Increasing Access to HIV Testing for Fishing Communities

The USAID SUSTAIN project committed to a surge plan, an U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) initiative, to increase the number of HIV positive clients newly initiated on treatment. To achieve the semi-annual target by the end of March 2018, the project has focused on increasing access to HIV testing services (HTS) and yield, and improving linkage of HIV positive clients to HIV treatment services. The project is implementing targeted HTS and index client testing at 74 health facilities and surrounding communities, strengthening linkage to HIV treatment services by attaching linkage facilitators at each facility to support enrollment of HIV positive clients on treatment, and following-up clients who have not started on ART. Performance is monitored on a weekly basis to document achievements and respond quickly to identified gaps in implementation. Notable progress has been made in yielding greater results in identifying, linking and initiating HIV positive individuals on treatment.                                                                                                                                                                            

As part of this effort, USAID SUSTAIN supported health center (HC) level facilities in Apac District (Wansolo HC II, Akokoro HC III, Nambieso HC III, and Chawente HC III), which serve the fishing communities, to increase access to HTS. The fishing community in Apac (a priority population of focus for targeting HIV services) live a nomadic existence, often traveling between Amolatar, Apac and Masindi districts, which are in proximity to Lake Kyoga and Kwania; their main source of economic activity. At some of the landing sites, the closest facilities are health center IIs that do not have ART clinics nor provide HTS which is a challenge due to the high HIV prevalence at the landing site.

To achieve the semi-annual target for newly initiating HIV positive individuals onto antiretroviral therapy, SUSTAIN set out to offer HTS in the fishing villages (which include the landing sites and the floating islands) and conduct index client testing. The testing was conducted by health workers from the facilities closest to the landing site, with support from the district health team, under the supervision of SUSTAIN staff. Fisher folk on the floating islands of Lake Kyoga and Kwania are suspicious of outsiders, so peers were used for mobilization. To ensure a positive welcome, the peer mobilizers called ahead to inform the residents of the approaching health workers. Health workers collected contact information for HIV positive clients’ families, including their village location, to conduct index client testing. A total of 2,183 individuals were tested during the outreaches in the fishing communities in which 183 were identified HIV positive and 182 linked to care at a health center III of their choice.