HIV testing service awareness and service uptake among female heads of household in rural Mozambique: results from a province-wide survey

Paulin, Heather N; Blevins, Meridith; Koethe, John R.; Hinton, Nicole; Vaz, Lara M. E.; Vergara, Alfredo; Mukolo, Abraham; Ndatimana, Elisée; Moon, Troy D.; Vermund, Sten H.; Wester, Carolyn

doi:10.1186/s12889-015-1388-z

Cited by 31 publications

(35 citation statements)

References 61 publications

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“…Previous studies have highlighted the success of community-based HTC to identify asymptomatic HIV-positive individuals at relatively higher CD4 counts compared with facility-based HTC [1,9,23]. Our findings are consistent with these previous studies in that nearly half of individuals diagnosed in the community-based sero-survey had CD4 counts >500 cells/mm 3 at care initiation compared to only 16% of those diagnosed using facilitybased VCT.…”

Section: Discussionsupporting

confidence: 91%

Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017

Rentsch

Wringe

Machemba

et al. 2018

Tropical Med Int Health

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ObjectiveTo measure linkage to care and antiretroviral therapy (ART) initiation among newly diagnosed individuals with HIV in a rural Tanzanian community.MethodsWe included all new HIV diagnoses of adults made between 2014 and 2017 during community‐ or facility‐based HIV testing and counselling (HTC) in a rural ward in northwest Tanzania. Community‐based HTC included population‐level HIV serological testing (sero‐survey), and facility‐based HTC included a stationary, voluntary HTC clinic (VCT) and an antenatal clinic (ANC) offering provider‐initiated HTC (ANC‐PITC). Cox regression models were used to compare linkage to care rates by testing modality and identify associated factors. Among those in care, we compared initial CD4 cell counts and ART initiation rates by testing modality.ResultsA total of 411 adults were newly diagnosed, of whom 10% (27/265 sero‐survey), 18% (3/14 facility‐based ANC‐PITC) and 53% (68/129 facility‐based VCT) linked to care within 90 days. Individuals diagnosed using facility‐based VCT were seven times (95% CI: 4.5–11.0) more likely to link to care than those diagnosed in the sero‐survey. We found no difference in linkage rates between those diagnosed using facility‐based ANC‐PITC and sero‐survey (P = 0.26). Among individuals in care, 63% of those in the sero‐survey had an initial CD4 count >350 cells/mm3 vs. 29% of those using facility‐based VCT (P = 0.02). The proportion who initiated ART within 1 year of linkage to care was similar for both groups (94% sero‐survey vs. 85% facility‐based VCT; P = 0.16).ConclusionsCommunity‐based sero‐surveys are important for earlier diagnosis of HIV‐positive individuals; however, interventions are essential to facilitate linkage to care.

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Section: Discussionsupporting

confidence: 91%

Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017

Rentsch

Wringe

Machemba

et al. 2018

Tropical Med Int Health

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“…In addition, patients often present at facilities late in the course of their illness, increasing HIV morbidity, mortality and transmission 7 . Community-based HTC (conducted outside of a health facility) has the potential to overcome these barriers, achieve high coverage, and identify asymptomatic HIV-positive individuals at high CD4 counts 8,9 . In addition, community HTC may reach more men, young adults, and key populations than facility HTC.…”

mentioning

confidence: 99%

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

Sharma

Ying

Tarr

et al. 2015

Nature

455

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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“…Increasing health education on HIV issues in general is vital as part of promoting means to reach more people through FBIT [21,22].…”

Section: Discussionmentioning

confidence: 99%

Family–Based Index Testing for HIV: a qualitative study of barriers and challenges among clients in Cape Coast, Ghana

Ampofo

Commey²,

Adu‐Gyamfi³

et al. 2020

Preprint

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Background Family-based Index HIV Testing, (FBIT) approach is known to be associated with a relatively higher testing yield compared to Provider-Initiated Testing and Counseling. The implementation of this strategy in several countries has exposed some barriers to optimal FBIT outcomes. With the scale up of FBIT in Ghana, stakeholders’ engagement is key in identifying and addressing all barrier to implementation. This study explored index clients’ perspective of barriers and challenges of FBIT. Methods Using an exploratory descriptive qualitative design, 17 individual in-depth interviews were conducted among seventeen purposively selected clients who had been offered FBIT at the Cape Coast Teaching Hospital (CCTH) utilizing a semi-structured interview guide. Each interview lasted between 45–60 minutes and the transcripts were transcribed verbatim and analyzed using qualitative content analysis procedure. Themes and sub-themes from the transcripts were generated and supported with verbatim texts to provide a rich understanding of the barriers and challenges. Results Age of participants ranged between 24–71 years, majority of whom were females. Themes and sub- themes emerged on barriers and challenges and these related to good understanding of the benefits of FBIT by index clients, challenge with getting family members to accept testing opportunities, fear and uncertainty of reaction of family members to a positive status, and issues of confidentiality and privacy related to health facility service provision. Key findings were: 1. Index clients perceived FBIT as a good approach to reach family members for testing. 2. Stigmatization, lack of confidentiality and privacy at service centers and 3. Inadequate information on FBIT were identified as barriers that can affect the uptake of FBIT. Getting listed family members to agree to be tested was perceived as a challenge. Conclusions Despite the acceptance of FBIT as a good strategy to reach family members of index clients for testing, there are barriers of stigmatization, fear and uncertainty of reaction of family members to a positive status, lack of confidentiality and privacy, and inadequate information on FBIT. Efforts should be made to address these barriers and challenges. Index clients and their families need tailored support to improve acceptance of this strategy.

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HIV testing service awareness and service uptake among female heads of household in rural Mozambique: results from a province-wide survey

Cited by 31 publications

References 61 publications

Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017

Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014–2017

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

Family–Based Index Testing for HIV: a qualitative study of barriers and challenges among clients in Cape Coast, Ghana

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