Expanding HIV Testing and Linkage to Care in Southwestern Uganda with Community Health Extension Workers

October 2017 - Structural Prevention

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Asiimwe, S., Ross, J.M., Arinaitwe, A., et al. Journal of the International AIDS Society (July 2017), 20(S4): 21633, doi: 10.7448/IAS.20.5.21633.

This study examined an intervention that used community health extension workers (CHEWs) to implement community-based HIV counseling and testing with facilitated linkages in rural Uganda. CHEWs, who administered rapid tests within homes, provided each newly identified HIV-positive person with a referral that included their result and the contact information of a specific provider at the clinic. Once at the clinic, the individual received documentation that they had attended the visit, which the CHEW reviewed during a follow-up home visit. During six months of implementation, CHEWs provided 43,696 home-based HIV counseling and testing visits (69.4% of adults in the study district); 2.2 percent of tests were positive, and 64 percent resulted in a linkage to a health facility. Men made up 47 percent of HIV tests, a greater proportion than in comparable studies. Regional public health facilities, which served as control sites, tested 15,117 individuals during the same time period, with a positivity rate of 5.1 percent and 76.1 percent linking to treatment. Total program cost was USD$132,167 and the cost per positive test was $135.70. Although more people were linked within the public health system, the number linked by CHEWs was still satisfactory in comparison to similar home-based testing programs. Additional CHEW follow-up visits could improve linkages.

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