MOPDD0102

Title

Universal test and treat: Reaching underserved farm workers and their families in four sub-districts of uMgungundlovu District, South Africa

Presenter

Irene Maina

Authors

E. Mungai¹, I. Maina², T. Ngwenya¹, F. Ndlovu³

Institutions

¹KZN Department of Treasury, Pietermaritzburg, South Africa, ²UNAIDS, Pretoria, South Africa, ³KZN Office of the Premier, Pietermaritzburg, South Africa

Background: In South Africa, both male and female farm workers are perversely affected by the HIV epidemic. In September 2016, the country adopted Universal test and treat (UTT) approach for HIV and TB. Studies indicate that farm workers have limited access to health services due to distance and the amount of time it takes to access health services which is often treated as unpaid leave. In response, a project was conceptualised whose aim was to increase access to UTT by farm workers age 15 - 49 years through door-to-door and community outreach services.
Methods: The Farm workers and families mobile HIV/TB outreach programme provided services listed in table 1 below. A two-pronged approach of door-to-door and community outreach was implemented between June - December 2018 in farms across four sub-districts in uMgungundlovu district, South Africa. Mobile teams consisted of professional nurse, lay counsellors, community mobilisers and data capturers. Data was captured onsite using laptops and later imported into the district health information system for the nearest clinic.

Intervention	Services Provided
HIV Counselling and Testing	HIV education, counselling to all occupants of the home and provide HIV testing to consenting individuals. Clients that test HIV positive will be referred to the Professional Nurse at the mobile unit for initiation and/or referral to the health facility. Condoms & lubrication distribution.
TB Screening	Screen clients using the DOH TB Screening Tools to identify presumptive TB patients. Collect sputum samples and send timeously to the laboratory at the local facility for TB testing. Link positive result patients to definitive care as soon as possible.
ART and TB treatment initiation	Collect baseline bloods and sputa. Initiate ART treatment as per standard guidelines. Do follow ups and linkage on patients on ART and TB patients as per guidelines. Mobile clinic serves as a distribution site for ARVs and other chronic medication for patients on treatment as per national guidelines.
TB/HIV Collaborative Activities	Screen all HIV positive clients, for latent and active TB and refer appropriately. All TB positive clients will be screened for HIV and referred appropriately. All HIV positive but TB negative will be initiated on IPT onsite.

[Table 1: HIV and TB Services Provided to Farm workers Through Mobile Outreach ]

Results: Table 2 shows people reached with various services through the programme. Seventy-seven percent of those testing HIV positive already knew their status and were on treatment. More males compared to females were screened for TB.
All clients (100%) diagnosed with TB and 87% of new HIV positive cases were initiated into treatment.

Number of Farm Workers and Family Members Screened for TB and Initiated on Treatment					Number of Farm Workers and Family Members Tested for HIV and Initiated on Treatment
Sub-district	Screened for TB	TB Presumptive cases	TB Presumptive cases diagnosed with TB	TB patients initiated on TB Treatment	Tested for HIV	Known HIV Positives	New HIV Positive	Initiated on ART Treatment	Initiated on IPT
Richmond	1476	277	8	8	992	149	90	84	91
uMkhabathini	1723	231	0	0	1080	236	73	71	39
uMgeni	1618	246	2	2	785	308	50	32	17
uMshwathi	1117	649	5	5	606	173	50	45	41
Total	5934	1403	15	15	3463	866	263	229	188
Male	2519	769	9	9	1587	279	108	99	78
Female	3415	634	6	6	1876	587	155	130	110

[Table 2: HIV and TB Service Uptake among Farm Workers and Families between June - December 2018, uMgungundlovu District]

Conclusions: Universal test and treat requires multi-pronged approaches to reach underserved populations. Mobile outreach services proved reliable in improving access to HIV and TB services by farm workers and their families. However, for increased positivity yield, more targeted testing is required such as the use of index testing approach. More analysis on known HIV positive and linkage to care needed.

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