Impact of combination prevention approaches on high-HIV prevalence in fishing communities: a case of Sigulu Islands, Namayingo district, east central Uganda
Background: In 2009, combination HIV prevention was recommended by PEPFAR as an essential component of a balanced response to the global HIV epidemic. Combination HIV prevention defined as “Combining quality biomedical, behavioral, and structural interventions to craft a comprehensive prevention response to targeted subpopulations with mutually reinforcing interventions.” Fishing communities are known to be at higher risk of acquiring HIV infection in many sub-Saharan African countries. STAR-EC, an eight-year district-based project funded by USAID and implemented by JSI and its partners, supported integrated outreach to fishing island communities from April 2010 to Oct 2015.
Description: Quarterly integrated combination prevention service delivery outreaches were conducted to the Sigulu Islands, an archipelago of 11 islands in Lake Victoria. Services included HIV testing and counseling (HTC), voluntary medical male circumcision (VMMC), family planning, malaria treatment, TB diagnosis and treatment, chronic HIV care, condom education and distribution, risk-reduction interventions, and dissemination of IEC materials. The program used multidisciplinary teams of health workers and trained 345 village health teams and 216 condom peer educators to deliver services in static health facilities and mobile community outposts.
Lessons learned: During the period of April 2010 to Oct 2015, 22,315 individuals received HTC; 1,219 people, including 251 pregnant and lactating mothers who started on antiretroviral therapy (ART); 6,200 males were circumcised; 107 TB patients completed treatment, 1,444 clients received sexually transmitted infection treatment; and 611,077 condoms were distributed. This archipelago has experienced a significant reduction in HIV positivity, from 19% in 2010 to 4.8% in 2015, steady progress toward the goal of ''zero new HIV infections.''
Conclusions/Next steps: Combination HIV-prevention approaches help reduce HIV transmission in high-prevalence pockets. These approaches should be adopted by community and facility health workers who provide HIV&AIDS services in high HIV prevalence communities.
E. Tibenderana1,2, S. Mashate1,2, M. Ndifuna1, A. Mugume1, F. Herbert Kazibwe1, H. Ndagire1, F. Ajok Odoch1
1JSI Research & Training Institute, Inc. (JSI)/ Strengthening TB and HIV&AIDS Responses in East Central Uganda (STAR-EC), Jinja, Uganda, 2AIDS Healthcare Foundation (AHF) / Uganda Cares, Kampala, Uganda