High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda

Abstract

BackgroundHIV testing is a key component of prevention and an entry point into HIV/AIDS treatment and care however, coverage and access to testing remains low in Uganda. Home-Based HIV Counseling and Testing (HBHCT) has potential to increase access and early identification of unknown HIV/AIDS disease. This study investigated the level of acceptance of Home-Based HIV Counseling and Testing (HBHCT), the HIV sero-prevalence and the factors associated with acceptance of HBHCT in an urban setting.MethodsA cross-sectional house-to-house survey was conducted in Rubaga division of Kampala from January-June 2009. Residents aged ≥ 15 years were interviewed and tested for HIV by trained nurse-counselors using the national standard guidelines. Acceptance of HBHCT was defined as consenting, taking the HIV test and receipt of results offered during the home visit. Multivariable logistic regression analysis was performed to determine significant factors associated with acceptance of HBHCT.ResultsWe enrolled 588 participants, 408 (69%, 95% CI: 66%-73%) accepted testing. After adjusting for confounding, being male (adj. OR 1.65; 95%CI 1.03, 2.73), age 25-34 (adj. OR 0.63; 95% CI 0.40, 0.94) and ≥35 years (adj. OR 0.30; 95%CI 0.17, 0.56), being previously married (adj. OR 3.22; 95%CI 1.49, 6.98) and previous HIV testing (adj. OR 0.50; 95%CI 0.30, 0.74) were significantly associated with HBHCT acceptance. Of 408 who took the test, 30 (7.4%, 95% CI: 4.8%- 9.9%) previously unknown HIV positive individuals were identified and linked to HIV care.ConclusionsAcceptance of home-based counseling and testing was relatively high in this urban setting. This strategy provided access to HIV testing for previously untested and unknown HIV-infected individuals in the community. Age, sex, marital status and previous HIV test history are important factors that may be considered when designing programs for home-based HIV testing in urban settings in Uganda.

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

“…Uptake was reported in 31 home HTC studies 5,14,15,18,27,29–38,40–45,53,62–74 , two home with self-testing 11,75 , two mobile 10,68 , three index partner or family member 48–50 , four campaign 46,47,76,77 , three workplace 78–80 , three facility VCT 54,56,81 , and 11 facility PITC studies 56,57,59,60,81–87 . Overall, community modalities had high uptake (Fig.…”

“…Coverage was reported in 19 home HTC studies 15,18,29–45 , one mobile 13 , two campaign 46,47 , three index partner/family member 48–50 , five facility VCT 51–55 , and five facility PITC studies 56–61 . Overall, community HTC modalities achieved higher coverage than facility, with home (70%, 95% CI = 58–79) and campaign (76%, 95% CI = 49–95%) having the highest population coverage (Fig.…”

“…The percentage of men out of total persons tested was reported in 25 home HTC studies 5,14,18,29,31,32,37,38,41–45,63,64,66,68–72,88–90 , two home with self-testing 11,75 , 10 mobile 10,13,68,72,91–99 , 3 index partner 47,49,88 , 3 campaign 46,47,76 , 2 workplace 100,101 , 20 facility VCT 52,54,61,64,81,88,89,92,93,95,96,98,102–107 , and 13 facility PITC 58,60,82–84,86,99,108–113 (Fig. 2).…”

“…Percentage of participants reporting testing for the first time was included in 20 home HTC studies 5,14,18,29,31,32,38,41–44,63,65,66,68–72,88 , 11 mobile 10,12,68,93–95,97,103,114 , 3 campaign 46,47,77 , 3 key populations 25,115,116 , and 7 facility VCT 12,54,91,93,95,106 , and 5 facility PITC 58,86,88,111,112 . Pooled percentages of first-time testers were higher for community than facility modalities (Fig.…”

“…We characterize each modality by population coverage, since high coverage is beneficial to both HIV-positive and -negative people. HTC can reduce risk behaviour in HIV-negative individuals, while providing a means to link them to primary prevention (including circumcision and pre-exposure prophylaxis (PrEP)) 18–21 . We evaluate effectiveness in reaching men and young adults (both groups have a disproportionately high risk of HIV acquisition and poorer clinical outcomes once infected 22–24 ) and targeted HTC for key populations (men who have sex with men (MSM), commercial sex workers (CSWs) and people who inject drugs (PWID)) — groups that generally have very high HIV prevalence and low access to health care 25 .…”