A Case of TASO Tororo Surge Strategy: Using Double Layered Screening to Increase the Rate of Identification of New HIV Positive Clients in the Community

Introduction: HIV testing services is the entry point to HIV prevention, care, treatment, and support services. According to Uganda Population HIV impact assessment preliminary report released in 2018, 72.5% of people living with HIV in Uganda knew their status, which is below the UNAIDS target of 90%. We proposed a double layered screening of the population using the Ministry of Health HIV Testing Services (HTS) screening tool to identify more HIV positives and start them on treatment. The objective of this study was to assess the impact of the double layered screening approach on HIV test yield. Methods: A double layered screening approach involved using community and technical teams from TASO Tororo HIV clinic through the surge strategy. The community team (first layer) comprised of expert clients, local council 1, market and church leaders who were trained on how to screen the people in the community using the HTS screening tool. The technical team (second layer) comprised of medical personnel and counselors who subjected all people mobilized and screened by the community team to a second layered screening before offering an HIV test. We compared proportions of HIV test yields before and after the implementation of the double layered HTS strategy using proportions test and we assessed the impact of the double layered screening using a difference in difference (DID) evaluation method. Results; There was a general increase in HIV test yield from 4.75% with single screening (period: January-March 2018) to 12.25% with double screening (period: April – June 2018) (P<0.001). The increase was more in males (from 3.51% to 11.06%) than in females (from 6.36% to 13.31%) and this difference was significant (P=0.035). The increase in HIV test yield did not differ by age (P=0.060), by marital status (P=0.606) or by first time tester (P=0.167), Conclusion: The double layered screening before HIV test could be an effective strategy to maximize HIV test yield in the general population, which if scaled up can save huge resources, time and help focus on actual targets for HIV testing services, leading to early attainment of the UNAIDS 1st target of 90-90-90.