High impact of mobile units for mass HIV testing in Africa

Despite the usefulness of voluntary counselling and testing centres implemented in Africa [1,2], their limited capacity does not allow for vast testing of the general population. Therefore, in order to increase the number of individuals tested for HIV with the aim of enhancing the scaling up, we developed a strategy based on bringing the healthcare package much closer to the people, by using mobile HIV testing units. We herein report the Cameroon experience of mobile HIV testing unit strategy, demonstrating its effectiveness in reaching a great number of individuals, including those without usual access to HIV testing facilities. The pilot project was conducted by the Laboratoire National de Santé Hygiene Mobile (LSHM). LSHM acquired a 7.5 m long van (Coaster, Toyota, Japan), comprising seats for the medical team and a space for laboratory facilities. The medical team is composed of eight people, including the senior coordinator, three counsellors, two laboratory technicians, an animator and a driver. HIV testing was conducted as recommended by the World Health Organization [3]. The testing of HIV-specific antibodies in serum samples consisted of initial HIV testing by a rapid test (Determine; Abbott, Tokyo, Japan); samples were declared negative for HIV, undetermined or positive. Undetermined or positive samples were immediately retested by another rapid test (ImmunoComb II HIV 1&2 Bispot; Orgenics, Yavne, Israel); samples tested positive by both HIV testing assays were declared positive for HIV, and samples with discrepant results were referred to the LSHM for further investigations. HIV mobile testing strategy is comprised of the following steps. First, placing the HIV testing mobile unit in a public setting after authorization from government officials; mobilizing community-based associations and non-governmental organizations involved in HIV control and district hospitals. Second, informing the public on the usefulness of voluntary HIV testing coupled with free and rapid HIV testing. An increasing number of individuals turned out after this information willing to do the test. They were then invited to get registered, and to proceed to the pretest counselling session in a separate area. Then, 5 ml of blood sample was collected by venipuncture, and the tube sent to the laboratory of the mobile unit for HIV testing. One hour later, the results were given to the volunteers during the posttest counselling session in a separate area. From April 2005 to December 2006, 71 campaigns from one to 3 days were organized in six out of 10 provinces in Cameroon, including 23 rural and 48 urban settings. Among 16 919 volunteers receiving the pretest counselling, 16 869 (10 810 men; 6059 women) were tested for HIV, giving an HIV testing acceptability rate of 99.7%. Out of this percentage, 12 769 (75.7%) had never been tested before for HIV. Their average age was 27 years (ranging between 15 and 83), and the male to female sex ratio was 1.78. Among the tested volunteers, 16 850 (99.9%) received posttest counselling. A mean number of 336 volunteers (ranging between 104 and 469) could then be tested for HIV in a one-day campaign. By the first testing assay used in the alternative strategy for HIV serodiagnosis, 15 828 sera were found negative; 1090 were clearly positive for HIV, and 51 (0.3%) sera gave a faint band on the Determine assay and were interpreted as indeterminate. All positive sera were further confirmed as positive by the ImmunoComb assay. All indeterminate sera were found to be negative by the ImmunoComb assay, and were confirmed negative by HIV testing enzyme-linked immunosorbent assay performed in LSHM. The overall HIV prevalence stood at 6.86%. The distribution of HIV serological status by province, urban and rural areas, sex and age is shown in Fig. 1. The most affected groups were women aged between 25–34 years and men in the 35–44 years bracket. In each age group (except the 35–39 year group) and each province, the percentages of HIV-infected women were far higher than those of HIV-infected men (P < 0.01 with STATA version 7 software; STATA Corp., College Station, Texas, USA).Fig. 1: Seroprevalences for HIV-1 among the general, female and male populations attending the pilot voluntary HIV testing mobile strategy from April 2005 to December 2006, by age classes and location in Cameroon, including the Centre, South, South-West, Littoral, West, North, and North-West provinces and a total of 23 rural and 48 urban settings. General population;HIV-infected women;HIV-infected men.This pilot study, for the first time in the central African region, clearly demonstrates the acceptability, feasibility and effectiveness of using mobile units as a tool for mass HIV testing in individuals with limited access to voluntary counselling and testing [4]. Successful HIV testing with mobile units was unexpected, given that resistance and sociocultural impediments to HIV testing have been identified in sub-Saharan Africa, especially in central Africa [5,6]. Our observations demonstrate that the traditional drawbacks to HIV testing in Africa no longer exist, and the offer of HIV testing with adapted counselling is now well accepted by a high proportion of the population. On the whole, HIV testing, through mobile units probably constitutes a useful tool to promote large-scale HIV testing in sub-Saharan Africa, and should be integrated into the national HIV control programme. Acknowledgements The authors are grateful to the many anonymous individuals whose contributions made this work possible, the staff of the mobile unit of the LSHM, particularly Ms Chantal Deugoue Kalla. They also thank the Global Fund to fight AIDS Tuberculosis and Malaria and the Cameroon Ministry of Public Health for support.