Evaluation of a home-based voluntary counseling and testing intervention in rural Uganda

Medical Research Council, P.O. 49, Entebbe, Uganda.
Health Policy and Planning (Impact Factor: 3). 04/2005; 20(2):109-16. DOI: 10.1093/heapol/czi013
Source: PubMed

ABSTRACT Uptake of HIV test results from an annual serosurvey of a population study cohort in rural southwestern Uganda had never exceeded 10% in any given year since inception in 1989. An intervention offering counselling and HIV results at home was conducted in four study villages following the 2001 serosurvey round, and followed by a qualitative evaluation exploring nature of demand and barriers to knowing HIV status.
Data from annual serosurveys and counsellor records are analyzed to estimate the impact of the intervention on uptake of HIV test results. Textual data are analyzed from 21 focus group discussions among counsellors, and men and women who had received HIV test results, requested but not yet received, and never requested; and 34 in-depth interviews equally divided among those who had received test results either from counselling offices and homes.
Offering HIV results at home significantly increased uptake of results from 10 to 37% for all adults aged 15 (p<0.001), and 46% of those age 25 to 54. Previous male advantage in uptake of test results was effectively eliminated. Focus group discussions and in-depth interviews highlight substantial non-monetary costs of getting HIV results from high-visibility public facilities prior to intervention. Inconvenience, fear of stigmatization, and emotional vulnerability of receiving results from public facilities were the most common explanations for the relative popularity of home-based voluntary counselling and testing (VCT). It is seen as less appropriate for youth and couples with conflicting attitudes toward testing.
Home delivery of results revealed significantly higher demand to know HIV status than stubbornly low uptake figures from the past would suggest. Integrating VCT into other services, locating testing centres in less visible surroundings, or directly confronting stigma surrounding testing may be less expensive ways to reproduce increased uptake with home VCT.

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Available from: AJ Ruberantwari, Jul 30, 2015
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    • "; Tumwesigye, Wana, Kasasa, Muganzi, & Nuwaha, 2010; Were et al., 2003, 2006; Wolff et al., 2005); this includes a high uptake of couple counselling and testing, which represents an effective strategy for reducing sexually transmitted infections and HIV transmission within married or cohabiting couples (Allen, Serufilira et al., 1992, Allen, Tuce et al, 1992). The only published cluster randomized trial on home-based VCT was conducted in an urban setting in Zambia within the framework of a population-based HIV survey. "
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    ABSTRACT: Home-based voluntary HIV counselling and testing (HB-VCT) has been reported to have a high uptake, but it has not been rigorously evaluated. We designed a model for HB-VCT appropriate for wider scale-up, and investigated the acceptance of home-based counselling and testing, equity in uptake and negative life events with a cluster-randomized trial. Thirty six rural clusters in southern Zambia were pair-matched based on baseline data and randomly assigned to the intervention or the control arm. Both arms had access to standard HIV testing services. Adults in the intervention clusters were offered HB-VCT by local lay counsellors. Effects were first analysed among those participating in the baseline and post-intervention surveys and then as intention-to-treat analysis. The study was registered with, number ISRCTN53353725. A total of 836 and 858 adults were assigned to the intervention and control clusters, respectively. In the intervention arm, counselling was accepted by 85% and 66% were tested (n = 686). Among counselled respondents who were cohabiting with the partner, 62% were counselled together with the partner. At follow-up eight months later, the proportion of adults reporting to have been tested the year prior to follow-up was 82% in the intervention arm and 52% in the control arm (Relative Risk (RR) 1.6, 95% CI 1.4-1.8), whereas the RR was 1.7 (1.4-2.0) according to the intention-to-treat analysis. At baseline the likelihood of being tested was higher for women vs. men and for more educated people. At follow-up these differences were found only in the control communities. Measured negative life events following HIV testing were similar in both groups. In conclusion, this HB-VCT model was found to be feasible, with a very high acceptance and to have important equity effects. The high couple counselling acceptance suggests that the home-based approach has a particularly high HIV prevention potential.
    Social Science [?] Medicine 06/2013; 86:9-16. DOI:10.1016/j.socscimed.2013.02.036 · 2.56 Impact Factor
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    • "A study done on home-based VCT reports that it enhances disclosure among couples (Bateganya et al., 2007). While another evaluation of home-based VCT was skeptical about its efficacy and social consequences (Wolff et al., 2005). These mixed results from the different studies indicate a need for further research to examine the relationship between VCT service provision models and behavior outcomes. "
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    ABSTRACT: Abstract Home-based human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) in Uganda is being promoted to increase coverage, in addition to main stay approach of service provision through health facilities. The aim of this study was to compare self reported risk reduction behavior among clients receiving facility and home-based HIV VCT within a rural context. Pre-post intervention client surveys were conducted in November 2007 (baseline) and March 2008 (follow up) in southwestern Uganda. The facility-based VCT intervention was provided to 500 clients and home-based VCT to 494 clients at baseline, in 2 different sub-counties. A total of 76% (759/994) of these clients were interviewed at the follow up visit. The respondents who received facility-based VCT were more likely to report abstinence (adjusted Odds Ratio [aOR]=1.47, 95% CI 1.074, 2.02), reducing multi sexual relationships (aOR=3.23, 95% CI 2.02, 5.16) and more frequent use of condoms (aOR=3.14, 95% CI 1.60, 6.18). However, they were less likely to report, discussing HIV (aOR=0.63, 95% CI 0.46, 0.85) with their sexual partner/s and having sex with only one partner (aOR=0.72, 95% CI 0.519-0.99). While facility-based VCT appears to promote abstinence and condom use home-based VCT on the other hand promotes faithfulness and disclosure. VCT services should, therefore, be provided through both models in a complementary relationship and not as surrogates within given settings.
    AIDS Care 10/2012; DOI:10.1080/09540121.2012.729805 · 1.60 Impact Factor
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    • "sk . Provider - initiated testing , however , poses different challenges including the need to educate more providers to test and to provide necessary resources for testing at different health service facilitates . Home - based VCT programmes are also promoted as a means to increase access to anti - retroviral therapy ( ART ) ( Were et al . 2003 , Wolff et al . 2005 ) . To date , however , there is only limited evidence that scale up of home - based VCT is feasible in Uganda ( Bateganya et al . 2010 , Tumwesigye et al . 2010 , Sekandi et al . 2011 ) . Ultimately , the challenge of retaining HIV - infected persons in care remains significant , especially if they do not have symptoms they attribute t"
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    ABSTRACT: Public health initiatives to 'test and treat' HIV-infected persons require understanding HIV care seeking. A study of 101 HIV-infected women receiving anti-retroviral medications in Kampala, Uganda, examined barriers to HIV care. Participants entered HIV/AIDS care late, despite knowing their risk and having sought care for symptoms. Over half of the participants (51%) reported delays of up to 5 years from when they suspected they were infected to seeking an HIV test. Some women reported that they did not perceive a need to be tested because they 'knew' they had HIV due to their partner's death from AIDS. Once tested, delays in entering HIV specific care ranged from less than 6 months to over 5 years. The most common reason reported for entering HIV care was the occurrence of serious or persistent symptoms. Late presentation for HIV care in this cohort is due to the inability of the medical system to link women to appropriate care. Women 'slip through the cracks' of this system, despite their care seeking behaviours. The inability to provide linkage to care is a challenge at the health system level that threatens the success of 'test and treat' protocols.
    Global Public Health 07/2012; 7(10). DOI:10.1080/17441692.2012.701318 · 0.92 Impact Factor
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