滋病毒阳性。27%(751/2753)的参与者报告有发热症状并接受了疟疾快速诊断检测:5.3%(40/751)检测呈阳性。在接受筛查的成年人中,19%(271/1452)患有高血压,3%(18/637)随机血糖>11.1 mmol/L。在805名男性和男孩(>10岁)中,91名(11%)接受了当天诊所转诊并进行了医学包皮环切术。在900名获得当天长期计划生育转诊的女性中,25名接受了转诊。社区主导健康运动的成本,包括普查、动员和检测服务,为23597美元(8.57美元/参与者)。 结论:当选村长成功计划并开展了为期6天的多疾病健康运动,由当地诊所工作人员提供服务,覆盖了乌干达农村社区一半以上的人口。这些数据表明,当地领导人和诊所采用多疾病健康运动方法在非洲农村扩大艾滋病毒检测是可行的。
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