Abana et al. BMC Public Health         (2023) 23:1051 BMC Public Health
https://doi.org/10.1186/s12889-023-15948-6
R E S E A R C H Open Access
Community based multi-disease health 
screening as an opportunity for early 
detection of HIV cases and linking them 
to care
Christopher Z-Y. Abana1,2,3, Dennis K. Kushitor1, Theodore W. Asigbee1,6, Prince K. Parbie5,6, Koichi Ishikawa5, 
Hiroshi Kiyono7,8,9, Taketoshi Mizutani7, Samuel Siaw4, Sampson B. Ofori4, Gifty Addo-Tetebo4, Maclean R. D. Ansong1, 
Marion Williams4, Samuel Morton4, George Danquah4, Tetsuro Matano5,6,7, William K. Ampofo1 and  
Evelyn Y. Bonney1*
Abstract
Background The 95-95-95 UNAIDS global strategy was adapted to end the AIDS epidemic by 2030. The target is 
based on the premise that early detection of HIV-infected persons and linking them to treatment regardless of their 
CD4 counts will lead to sustained viral suppression. HIV testing strategies to increase uptake of testing in Western and 
Central Africa remain inadequate. Hence, a high proportion of people living with HIV in this region do not know their 
status. This report describes the implementation of a community based multi-disease health screening (also known as 
“Know Your Status” -KYS), as part of basic science research, in a way that contributed to achieving public health goals.
Methods A community based multi-disease health screening was conducted in 7 communities within the Eastern 
region of Ghana between November 2017 and April 2018, to recruit and match HIV seronegative persons to HIV 
seropositive persons in a case-control HIV gut microbiota study. Health assessments included blood pressure, body 
mass index, blood sugar, Hepatitis B virus, syphilis, and HIV testing for those who consented. HIV seronegative 
participants who consented were consecutively enrolled in an ongoing HIV gut microbiota case-control study. 
Descriptive statistics (percentages) were used to analyze data.
Results Out of 738 people screened during the exercise, 700 consented to HIV testing and 23 (3%) were HIV positive. 
Hepatitis B virus infection was detected in 4% (33/738) and Syphilis in 2% (17/738). Co-infection of HIV and HBV 
was detected in 4 persons. The HIV prevalence of 3% found in these communities is higher than both the national 
prevalence of 1.7% and the Eastern Regional prevalence of 2.7 in 2018.
Conclusion Community based multi-disease health screening, such as the one undertaken in our study could be 
critical for identifying HIV infected persons from the community and linking them to care. In the case of HIV, it will 
greatly contribute to achieving the first two 95s and working towards ending AIDS by 2030.
*Correspondence:
Evelyn Y. Bonney
ebonney@noguchi.ug.edu.gh
Full list of author information is available at the end of the article
© The Author(s) 2023. Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, 
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in this article, unless otherwise stated in a credit line to the data.
Abana et al. BMC Public Health         (2023) 23:1051 Page 2 of 7 
Keywords Community-based, Multi-disease screening, Know your status, HIV
      Introduction Most large-scale community-based health screening 
Human Immunodeficiency Virus (HIV) continues to be campaigns are usually designed to create awareness of 
a major global public health problem with an estimated pertinent health issues. A few like the KYS goes a step 
38.0  million people living with HIV (PLWH) with the further by linking participants to treatment and care 
greatest impact in Africa (25.7 million) [1]. In 2019, the services.
estimated adult HIV prevalence for Ghana was 1.7% with Here, we describe how we implemented a community 
an estimated HIV population of 316, 352 and 25, 955 based multi-disease health screening to recruit healthy 
adults and children respectively [2]. In the same year, controls in seven communities in an ongoing HIV Micro-
Ghana’s Eastern Region recorded an HIV prevalence of biome study [14] and in the process identified PLWH and 
2.7% according to the annual HIV Sentinel Survey con- linked them to care. Data on the HIV-Microbiome study 
ducted by the National AIDS/STIs Control Programme has been published elsewhere [14]. The HIV-Microbiome 
[3]. study is under the project for Science and Technology 
Early detection, coupled with rapid linkage to care is Research Partnership for Sustainable Development Pro-
particularly essential in mitigating the HIV/AIDS epi- gram (SATREPS). It is a collaborative project between 
demic. However, the proportion of people living with the Noguchi Memorial Institute for Medical Research 
HIV (PLWH) who know their status remains inadequate (NMIMR), Eastern Regional Hospital, Koforidua, Ghana 
in Western and Central Africa populations [4]. As of Health Service (GHS), and Japanese partner institutions 
2017, only 48% of people living with HIV in Western (National Institute of Infectious Diseases- NIID, Institute 
and Central African knew their status [4]. Scaling-up of Medical Sciences, the University of Tokyo).
antiretroviral therapy (ART) is crucial to the control of 
the HIV/AIDS pandemic [5]. Initiation of early ART Methods
does not only reduce morbidity and mortality but also Study design
reduces incidence rates of HIV, resulting in the concept This was a cross-sectional study conducted from Novem-
of “Treatment as Prevention (TasP)” [6, 7]. To maximize ber 2017 to April 2018 in 7 communities in the East-
the benefits of TasP, PLWH must be diagnosed early in ern Region of Ghana. The regional hospital, located in 
the course of their HIV infection, link to care and remain Koforidua, serves as the main HIV and ART clinic and 
adherent to ART to attain full virologic suppression [8]. referral center in the region; with the responsibility of 
However, due to poor health-seeking behaviour coupled coordinating HIV/AIDS prevention and intervention 
with socio-cultural dynamics, most PLWH in Africa do programmes and providing care and support to PLWH in 
not access health facility-based voluntary counselling and the region. Our case-control HIV Gut Microbiome Study 
testing services resulting in delayed diagnosis. recruited HIV seropositive persons from the regional 
In response to the 95-95-95 global strategy, by the Joint hospital and needed seronegative persons from their resi-
United Nations Programme on HIV/AIDS to acceler- dent communities to match. HIV screening was therefore 
ate efforts toward ending the AIDS epidemic by 2030 conducted in these communities as part of a community-
[9], the Ghana National AIDS/STI Control Programme based multi disease screening to identify and recruit HIV 
(NACP) developed a 5-year road map to Locate, Test, seronegative persons. Participants were recruited from 7 
Treat and Retain (L2TR)  [10]. The road map focussed on communities in 4 districts of the Eastern Region where 
lower-level health workers, volunteers, and other stake- the majority of the HIV-positive persons seeking care at 
holders but also included expanding community health the Eastern Regional Hospital in Koforidua reside. The 7 
screening, also known as HIV “know your status” (KYS) communities were Koforidua, Oyoko, Akwadum, Jumapo 
campaigns to scale up HIV testing in communities and (New Juaben District), Nkurakan (Yilo Krobo District), 
timely ART initiation. The KYS campaign is an outreach Tafo (East Akim District), Suhum (Suhum District) as 
program that was introduced in Ghana in 2007 following shown in the map in Fig. 1.
its success in other resource-limited settings to encour-
age the general population to know their HIV status [11]. Study population
This innovative approach to HIV testing which has been Enrolment of study participants from each community
demonstrated to improve testing uptake [12, 13] is an In each selected community, information vans were used 
important step in realizing the goal of diagnosing at least to announce the arrival of the health team in the com-
95% of PLWH in the UNAIDS strategy to end the HIV munity and to indicate the date, time and venue for the 
epidemic [9]. health screening exercise. A durbar (public reception) 
was organised in each community. During the durbar, the 
Abana et al. BMC Public Health         (2023) 23:1051 Page 3 of  7
 
Fig. 1 Map showing the 7 communities in eastern region of Ghana
Regional HIV/AIDS Coordinator gave a welcome address Results
and a talk on HIV. This talk covered the importance and A total of 738 persons from the 7 communities partici-
benefits of knowing one’s HIV status, as well as checking pated in the health screening exercise with females con-
for other infections and health indicators such as syphi- stituting the highest number 68% (500/738). Over 70% 
lis, Hepatitis B, obesity, and Diabetes. Participants were had formal education, 48% were traders and over 50% 
allowed to consent and undertake their choice of tests were not married. Some participants (48%) have ever 
among all that was on offer: syphilis, hepatitis B, HIV participated in a health screening exercise but only 30% 
and body mass index (BMI). Each participant then pro- and 12% have ever tested for HIV and HBV respectively 
ceeded to the laboratory for their chosen test to be per- (Table 1). A clear majority of the participants (71%) just 
formed. Only consenting persons were tested for HIV. wanted to know their health status.
Participants were screened for syphilis and HIV using The health screening exercise varied significantly 
First Response Rapid HIV syphilis combo card test kit between males and females across the communities 
(Premier Medical Corporation Ltd, India). Hepatitis B (p < 0.001). Half (50%) of the participants had a normal 
screening was done using SD Bioline HBsAg (Standard BMI. There was a significant association between BMI 
Diagnostic Incorporated, Korea). The BMI was calcu- and the communities; with the highest number of peo-
lated using the Metra BYH01-BMI weight and height ple with normal BMI coming from Koforidua township. 
scale (Metra, UAE). Participants were counselled and Similarly, the reason for the health screening, educational 
presented with their results. All individuals with out-of- status (p < 0.001), occupation (p < 0.001), and marital sta-
range health indicators were referred to local health facil- tus (p < 0.001) also varied significantly across the 7 com-
ities for further assessment and management. munities. However, there was no significant association 
HIV positive persons were referred to the Eastern between testing positive for syphilis and gender. Fur-
Regional Hospital, Koforidua to be linked to care and ini- thermore, there was no significant association between 
tiated on antiretroviral therapy. Consent was sought from the various indicators (Syphilis, HIV, and HBV) and age 
matched HIV seronegative persons to be consecutively groups.
enrolled in the study. Unmatched participants and those All 738 persons recruited consented to syphilis and 
who did not consent were excluded from the study. HBV testing. However, 38 of them did not consent to 
Abana et al. BMC Public Health         (2023) 23:1051 Page 4 of 7 
Table 1 Demographics of participants in the community health screening
Community
Koforidua Suhum Tafo Nkurakan Oyoko Akwadum Jumapo Total P-value
Total Male 100 20 72 32 8 3 3 238 32% < 0.001
Recruited Female 141 67 99 178 5 6 4 500 68%
Total 241 87 171 210 13 9 7 738
% 33% 12% 23% 28% 2% 1% 1%
BMI Normal 128 33 86 111 2 3 3 366 50% < 0.001
Underweight 31 12 18 16 2 1 2 82 11%
Overweight 55 2 59 54 4 3 1 178 24%
Obese 27 40 8 29 5 2 1 112 15%
Educational Educated 201 81 111 157 7 5 3 565 77% < 0.001
Status Not Educated 40 6 60 53 6 4 4 173 23%
Occupation Trader 90 40 94 126 4 2 1 357 48% < 0.001
Student 46 13 36 21 3 3 2 124 17%
Teacher 45 18 18 22 1 0 2 106 14%
Farmer 35 9 5 24 4 3 4 84 11%
Others 23 7 18 17 1 1 0 67 9%
Marital Married 117 33 50 104 6 3 4 317 43% 0.001
Status Not Married 124 54 121 106 7 6 3 421 57%
Ever par- Yes 110 38 129 68 2 3 1 351 48% < 0.001
ticipated in No 131 49 42 142 11 6 6 387 52%
a commu-
nity health 
screening
Reason for To know my health 135 52 132 185 10 5 4 523 71% < 0.001
the health status
screening To test for HIV 70 23 25 15 3 3 2 141 19%
To test for HepBsAg 36 12 14 10 0 1 1 74 10%
Ever Tested Yes 129 32 22 31 1 2 1 218 30% < 0.001
for HIV No 112 55 149 179 12 7 6 520 70%
Ever Tested Yes 45 10 20 15 0 1 0 91 12% 0.009
for HepBsAg No 196 77 151 195 13 8 7 647 88%
be tested for HIV. Of the 700 participants that tested the highest proportion (7%) of HIV was detected in the 
for HIV, 23 (3%) were positive while 2% (17/738) were 36–40 year age group.
positive for syphilis and 4% (33/738) for HBV infection 
(Table  2). Co-infection of HIV and HBV was detected Discussion
in 4 participants. However, there was no co-infection of Community-based multi-disease screening, such as the 
syphilis with either HIV or HBV. Tafo and Suhum com- one undertaken in our study could be critical for iden-
munities recorded the highest proportion (6.8% and tifying HIV infected persons from the community and 
6.0% respectively) of HIV-infected individuals (Table 2). linking them to care. This study will greatly contribute 
A higher proportion of males were infected with HBV to achieving the first two 95s towards ending the AIDS 
(Males = 13/238, 6%; Females = 20/500, 4%) and syphi- pandemic by 2030. Using this approach, we were able 
lis (Male = 9/238, 4%; Females = 8/500, 2%). In contrast, to recruit HIV seronegative persons as a control cohort 
the proportion of males infected with HIV (6/226, for an ongoing study on HIV and Gut Microbiota [14]. 
3%) was lower compared to females (17/474, 4%). The Participants identified to be infected with HIV were 
majority of the participants were older than 40 years referred for counselling and linked to care at the commu-
(441/738) (Table 3). However, the proportion of partici- nity health facilities. Of the total number of individuals 
pants infected with syphilis, HBV, and HIV was higher recruited, 52% were participating in a community health 
among individuals in the age group less than 40 years. screening such as KYS for the first time. We observed 
The highest proportion of syphilis (4%) was detected in that HIV/STI testing uptake was very low in our study 
the 31–35 year age group. The highest proportion (7%) of population; 30% and 12% of participants had ever tested 
HBV was detected in the 36–40 year age group. Likewise, for HIV and HBV respectively. The lower patronage 
could be attributed to stigma and discrimination. It was 
Abana et al. BMC Public Health         (2023) 23:1051 Page 5 of 7 
Table 2 Summary of STI test results
Indicators Community
Koforidua Suhum Tafo Nkurakan Oyoko Akwadum Jumapo Total (%) P-value
Total Screened Male 100 20 72 32 8 3 3 238 (32%) < 0.001
(N = 738) Female 141 67 99 178 5 6 4 500 (68%)
Total 241 87 171 210 13 9 7 738
% 33% 12% 23% 28% 2% 1% 1%
Syphilis (VDRL) Male 7 1 1 0 0 0 0 9 17 0.52
Positive (N = 738) Female 2 0 3 3 0 0 0 8 (2%)
Total 9 1 4 3 0 0 0 17
% 3.7% 1.1% 2.3% 1.4% 0.0% 0.0% 0.0%
HBsAg (N = 738) Male 8 2 1 0 2 0 0 13 33 0.190
Female 8 2 3 6 1 0 0 20 (4%)
Total 16 4 4 6 3 0 0 33
% 6.6% 4.6% 2.3% 2.9% 23.1% 0.0% 0.0%
HIV Total Male 95 19 68 30 8 3 3 226 (32%) < 0.001
tested Female 134 64 94 169 5 5 3 474 (68%)
(N = 700) Total 229 83 162 199 13 8 6 700
% 32.7% 11.9% 23.1% 28.4% 1.9% 1.1% 0.9%
Positive Male 1 1 4 0 0 0 0 6 23 0.624
Female 3 4 7 3 0 0 0 17 (3%)
Total 4 5 11 3 0 0 0 23
% 1.7% 6.0% 6.8% 1.5% 0.0% 0.0% 0.0%
Table 3 Age group of persons who participated in the community health screening
Age groups (years)
15–20 21–25 26–30 31–35 36–40 41–45 46–50 > 50 Total P-value
HIV Tested 10 59 68 69 77 66 83 268 700
Positive 0 3 2 2 5 2 2 7 23 0.769
% 0.0% 5.1% 2.9% 2.9% 6.5% 3.0% 2.4% 2.6% 3%
Syphilis Tested 11 60 72 73 81 70 88 283 738
Positive 0 1 1 3 1 1 1 9 17 0.798
% 0.0% 1.7% 1.4% 4.1% 1.2% 1.4% 1.1% 3.2% 2%
HBV Tested 11 60 72 73 81 70 88 283 738
Positive 0 4 5 1 6 2 3 12 33 0.517
% 0.0% 6.7% 6.9% 1.4% 7.4% 2.9% 3.4% 4.2% 4%
shown that a major barrier to voluntary testing and coun- contributing to the positive response of consenting to 
selling in sub-Saharan Africa is the stigma and discrimi- HIV-STI testing.
nation associated with HIV/AIDS [15–17]. In this study, We observed that the majority (68%) of participants in 
pre-test screening revealed that the majority (71%) of the the study were females (Table 1). This could be because 
participants wanted to know their general health status females in Ghana are known to exhibit a more favorable 
but not HIV and HBV status. Only 11% and 10% wanted health-seeking behavior compared to the males [17, 18]. 
to know their HIV and HBV status respectively. However, However, it is also worth noting that females constitute 
through comprehensive education, counseling, and inte- a majority (51%) of the population of the Eastern Region 
gration of HIV testing with a general health screening in [19]. Thus, the higher proportion of female participants 
our KYS model, we were able to consent all participants in this study may not be entirely attributable to better 
for HBV testing and 95% (700/738) for HIV testing. This health seeking behavior in women.
indicates that through appropriate education, counsel- Though the Eastern Region has a youthful popula-
ling, and sensitization methods, the impact of stigmati- tion structure [19], we observed that more participants 
zation and discrimination on HIV testing uptake could (59%) in this study were older than 40 years, while there 
be significantly reduced as recommended elsewhere was low patronage from the youth (Table 3). This is con-
[16]. Also, educational level is reported as a predictor of sistent with other studies that reported that stigma and 
uptake of HIV testing [17, 18]. In this study we observed fear associated with knowing one’s health status, espe-
that 77% of participants have had formal education, thus cially HIV, discourage the youth from participating in 
Abana et al. BMC Public Health         (2023) 23:1051 Page 6 of 7 
KYS campaigns [15–18, 20–22]. However, the propor- Declarations
tion of participants infected with syphilis, HBV, and HIV Competing interests
was higher among individuals in age groups less than The authors declare no competing interests.
40 years. Particularly, individuals in the 36–40 years age Ethics approval and consent to participate
group recorded the highest proportion of HIV (7%) and The study was approved by the Institutional Review Board of the Noguchi 
HBV (7%) infections (Table  3). All 4 cases of HIV-HBV Memorial Institute for Medical Research (NMIMR-IRB CPN 096 − 17) and the 
co-infection were recorded in the same age group. We Ghana Health Service Ethics Review Committee (GHS-ERC:06/05/17). Informed consent was obtained from all the subjects and or their legal guardians for 
did not detect co-infections with syphilis. study participation. All methods were performed in accordance with the 
Women are disproportionately affected by the HIV/ relevant guidelines and regulations.
AIDS epidemic in sub-Saharan Africa [23]. Consistently, Consent for publication
we recorded a higher proportion of females (17/474, Not Applicable.
3.6%) infected with HIV compared to males (6/226, 2.7%) 
(Table 2). In contrast, a higher proportion of males were Author details1Virology Department, Noguchi Memorial Institute for Medical Research 
infected with HBV (13/238, 5.5%) and Syphilis (9/238, (NMIMR), University of Ghana, Accra, Ghana
3.8%) than females. The overall HIV prevalence (3%) 2West African Center for Cell Biology of Infectious Pathogens (WACCBIP), 
found in this study is higher than both the national prev- University of Ghana, Accra, Ghana3Department of Biochemistry, Cell and Molecular Biology, College of Basic 
alence of 1.7% [24] and the Eastern Regional prevalence and Applied Sciences, University of Ghana, Accra, Ghana
of 2.7% in 2017 [25]. Routine community based multi dis- 4Eastern Regional Hospital, Koforidua, Ghana
5
ease health screening campaign models such as the one AIDS Research Center, National Institute of Infectious Diseases (NIID), Tokyo, Japan
reported in this study and other studies [26–28] could be 6Joint Research Center for Human Retrovirus Infection, Kumamoto 
a spring board to inform prevention and control strate- University, Kumamoto, Japan
7
gies for HIV/AIDS and other STIs. Institute of Medical Sciences, The University of Tokyo, Tokyo, Japan8Future Medicine Education and Research Organization, Institute 
Community based testing and counselling is part of for Global Prominent Research, Graduate School of Medicine, Chiba 
the HIV testing approaches used in Ghana to improve University, Chiba, Japan
9
achievement of the first 95 of the UNAIDS target goals Allergy and Vaccines (cMAV), Department of Medicine, Chiba University-University of California San Diego Center for Mucosal Immunology, 
for 2030 [10, 24]. However, uptake of HIV testing remains University of California San Diego, Chiba, USA
low. In this study we demonstrated that integrating HIV 
testing into a general health screening in communities Received: 22 August 2022 / Accepted: 21 May 2023
improves HIV testing uptake. Adapting a model such as 
ours could contribute to improving the first two  95s of 
the UNAIDS 95 95 95 target by 2030[9].
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