This integrated HCT and disease prevention campaign conducted in rural Kenya achieved 87% coverage among the estimated targeted population of the 15–49 years old in only 7 days. Integrated disease prevention campaigns are feasible and may leverage limited resources to alleviate high burden of diseases.
High HCT coverage was achieved with HCT counselor loads of 15–17 clients served per day with in national recommended optimum for mass HCT campaigns. High uptake of HCT during this campaign may have been due to; buy–in and involvement of the community leadership, delivery of services at convenient locations near participants' homes and concomitant distribution of free LLINs, water filters, and condoms. There was a higher uptake of the entire MPP than has been seen in social marketing campaigns for LLINs, safe water systems
and HCT, suggesting that combining multiple-disease interventions increases utilization of services.
High HCT acceptance is comparable to over 90% rates observed in home-based, door-to door testing interventions successfully implemented in Uganda
, and were achieved in a considerably less time. Such initiatives represent alternative options for wide spread coverage and acceleration of access to HCT services a necessary entry point for prevention and care,
in regions with generalized HIV epidemics particularly Kenya where less than 20% of adults living with HIV know that they are infected.
The average national HIV prevalence in Kenya is 7%, yet 84% of those infected with HIV do not know their HIV status
emphasizing the need to expand HCT services. During the campaign 96% of persons living with HIV were offered a 3-month course of cotrimoxazole prophylaxis and were referred for ongoing care and treatment. Identified persons living with HIV at two of the sites where offered point-of-care CD4 cell count testing, they had relatively high CD4 counts with a median of 541cell/µL, providing an opportunity for early provision of care and treatment.
Age, current marital status and occupation were associated with HIV-infection. These results support findings from other studies.
Women of all ages experienced a higher risk of HIV infection than men of the same age-group, and throughout their lives, men were more likely to have sexual partners outside of marriage. These differences highlight the potential benefit of focusing specific interventions on changing social norms, such as power differentials between men and women regarding sex and reproductive choice, social expectations regarding sex, and access to financial resources and education. The high rate of HIV infection among divorced/separated individuals may reflect some of these imbalances. The increased odds of HIV infection among widows may result from some of the same factors as well as a high risk for HIV transmission during end-stage HIV disease when an individual's viral load is high.
Malaria is still a leading cause of childhood morbidity and mortality in Kenya.
Several trials in Africa have shown that use of LLINs is effective in reducing morbidity and mortality.
When an entire village uses them a mass community effect extends even to those who do not use them.
Scaled-up control efforts which include free distribution of LLINs to rural Africa is recommended
but complete coverage is still uncommon. Mass LLINs campaigns target pregnant women and children less than 5 years of age. However, adults and children with HIV are at higher risk for clinical malaria and severe outcomes. Mass campaigns such as this enhance access for both adults and children, thus promote universal coverage.
Lack of access to safe drinking water and inadequate sanitation contributes to increased risk of diarrheal diseases and causes an estimated two million deaths per year in under 5 year olds.
The 2003 Kenya Demographic and Health survey indicated that 75% of Nyanza province population in Western Kenya lacked access to improved water supplies and reported the third highest diarrhea rates in the country.
Evidence indicates that simple, acceptable, low-cost interventions such as water filtration offers the most consistent and effective means of improving household water and risk of diarrhea diseases and associated deaths.
. The campaign rapidly increased access to a safe drinking water intervention.
Challenges faced in this campaign included maintaining efficiency and quality of service provision when dealing with a large population within a short time. Waiting times were sometimes longer than desirable during peak hours, further complicated by massive population turn up at the same time. In addition, scores of school children below the age of 15 turned up for the campaign but were turned away highlighting the need for youth in school targeted interventions. A further challenge was to ensure sufficient staffing, particularly trained and certified HCT counselors and laboratory technicians. Through buy-in and collaboration with the local community leadership, we were able to mobilize trained personnel from two provinces creating a shortage. However, we ensured that other HCT centers operated with skeleton staffing during the short period of 7 days. Staff shortage could be addressed by enhanced training efforts in future campaigns. Integrated multi-disease prevention benefit to the community is likely to decrease both burden and cost on existing health systems in the long run. We did not assess the success of clinic referral for participants living with HIV. This should be addressed in future campaigns, especially when dealing with larger populations such as would be found in entire districts and provinces.
This campaign presents an operational model for reaching the magnitude of HCT coverage required for many national goals and may help control the HIV epidemic.
It is time to consider changing our current approach to include ‘outside the facility’ services if we are to achieve health targets and a healthy population. Multi-disease integrated campaigns represent an important and effective modality to augment routine health services if we are to achieve rapid, high and equitable coverage of multiple health challenges. This model could be adapted to other underserved communities. This may well be one of the fastest approaches to achieve national health objectives spelt out in the Millennium Development Goals (MDGs).