Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda

Abstract

BackgroundRefugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale.MethodsFrom February–March 2014, we visited homes in 3 villages in Nakivale up to 3 times and offered HIV testing. We enrolled adults who spoke English, Kiswahili, Kinyarwanda, or Runyankore; some were refugees and some Ugandan nationals. We surveyed them about their socio-demographic characteristics. We evaluated the proportion of individuals encountered (feasibility) and assessed participation in HIV testing among those encountered (acceptability). We compared characteristics of home-based and clinic-based testers (from a prior study in Nakivale) using Wilcoxon rank sum and Pearson’s chi-square tests. We examined the relationship between a limited number of factors (time of visit, sex, and number of individuals at home) on willingness to test, using logistic regression models with the generalized estimating equations approach to account for clustering.ResultsOf 566 adults living in 319 homes, we encountered 507 (feasibility = 90%): 353 (62%) were present at visit one, 127 (22%) additional people at visit two, and 27 (5%) additional people at visit three. Home-based HIV testing participants totaled 378 (acceptability = 75%). Compared to clinic-based testers, home-based testers were older (median age 30 [IQR 24–40] vs 28 [IQR 22–37], p < 0.001), more likely refugee than Ugandan national (93% vs 79%, < 0.001), and more likely to live ≥1 h from clinic (74% vs 52%, < 0.001). The HIV prevalence was lower, but not significantly, in home-based compared to clinic-based testing participants (1.9 vs 3.4% respectively, p = 0.27). Testing was not associated with time of visit (p = 0.50) or sex (p = 0.66), but for each additional person at home, the odds of accepting HIV testing increased by over 50% (OR 1.52, 95%CI 1.12–2.06, p = 0.007).ConclusionsHome-based HIV testing in Nakivale Refugee Settlement was feasible, with 90% of eligible individuals encountered within 3 visits, and acceptable with 75% willing to test for HIV, with a yield of nearly 2% individuals tested identified as HIV-positive.

Feasibility, Acceptability, and Effectiveness of Non-Pharmaceutical Interventions for Infectious Disease Prevention and Control in Crisis-Affected Settings and Informal Settlements: A Scoping Review

“…Nearly half (N = 39, 45.9%) of the articles were from the Sub-Saharan African region. The majority of these studies were in East and Central Africa, with nine from the Democratic Republic of the Congo (DRC) [36,49,61,64–66,72,105,107], seven from Sudan/South Sudan [30,39,79,80,104,106,108] and four from Uganda [75,76,78,99]. Almost all (N = 35, 89.7%) of the studies in this region were in conflict-affected settings, with two of the remaining four studies being the sole examples of both food crises [106] and complex emergencies [35] (Figure 2).…”

“…Educational campaigns were generally highly effective for STIs. Community sensitisation programmes were associated with increased rates of HIV testing and case finding [76,83], while education and radio messaging campaigns improved STI risk awareness and behaviour [40,102,109]. However, STI education campaigns in Ngara refugee camp, Tanzania, were found to be ineffective, with no apparent impact on sexual behaviour and with STI prevalence increasing over time [68].…”

“…Active case finding (ACF) for HIV and TB was judged to be both feasible [75,76,106] and acceptable [76] in refugee camps in Sudan and Uganda, while ACF of diarrhoeal disease by household visitation and mobile phone surveillance was feasible, but limited by technical issues, lack of treatment follow-up and by poor information sharing and coordination [32,38]. For case detection of human African trypanosomiasis, passive screening at health facilities was easier to implement than ACF among refugees in South Sudan [79], while widespread ACF among a rural, non-displaced conflict-affected population in the DRC was prevented by conflict and instability [105].…”

“…Desire for knowledge of HIV status, peer encouragement, and provision of a “package” (including RCCE and bundling with tests for other diseases) were key to the high acceptability of HIV voluntary counselling and testing (VCT) observed in informal settlements [56,83]. ‘Opt-out’ and community-based screening strategies increased access and uptake, particularly among high-risk groups [61,76,83]. In a refugee camp in Sudan, refusal of TB screening was associated with a fear of negative consequences of a positive test result, linked to the status of refugees within the host country and lack of trust [106].…”

Sociodemographic characteristics of adolescents preferring home-based HIV self-testing over facility-based voluntary counseling and testing: a cross-sectional study in Kisangani, Democratic Republic of the Congo

“…17 However, previous studies assessing the acceptability of facility-based VCT versus home-based VCT did not find any association between sociodemographic characteristics of participants and their acceptance of home-based VCT. 23 However, home-based VCT was demonstrated to be the least costly strategy per client tested and was also cost effective in identifying HIV seropositive clients. 24 Since HIV testing is low among young men in sub-Saharan Africa due to fears over loss of privacy and confidentiality, stigma, and discrimination, HIVST offers a good opportunity to reach men who are not yet tested for HIV.…”