Integrated Prevention Campaign Implementation Dr. Eric Lugada MD. PhD

Background  HIV diagnosis is critical for prevention and treatment. Prevention of co-infections such as malaria and diarrhea delays disease progression  Preventive interventions such as long-lasting insecticidal bed nets, point-of-use water filters, condoms and HIV counseling and testing (HCT), when implemented on a large scale, reduce malaria, diarrhea and HIV.  Multi disease prevention campaigns can achieve rapid and high coverage at low cost, but have not been widely evaluated in combination with HIV testing and prevention  The Integrated Prevention Campaign, a 7-day campaign held in Kenya in September 2008, combined voluntary HCT with distribution of a CarePack® containing a bed net, water filters, condoms and educational materials.

Method  The campaign –Mobilized stake holders and implemented a 7 day campaign intended to cover 80% of the population aged  Post campaign survey –Two-months post-campaign survey to measure uptake of products and utilization of services  Qualitative analysis –Qualitative program evaluating contextual circumstances facilitating or discouraging uptake of interventions  Costs and cost - effectiveness analysis - Cost and cost-effectiveness

The Campaign  Micro planning- obtain buy in from ministry of health, district health authorities, community leaders, PLWHA networks  Mapped and selected 30 uniformly distributed test sites in Lurambi division in Kakamega district Western Kenya  Recruited and trained 600 personnel; MOH trained counselors, laboratory technicians and product demonstrators  HCT following Kenya MOH guidelines, after obtaining consent and filling national VCT forms. Parallel testing done. QC done by sending 10% of samples for dry blood testing  Group counseling (~20 people) received health education and instructions on how to use the CarePack® contents; bed nets, water filters, condoms.  CD4 cell count was determined at the community level outside traditional health structures, those testing HIV(+) given a 3 months doze of cotrim and referred for further care

Campaign Process Social Mobilisation HIV pre-test counselling Product demonstration Public health education messages on newspapers, radio, etc Opt out of HIV testing Commodity distribution Pre-Campaign During the Campaign Post-Campaign Campaign announcement through banners, road shows, etc Client follow-up Campaign analysis Care for the HIV positives Testing Post-test counselling Commodity distribution Registration

Campaign Experience and Delivery of Preventive Interventions All participating in the campaign received the CarePack ®.

Summary campaign results: The Integrated Prevention Campaign reached universal testing goal in 7 days. Target population51,178 sexually-active yrs age group Total tested47007 Tested in age group 15 to 4941,040 (>80%) Women28906 Women diagnosed HIV+1448 (5.0%) Men18101 Men diagnosed HIV+508 (2.8%) Lowest HIV prevalence by age15-19 years (0.8%) Highest HIV prevalence by age30-39 years (6.7%) HIV+ put on cotrimoxazole96%

Conclusion  Integrated Campaign has the potential to: –Address multiple public health problems in a country simultaneously thus achieving various national objectives and MDGs in an efficient way. –Reach universal testing goal in a short time, thus ensuring access to treatment. –Break the social barriers associated with HIV testing. (stigma and domestic violence) –Achieve universal coverage with bed nets, water filters resulting in prevention of malaria and diarrhea –To get people early in the HIV disease cycle. –Reduce disease programme costs by up to one half in some countries –Avert significant DALYs in the target population, with economic savings. –Strengthen health systems

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