Home-Based Versus Mobile Clinic HIV Testing and Counseling in Rural Lesotho: A Cluster-Randomized Trial

Labhardt, Niklaus Daniel; Motlomelo, Masetsibi; Cerutti, Bernard; Pfeiffer, Karolin; Kamele, Mashaete; Hobbins, Michael; Ehmer, Jochen

doi:10.1371/journal.pmed.1001768

Cited by 90 publications

(146 citation statements)

References 37 publications

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“…The percentage of testers who were young adults testers <age 25 or <30 years) was reported in 17 home HTC studies 5,18,29–31,35,37,38,45,63,64,68–70,73,74,90,117 , one home with self-testing 11 , 13 mobile 10,12,13,68,91,93,95–97,103,107,114 , two index partner 48,88 , two campaign 47,77 , 20 facility VCT 12,51,52,54,64,88,89,91–93,95,104–107,114,118–120 , and six facility PITC 58,82,86,88,110,113 . Results varied considerably by study (Supplementary Figures S29–S35).…”

Section: Resultsmentioning

confidence: 98%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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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“… b The formula for number of new HIV infections is a function of 2 additional HIV transmission parameters: (1) the β parameter (0.098) represents the average number of transmissions per person per year resulting from PLHIV without suppressed viral load and was consistently estimated from the other parameters in the incidence formula; (2) the ϕ parameter represents the percentage reduction in infectivity among people with suppressed virus and was estimated conservatively as 0.98, given that no linked infections were observed in index participants whose HIV infections were stably suppressed by ART in the HIV Prevention Trials Network 052 trial [28]. …”

Section: Resultsmentioning

confidence: 99%

Low Case Finding Among Men and Poor Viral Load Suppression Among Adolescents Are Impeding Namibia’s Ability to Achieve UNAIDS 90-90-90 Targets

Agolory¹,

Klerk²,

Baughman³

et al. 2018

Open Forum Infectious Diseases

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BackgroundIn 2015, Namibia implemented an Acceleration Plan to address the high burden of HIV (13.0% adult prevalence and 216 311 people living with HIV [PLHIV]) and achieve the UNAIDS 90-90-90 targets by 2020. We provide an update on Namibia’s overall progress toward achieving these targets and estimate the percent reduction in HIV incidence since 2010.MethodsData sources include the 2013 Namibia Demographic and Health Survey (2013 NDHS), the national electronic patient monitoring system, and laboratory data from the Namibian Institute of Pathology. These sources were used to estimate (1) the percentage of PLHIV who know their HIV status, (2) the percentage of PLHIV on antiretroviral therapy (ART), (3) the percentage of patients on ART with suppressed viral loads, and (4) the percent reduction in HIV incidence.ResultsIn the 2013 NDHS, knowledge of HIV status was higher among HIV-positive women 91.8% (95% confidence interval [CI], 89.4%–93.7%) than HIV-positive men 82.5% (95% CI, 78.1%–86.1%). At the end of 2016, an estimated 88.3% (95% CI, 86.3%–90.1%) of PLHIV knew their status, and 165 939 (76.7%) PLHIV were active on ART. The viral load suppression rate among those on ART was 87%, and it was highest among ≥20-year-olds (90%) and lowest among 15–19-year-olds (68%). HIV incidence has declined by 21% since 2010.ConclusionsWith 76.7% of PLHIV on ART and 87% of those on ART virally suppressed, Namibia is on track to achieve UNAIDS 90-90-90 targets by 2020. Innovative strategies are needed to improve HIV case identification among men and adherence to ART among youth.

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“…Some countries in SSA, like Malawi, South Africa and Zambia, have integrated HIV testing within community campaigns that provide screening or prevention services for diseases other than HIV [8]. HPTN 043, a community-randomised trial showed increased rates of HIV testing amongst 16 to 32 years old and detected 3.6 times as many HIV-positive clients with community-based HCT when compared to standard clinic-based HCT [41]. Another recent community randomised trial from Lesotho confirmed these trends, finding higher uptake of HCT during home-based testing when compared to HCT conducted at health facilities and that home-based testing was better for accessing men [42].…”

Section: Innovative Strategies For Universal Test and Treatmentioning

confidence: 99%

Innovative Strategies for Scale up of Effective Combination HIV Prevention Interventions in Sub-Saharan Africa

Shanaube

Böck

2015

Curr HIV/AIDS Rep

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For the last three decades, sub-Saharan Africa has been the epicentre of the HIV epidemic. Some key drivers of the epidemic are specific to this region and there is an urgent need to develop context-specific strategies to reduce HIV-related burden. Implementation frameworks should endeavour to combine structural, behavioural and biomedical interventions and the future of the HIV response involves embracing different approaches for different populations; it is not 'one-size fits all approach'. Expanded use of community-based interventions will be key in expanding the role of antiretroviral treatment as prevention (TasP) in the region. For TasP to be effective, high antiretroviral therapy (ART) coverage rates need to be attained. Data from programmatic trials currently underway will provide crucial data to guide the future implementation of TasP.

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Home-Based Versus Mobile Clinic HIV Testing and Counseling in Rural Lesotho: A Cluster-Randomized Trial

Abstract: Niklaus Labhardt and colleagues investigate how different HIV testing and counseling strategies, based on home visits or mobile clinics, reach different populations in a rural African setting. Please see later in the article for the Editors' Summary

Cited by 90 publications

References 37 publications

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

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

Low Case Finding Among Men and Poor Viral Load Suppression Among Adolescents Are Impeding Namibia’s Ability to Achieve UNAIDS 90-90-90 Targets

Innovative Strategies for Scale up of Effective Combination HIV Prevention Interventions in Sub-Saharan Africa

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