Should Home-Based HIV Testing and Counseling Services be Offered Periodically in Programs of ARV Treatment as Prevention? A Case Study in Likoma (Malawi)

Abstract

To reduce HIV incidence, prevention programs centered on the use of antiretrovirals require scaling-up HIV testing and counseling (HTC). Home-based HTC services (HBHTC) increase HTC coverage, but HBHTC has only been evaluated during one-off campaigns. Two years after an initial HBHTC campaign (“round 1”), we conducted another HBHTC campaign (“round 2”) in Likoma (Malawi). HBHTC participation increased during round 2 among women (from 74% to 83%, p<0.01). New HBHTC clients were recruited, especially at ages 25 and older. Only 6.9% of women but 15.9% of men remained unreached by HBHTC after round 2. HIV prevalence during round 2 was low among clients who were HIV-negative during round 1 (0.7%), but high among women who first tested during round 2 (42.8%). The costs per newly diagnosed infection increased significantly during round 2. Periodically conducting HBHTC campaigns can further increase HTC, but supplementary interventions to enroll individuals not reached by HBHTC are needed.

Brief counselling after home‐based HIV counselling and testing strongly increases linkage to care: a cluster‐randomized trial in Uganda

“…Consistent with previous studies in similar settings 42, 44, uptake of repeat HCT among HIV‐negative individuals was high. Previous HCT may reduce the psychological stress associated with testing hence making it easier to accept repeat HCT.…”

A New Approach to Measuring Partnership Concurrency and its Association with HIV Risk in Couples

“…We used data from two home-based HIV testing and counseling campaigns (HTC [66, 67]) to determine the HIV status of each partner in a matched couple. The variable describing HIV status of each partner is coded as infected = 1 versus not infected = 0.…”

Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With High HIV Testing Coverage in East Africa

“…5,6 However, CBHTC programs are delivered through different strategies, and their costs and efficiency in HIV diagnosis vary both between and within specific CBHTC strategies. Prior published estimates of the cost per person tested varied from US$9.6 to $34.7 for mobile CBHTC strategies, 7-13 $5.5 to $18.7 for home-based CBHTC strategies, 11,12,14-18 and $8.3 to $42.0 for venue-based CBHTC strategies that offer HIV testing at convenient locations within the communities (2014 dollars). 8,15,19,20 The costs per person testing HIV positive through CBHTC programs had a wider range from $60.2 to $1725.3, 7-24 which is mainly due to the differences in HIV positivity rate (i.e.…”

“…Among the few costing studies that have reported HIV testing coverage, only two included an individual-level census as part of home-based HTC, and achieved 91% testing coverage among all adults 24 and 77% among adults aged 18-35. 14 Other studies reported HIV testing coverage from 26% to 80% based on either estimated number of individuals living in the catchment area 7,10,17 or number of households. 12,18 To reach the UNAIDS 90-90-90 goal, empirical data on the costs of achieving 90% population-level HIV testing coverage are urgently needed.…”