Communities Benefit from Door-to-Door HIV Testing

On a rainy day in Obuya village, a rural town located on the hills in Homa Bay, Kenya, James Aduda, a farmer hurries to return his cows back home to shelter. At the entrance of his homestead he is met by the familiar greeting of his chief and one of the village elders. He ushers the visitors inside, and sends his youngest son to call for his mother. After they greet each other, the chief informs Aduda and his family that health care workers will be visiting every house in the coming days to offer HIV testing (HTS) and other health services.

Aduda is the only one in his family who has ever been tested for HIV, and welcomes the news to learn about his family’s health status.

To achieve universal access to treatment and to combat HIV and AIDS, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), in partnership with Kenya’s Ministry of Health, is providing door-to-door HTS in Homa Bay. The Kenya HIV Prevention Revolution Roadmap 2014, clusters Homa Bay County among the high-burden counties. The report shows that close to 65 percent of all new HIV infections occur in nine of the 47 counties in Kenya; creating a need for combination prevention strategies and geographic prioritization of the HIV response.

The report further estimates that refocused and prioritised HIV prevention would avert 1,149,000 new HIV infections and 761,000 AIDS related deaths by 2030 at a cost 19.9 billion USD.

“We are able to reach people in their homes, workplaces and leisure places like bars and lodges,” said Polycarp Musee, EGPAF-Kenya’s Technical Advisor – HIV Testing Services. The initiative involves door-to-door testing and mobile approaches (including in workplaces, schools, universities and venues frequented by key populations).

Before testing can commence, EGPAF meets with various stakeholders from the provisional administration, county administration, political leadership, religious leaders, special groups and priority populations to ensure the community buys-in to the process. The stakeholder meetings also help with mobilization of key populations. “We rely heavily on chiefs, assistant chiefs and village elders to map the villages and introduce us to the community,” said Musee.

During testing, the HTS counsellor is accompanied by a guide and an enumerator. The guide is usually a village elder who introduces the HTS team to the family. The enumerator takes the details of the household and steps out for the counselling and testing to commence.

“There has been good acceptance and we have had very minimal resistance,” said Corneleous Okal, the Sub County AIDS and STI Coordinator.

Other health services that are offered during the community testing include:

• Screening for tuberculosis
• Screening for HIV-exposed infants
• Screening for treatable conditions and transfers to facilities
• Mapping for pregnant women.

When An HIV Test is Positive

After counselling, the family is requested for consent to be tested for HIV.

When someone tests HIV-positive, they are linked to the facility on the same day. In case they have hesitations, the HTS counsellor offers to accompany them.

“It can be difficult [when] someone was not sick and you are telling them to go to the hospital,” said Musee.

“The guidance and counselling team has been doing good work,” said Robert Lango, the Chief from Arujo Location, “We have not had family disputes after the testing when one couple tests positive and the other negative.”

Continued expansion of community-based testing to complement facility-based testing is an important consideration in achieving universal knowledge of HIV status and earlier diagnosis and linkage to care and treatment. Community-based testing approaches may reach people with HIV earlier in the course of HIV disease than provider-initiated testing and counselling, as well as reaching populations that may not normally attend health services like men, adolescents and especially key populations.