Shenoi SV Moll AP Madi J Guddera V Madondo T Turner D Brooks RP Kyriakides T Andrews L Friedland G 22 July 2016 Communitybased VCT Extending services beyond health facilities ID: 564343
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Slide1
Community-Based Voluntary Counseling and Testing in Rural South Africa
Shenoi SV
, Moll AP,
Madi
J, Guddera V,
Madondo
T, Turner D, Brooks RP, Kyriakides T, Andrews L, Friedland G.
22 July 2016Slide2
Community-based VCT
Extending services beyond health facilities
Community events
Home-based servicesReach people where they areDiagnosis earlier in the course of disease (ie. at higher CD4 counts) AsymptomaticNot yet on ART
Sweat, Lancet ID, 2011
Van Rooyen, JAIDS, 2013
Barnabas, Lancet, 2014Slide3
Tugela Ferry, Rural South Africa
180,000 traditional Zulu people
31% HIV antenatal prevalence
1074/100,000 TB incidenceExtreme povertyhigh unemployment (85%)no electricity (70%)no access to clean water (70%)Served by 350 bed district hospital16 primary care clinicsPhilanjalo NGO
Tugela FerrySlide4Slide5
CBVCT
/ TB integration
Community-Based
VCT integrated with TB screeningIn partnership with local Department of HealthTeam of nurses, HIV counselors, field health workersHIV testing with phlebotomy for CD4 cell countTB symptom screen with sputum collectionLinkage to care and evaluation of clinical outcomesCongregate community sites:
Municipality events
Pension pay points
Prisons
Taxi ranksHome based care eventsSecondary schools Slide6Slide7
Feasibility, Acceptability, & Yield
880
community events
Screened13,975
HIV testing
11,963 (86%
)
HIV-positive
1430 (10.2%)
Phlebotomy for CD4 performed803 (56%) Median CD4 429 (IQR 275-586)-
583
Flow diagram of Community-based V
oluntary Counseling and Testing
March
2010
– Jan 2016
Self-identified as HIV+
775 Slide8
11,963 (85%) accepted HIV testingMedian age: 41 (IQR 23-56
)
15-24yo: 2858 (24%)
1221 (43%) men 4569 (38.2%) reported first time HIV testing1,430 (10.4%) HIV positiveMedian age: 38 (IQR 30-48)15-24yo: 169 (12%)775 (54%) self identified as HIV+Slide9
HIV Positive Individuals by Community Site
Congregate
Site
Number Tested
Number HIV+
% HIV+ by Site
NNS
Secondary schools
353
6
1.7
59
Pension pay points
2696
262
9.7
10
Home based care events
3153
307
9.7
10
Municipality events
5583
539
9.7
10
Health fairs
505
72
14.2
7
Taxi ranks
1494
209
14.0
7
Prisons
191
35
18.3
5.5Slide10
HIV Positive Individuals Identified by Community Site (n=1430)Slide11
HIV Positive Individuals by Gender and Community Site (n=1430)
n=331 n=1099Slide12
HIV Positive Individuals by Age Group and Community Site (n=1430)
n=169 n=391 n=534 n=323Slide13
Variable
Unadjusted p-value
Adjusted p-value
Socio-economic
demographics
Young Age
0.001
0.0001
Female Gender
0.02
0.0001
Marital Status
0.88
Electricity
0.23
Community Site
<.0001
0.0015
Health History
Previous HIV testing
<.0001
Contact with
a TB patient
(12
mo
)
0.0001
History
of TB treatment
<.0001
0.0001
Recurrent pneumonia
<.0001
History
of shingles
<.0001
0.0001
History of oral thrush
<.0001
Current
Symptoms
Lymph
nodes
<.0001
0.0001
Diarrhea > 2 weeks
<.0001
Cough > 2 weeks
0.006
Night sweats
0.04
Weight loss
<.0001
0.03Slide14
Conclusions
Community-based ICF is an effective strategy for improving early case detection of HIV
Identifies HIV positive individuals at an earlier stage of disease though many in this sample were not
asymptomaticUtilizing a variety of congregate community settings is essential to reach a variety of demographic groups including high risk young people42% of HIV positive 15-24yo women were found at municipality events30% of HIV positive 15-24yo men were found at taxi ranksCommunity-based HIV testing with CD4 count services may remove obstacles to HIV careIdentification of HIV positive, ART eligibility and need for further risk stratificationInforms urgency of referral to HIV careMay facilitate ART initiationSlide15
Acknowledgements
Tugela
Ferry-Yale Research Team
Madi JMadondo TGuddera VChonco NFuse CMajola TMajola ZMvelase HKhanyile NMvelase H
Malembe N
Sibiya
K
Myende H
Makhaya KGerald FriedlandRalph BrooksLaurie AndrewsAnthony MollRick AlticeTassos KyriakidesFrancois EksteenJennifer GilbertAlison GalvaniDavid Paltiel
FundersNIAID/NIHUSAIDGilead FoundationPEPFARUS CDCFogarty Yale School of Public HealthCIRAPatterson FoundationHealth Systems TrustIrene Diamond FoundationDoris Duke FoundationSlide16
Sheela.Shenoi@yale.edu