Reaching Men with Multi-Disease Testing

Transcription

1 Reaching Men with Multi-Disease Testing Ministry of Health Rukia Aksam Medical doctor MOH Kisumu county 6 November 2018

2 outline Introduction. Differentiated testing overview. Methodology Results Lessons learned and next step

3 Kenya Context 1 Kenya has the 4 th largest HIV epidemic in the world: na<onal HIV prevalence is ~6% and there are 1.5 million PLHIV HIV prevalence and incidence are highest in Western Kenya. Kisumu County HIV prevalence = 19%, the 3 rd highest in Kenya Kenya is not on track to reach the 1 st 90 for men 3

4 Kenya Context 2 Men Approximately 30% of men in Kenya have never tested for HIV HIV Tes=ng coverage in Kenya 2007 vs by gender 100% KAIS 2007 KAIS % 80% 63% 71% 60% 40% 41% 25% 34% Propor=on of young people in Kenya ever tested for HIV by age and gender 20% 0% Women Men Total 4

5 Differentiated Testing Overview: Target Groups Our project aimed to increase the uptake of HIV testing services amongst men in the general population in Kisumu County, Western Kenya The project was located at the Jaramogi Oginga OdingaTeaching and Referral Hospital in Kisumu Supported by ICAP through CDC funding. The CQUIN Learning Network 5

6 Case Study Methods / Intervention In March 2017, ICAP supported the launch of a multiple disease screening program, including screening for: TB disease Hypertension (blood pressure) Nutritional status (weight, height) HIV infection Patient education Located at the hospital entrance, clients and visitors (> 15 years old) were eligible to access the service from 8am to 9pm daily, including weekends Mul<ple disease screening booths at the hospital main entrance The CQUIN Learning Network 6

7 Mobilizing WHEN July 2017-OCT 2017 WHERE At the hospital in all the departments, surrounding private hospitals and clubs WHO Community peers, Health care workers and clients who have accessed the service WHAT Fliers/banners, posters and client referral system The CQUIN Learning Network 7

8 Testing WHEN 8am 9pm daily, including weekends WHERE In booths/kiosks at the entrance of the hospital WHO WHAT HTS counselors were trained to deliver the mul<ple disease screening services Support included SOPs, job aides and M&E tools Tes<ng for hypertension, TB disease, nutri<onal status The CQUIN Learning Network 8

9 Linkage WHEN WHAT Internal linkage is done the same day by use of trained linkage officers who escort clients from the Mul< disease center for other services within the hospital including CCC Clients op<ng for external linkage are referred to their preferred facility with a referral leeer and a follow up within 7 days. Clients are screened, referred for retest at the CCC, linked and followed up on treatment un<l the process is completed. Referral is also done for the clients with presump<ve Tb for gene xpert and further clinical assessment. The CQUIN Learning Network 9

10 Results 1 HIV Tes<ng Cascade 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 15,561 15,561 14,745 14,745 2, % 95% 100% 1% 83% Workload Screened Eligible Tested Positive Linked Period October17- September 2018 Data Source: MoH 362/HTS Register The CQUIN Learning Network 10

11 HTS within a Multiple Disease Screening Package (n=14,475) Gender distribu<on Age-Gender distribu<on Male Female Female Male , % 53% , , Period October17- September 2018 Data Source: MoH 362/HTS Register 4,000 2, ,000 4,000 # of clients

12 Proportion of men tested at the multiple disease screening service compared to other points of service % of clients 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 47% 57% 53% Multiple disease screening service (n=14,475) Period October17- September 2018 Data Source: MoH 362/HTS Register Male 43% Female Inpatient Wards (n=5,600) 66% 34% Outpatient Clinics (n=36,551)

13 Proportion of men tested at the multiple disease screening service compared to other points of service, by age group 70% Multiple disease screening service Inpatient wards Outpatient clinics % of clients 60% 50% 40% 30% 46% 43% 35% 49% 54% 54% 57% 47% 51% 37% 38% 43% 36% 29% 25% 56% 47% 45% 53% 42% 43% 20% 10% 0% yrs yrs yrs yrs yrs yrs 50+ yrs Period October17- September 2018 Data Source: MoH 362/HTS Register Age Group

14 HIV testing positivity yield among all tested at multiple disease screening service compared to other points of service 3.0% 2.6% % of clients testing HIV+ 2.5% 2.0% 1.5% 1.0% 0.5% 1.4% 1.4% 0.0% Multiple disease screening service (n=14,475) Inpatient Wards (n=5,600) Outpatient Clinics (n=36,551) Period October17- September 2018 Data Source: MoH 362/HTS Register

15 Case Study Discussion Providing HIV testing and counseling within a multiple disease screening service is an innovative approach to reach men who do not routinely access health service The extended hours on weekends and evenings were utilized more by men than women HIV positive yield among those tested was similar in multiple disease screening service as compared to inpatient and inpatient wards This approach also identified clients who had high or low BMI, hypertension and/or presumptive TB The CQUIN Learning Network 15

16 Lessons Learned and Next Steps Multi disease screening as a model of DSD can be applied to achieve the first 90 among men and clients with stigma. Scale up to other facilities. The CQUIN Learning Network 16

17 Acknowledgements Ministry of Health