Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers
Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers
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DOI：
10.7448/ias.20.5.21633
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发表时间：
2017-07-01
影响因子：
6
通讯作者：
Barnabas, Ruanne V.
中科院分区：
文献类型：
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作者：
Asiimwe, Stephen;Ross, Jennifer M.;Barnabas, Ruanne V.
简介：要实现联合国艾滋病规划署 90-90-90 的目标，乌干达接受艾滋病毒护理的人数将需要增加一倍以上。以社区为基础的艾滋病毒护理计划是扩大艾滋病毒护理服务范围的有效策略，但很少有计划特别注重扩大规模。方法：基于社区的综合倡议是一家总部位于乌干达的非政府组织，设计并实施了一项基于社区的艾滋病毒咨询和检测计划，并利用乌干达希马县农村地区的社区卫生推广工作者 (CHEW) 促进了与护理的联系。 CHEW 在 2015 年 10 月 1 日至 2016 年 3 月 31 日期间开展了项目活动。本次评估的结果包括 (1) HIV 检测人数，(2) 检测呈阳性者在检测呈阳性后三个月内到 ART 诊所就诊的比例，以及 (3) 每个新诊断出 HIV 患者的项目费用。使用微观成本法来计算项目成本。使用已发布的框架对计划可扩展性因素进行了评估。结果：62 名 CHEW 参加了为期五天的培训，培训内容介绍了 HIV 生物学、保密 HIV 检测的实施、HIV 预防信息以及链接、转诊和报告要求。 CHEW 每月获得 30 美元的津贴和现场检测套件，其中包括自行车、野外包、雨伞、胶靴、报告手册、笔和 HIV 检测材料。在为期六个月的计划期间，经过培训的 CHEW 对 43,696 人进行了 HIV 感染检测。 974 名参与者 (2.2%) 被确定为 HIV 阳性，623 名参与者 (64%) 接受了 HIV 护理。作为该活动的一部分，估计 69% 的成年居民接受了检测。该计划的费用为每人检测 3.02 美元，每名阳性患者 135.70 美元，每名 HIV 阳性患者与护理相关的费用为 212.15 美元。 结论：非专业社区健康推广工作者 (CHEW) 可以快速接受培训，以扩大家庭艾滋病毒检测和咨询 (HTC) 范围，并以高质量和低成本的方式为农村高负担环境中的大量人群提供护理服务。综合艾滋病毒检测方法，例如在社区检测中增加伴侣检测，可以增加艾滋病毒阳性者的确诊比例。
Introduction: Achieving the UNAIDS goals of 90-90-90 will require more than doubling the number of people accessing HIV care in Uganda. Community-based programmes for entry into HIV care are effective strategies to expand access to HIV care, but few programmes have been evaluated with a particular focus on scale-up.Methods: Integrated Community Based Initiatives, a Uganda-based non-governmental organization, designed and implemented a programme of community-based HIV counselling and testing and facilitated linkage to care utilizing community health extension workers (CHEWs) in rural Sheema District, Uganda. CHEWs performed programme activities during 1 October 2015 through 31 March 2016. Outcomes for this evaluation were (1) the number of people tested for HIV, and (2) the proportion of those testing positive who were seen at an ART clinic within three months of their positive test, and (3) the cost of the programme per person newly diagnosed with HIV. Microcosting methods were used to calculate the programme costs. Program scalability factors were evaluated using a published framework.Results: Sixty-two CHEWs attended a five-day training that introduced the biology of HIV, the conduct of confidential HIV testing, HIV prevention messages, and linkage, referral, and reporting requirements. CHEWs received a $30 monthly stipend and a field testing kit that included a bicycle, field bag, umbrella, gumboots, reporting booklet, pens, and HIV testing materials. Trained CHEWs tested 43,696 persons for HIV infection during the six-month programme period. Nine-hundred seventy-four participants (2.2%) were identified as HIV positive, and 623 participants (64%) were linked to HIV care. An estimated 69% of adult residents received testing as part of this campaign. The programme cost $3.02 per person test, $135.70 per positive person identified, and $212.15 per HIV-positive person linked to care.Conclusions: Lay community health extension workers (CHEWs) can be rapidly trained to scale-up home-based HIV testing and counselling (HTC) and linkage to care in a high-quality and low-cost manner to large numbers of people in a rural, high burden setting. A combination HIV testing approach, such as adding partner testing to community-based testing, could increase the proportion of HIV-positive persons identified.