Community intervention improves knowledge of HIV status of adolescents in Zambia

Abstract

Objective:To determine the uptake of home-based HIV counselling and testing (HCT) in four communities of the HPTN 071 (PopART) trial in Zambia among adolescents aged 15–19 years and explore factors associated with HCT uptake.Design:The PopART for youth study is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa which aims to evaluate the acceptability and uptake of a HIV prevention package, including universal HIV testing and treatment, among young people. The study is nested within the HPTN 071 (PopART) trial.Methods:Using a door-to-door approach that includes systematically revisiting households, all adolescents enumerated were offered participation in the intervention and verbal consent was obtained. Data were analysed from October 2015 to September 2016.Results:Among 15 456 enumerated adolescents, 11 175 (72.3%) accepted the intervention. HCT uptake was 80.6% (8707/10 809) and was similar by sex. Adolescents that knew their HIV-positive status increased almost three-fold, from 75 to 210. Following visits from community HIV care providers, knowledge of HIV status increased from 27.6% (3007/10 884) to 88.5% (9636/10 884). HCT uptake was associated with community, age, duration since previous HIV test; other household members accepting HCT, having an HIV-positive household member, circumcision, and being symptomatic for STIs.Conclusion:Through a home-based approach of offering a combination HIV prevention package, the proportion of adolescents who knew their HIV status increased from ∼28 to 89% among those that accepted the intervention. Delivering a community-level door-to-door combination, HIV prevention package is acceptable to many adolescents and can be effective if done in combination with targeted testing.

Barriers to, and emerging strategies for, HIV testing among adolescents in sub-Saharan Africa

“…In Zambia, the PopART trial showed an 81% uptake of HTC among adolescents aged 15 to 19 years using a community based door-to-door approach. However, within households enumerated, contact was not made with 25% of adolescents and one of the major challenges cited in this study was difficulty in obtaining consent from parents for their adolescents to undergo HTC (30). The yield in this study was 3% among females and 1% among males.…”

“…While community-based HTC strategies appear to have high acceptance, reduced barriers to access, and may identify those who are otherwise hard-to-reach and are asymptomatic and would therefore not attend health facilities, they have a low yield of HIV, and require considerable resources (30). The cost effectiveness of these strategies must be assessed to inform the feasibility of scalability and long-term sustainability (46,47).…”

Qualitative research on community experiences in large HIV research trials: what have we learned?

“…In 2013, during the initial selection of the 21 communities in Zambia and South Africa for HPTN 071, rapid qualitative research (termed a Broad Brush Survey [26]) was conducted to gather data on each community, prior to the implementation of the trial intervention. While the results of this work are drawn on in a number of publications [27][28][29][30], this example focuses on the work published by Bond and colleagues in 2016 [31]. For the rapid assessment, a small team of social science researchers spent about two weeks staying in each study community to undertake data collection, using group discussions, key informant interviews and observations.…”

<p>The Prevalence of HIV-Positive Infants Born to HIV-Positive Mothers Attended at the University of Gondar Specialized Hospital Anti-Retroviral Therapy Services, Northwest Ethiopia, 2018</p>

“…Globally 1.4 million pregnant women were lived with HIV, and 80% received ART. 5,6 About 1.2 million AIDS-related mortalities and 1.6 million newly infected children, were reported in Sub-Saharan Africa in 2015. 4 Ethiopia is one of the countries in Sub-Saharan African with similar HIV cases.…”