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Reuben Granich HIV/AIDS Department World Health Organization

Early access to voluntary HIV counseling and testing, bed nets and water filters through an integrated campaign in Kenya: potential impact on HIV and TB transmission. Reuben Granich HIV/AIDS Department World Health Organization. International AIDS Conference, Vienna July 18-23, 2010.

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Reuben Granich HIV/AIDS Department World Health Organization

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  1. Early access to voluntary HIV counseling and testing, bed nets and water filters through an integrated campaign in Kenya: potential impact on HIV and TB transmission Reuben GranichHIV/AIDS DepartmentWorld Health Organization International AIDS Conference, Vienna July 18-23, 2010

  2. Outline: • Background • Methods • Results • Conclusions

  3. Smallpox eradication 1796 to 1977: Edward Jenner to Merca Town, Somalia

  4. Campaigns against Guinea Worm Guinea worm eradication

  5. Campaigns against preventable blindness Preventable blindness

  6. Community counseling and testing is feasible and works in a wide variety of settings Photos courtesy of Bunnell R, Marum E, and Vestergaard Frandsen

  7. Late initiation of ART and mortality Source: Egger M, CROI 2007

  8. Havlir, Getahun et al. 2008 JAMA 300(4):423-430 CD4 level is associated with TB incidence:earlier start may decrease TB risk "TB death zone" Slide adapted by Dr. Abhishek Sharma

  9. Coverage of ART among eligible people living with HIVKenya (2007 KAIS) 39% know status, on ART 57% Unaware of status, not on ART 39% 57% 4% know status, not on ART HIV test Among those who knew status and were eligible 92% were on ART Mohammed, CROI 2009

  10. Kenya Aids Indicator survey (KAIS) 2007 • ~1,300,000 persons living with HIV (15-64yrs) • Prevalence 7.1% • range (1% to 15%) • Nyanza and Rift Valley home to >50% ofHIV-infected adults (15-64 yrs) Kisii Population – 37,538,000

  11. Kisii (Nyanza) campaign sites Mosocho Kisii Level 5 Hospital Keumbu Kiogoro

  12. Methods • Kisii District, Nyanza Province (population 4.7 million; target population 5000) • September 2009 three days day, three site campaign • Campaign objective: • Lessons from the 2008 Kakamega campaign • Feasibility of scaling up onsite CD4 cell counts • Testing the campaign in a peri-urban setting • Determine potential benefits of early HIV identification • Interventions: • LLIN, water filters, 60 condoms • Health education information

  13. Methods: logistics and laboratory • Ministry of Health and Vestergaard Frandsen collaboration • Participants with HIV received a 3-month supply of cotrimoxazole and referral for further care and treatment • Campaign cohort used Guava AUTOCD4 flow cytometers for CD4 counts • Hospital reference cohort used Becton Dickinson FACS Calibur • External quality control of CD4 counts • 5% campaign samples sent to Kisii Hospital for quality control • Kisii hospital works in partnership with CDC Kisumu for quality control of CD4 counts

  14. Methods: Hospital cohort • Kisii Hospital 6 month historical reference cohort abstracted from medical records (March to August 2009) • First CD4 counts of all patients aged 15 and above diagnosed with HIV • Historical cohort of 1284 patients • Modeling of potential benefits was done using similar parameters and model • 2007 KAIS CD4 data

  15. Results • Campaign reached 5203 individuals • Package given to 5203 (100%) of people whether or not they decided to have HIV test • 100% tested for HIV • 329 (6.3%) tested HIV positive • 255 (78%) had CD4 count determination • median of 536 cells/ µL (IQR 350;759) • Kisii Hospital reference cohort • 1284 first CD4 counts • Median 348 cells/ µL (IQR 185;551)

  16. CD4+ cell count distribution in Nyanza Province (KAIS survey) and the Kisii campaign Nyanza Province (KAIS) Campaign participants No significant difference in the distributions

  17. CD4+ cell count distribution in Nyanza Province (KAIS survey) and the Kisii campaign hospital cohort Nyanza Province (KAIS) Kisii Hospital reference cohort Hospital cohort significantly lower

  18. CD4+ cell count distribution in Kisii hospital reference cohort and the Kisii campaign Kisii Hospital reference cohort Campaign participants Campaign cohort significantly higher

  19. CD4+ cell count frequency distribution (Hospital reference, Campaign, KAIS) Hospital reference Campaign Nyanza (KAIS)

  20. Modeled impact of campaign approach for Nyanza Province

  21. Conclusions • Integrated campaigns have a significant potential to bring services to people where they live • Possible to bring CD4 technology to the community • Improved access translates into earlier HIV diagnosis • Early HIV diagnosis has significant prevention, care and treatment benefits • To reach Universal Access and achieve MDGs we will need to expand access to HIV services in the community

  22. Thank you People of Kisii town and surrounding areas Nicolas Muraguri (MoH Kenya) Alex Doyen (Vestergaard Frandsen) Navneet Garg (Vestergaard Frandsen) Brian Williams (SACEMA) MoH Kenya staff Vestergaard Frandsen

  23. Public health is purchasable. Within a few natural and important limitations any community can determine its own health. --Hermann M. Biggs (29 Sep 1859 - 28 Jun 1923) New York City's Public Health Officer and public health pioneer

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