Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania: A household longitudinal survey

Abstract

Background Substantial number of women who deliver at home (WDH) are not captured in prevention of mother-to-child transmission (PMTCT) services. This delays HIV infection detection that negatively impacts endeavours to fight the HIV pandemic and the health of mothers and children. The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania.Methods A longitudinal household survey was conducted. The study involved all mentally-able women who delivered within two years (WDTY) preceding the survey and their children under the age of two. The study was conducted in Geita District Council in Geita Region, Tanzania from June to July 2017. Geita is among the region with high HIV prevalence and proportion of women delivering at home.Results Of the 993 women who participated in the study, 981 (98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. HIV prevalence was 5.3% (52 women). HBHCT identified 26 (2.7%) new HIV infections; 23 (23.4%) were those tested negative at ANC and the remaining three (0.3%) were those who had no HIV test during the ANC visit. Among the 51 HIV+ women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV+ participants who delivered at home, eight (25.8%) were enrolled in the PMTCT compared to 100 percent (13/13) of the women who delivered at a health facility.Conclusion HBHCT uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. The study findings emphasize the importance of extending re-testing to women who breastfeed. HBHCT is feasible and can be used to improve PMTCT services among WDH. BackgroundDespite major progress in implementing interventions for PMTCT in Sub-Saharan Africa, rates of new paediatric HIV infections remain unacceptably high, contributing to over 10% of new HIV infections globally and 15% of all HIV related mortality[1] .The PMTCT program effectively reduces mother-to-child transmission of HIV. Women are enrolled in the program at the health facility, either at an antenatal care (ANC) visit, or when they come for delivery. In Tanzania, only around 60-70% of pregnant women receive HIV counselling and testing