Abstract
IntroductionHome Based Testing and Counselling (HBTC) aims at reaching individuals who have low HIV risk perception and experience barriers which prevent them from seeking HIV testing and counseling (HTC) services. Saturating the community with HTC is needed to achieve the ambitious 90-90-90 targets of knowledge of HIV status, ARV treatment and viral suppression. This paper describes the use of health belief model and community participation principles in HBTC to achieve increased household coverage and HTC uptake.MethodsThis cross sectional survey was done between August 2009 and April 2011 in Kibera slums, Nairobi city. Using three community participation principles; defining and mobilizing the community, involving the community, overcoming barriers and respect to cultural differences and four constructs of the health belief model; risk perception, perceived severity, perceived benefits of changed behavior and perceived barriers; we offered HTC services to the participants. Descriptive statistics were used to describe socio-demographic characteristics, calculate uptake and HIV prevalence.ResultsThere were 72,577 individuals enumerated at the start of the program; 75,141 residents were found during service delivery. Of those, 71,925 (95.7%) consented to participate, out of which 71,720 (99.7%) took the HIV test. First time testers were (39%). The HIV prevalence was higher (6.4%) among repeat testers than first time testers (4.0%) with more women (7.4%) testing positive than men (3.6%) and an overall 5.5% slum prevalence.ConclusionThis methodology demonstrates that the use of community participation principles combined with a psychosocial model achieved high HTC uptake, coverage and diagnosed HIV in individuals who believed they are HIV free. This novel approach provides baseline for measuring HTC coverage in a community.
Highlights
Home Based Testing and Counselling (HBTC) aims at reaching individuals who have low HIV risk perception and experience barriers which prevent them from seeking HIV testing and counseling (HTC) services
There has been rapid expansion of HIV testing and counseling services in Kenya with changing models of service delivery moving from client initiated counseling and testing at static voluntary counseling and testing (VCT) sites to diagnostic testing and counseling (DTC) which was done at the discretion of the attending clinician for purposes of patient management to provider initiated testing and counseling (PITC) [2] where all clients visiting the health facility are offered services
Setting: The Kibera program funded by President's Emergency Program for AIDS Relief (PEPFAR) through Centers for Disease Control and Prevention (CDC) was to increase HTC access by offering HBTC services to all eligible community residents with an aim of saturation of the entire slum dwelling
Summary
Home Based Testing and Counselling (HBTC) aims at reaching individuals who have low HIV risk perception and experience barriers which prevent them from seeking HIV testing and counseling (HTC) services. This paper describes the use of health belief model and community participation principles in HBTC to achieve increased household coverage and HTC uptake. Conclusion: This methodology demonstrates that the use of community participation principles combined with a psychosocial model achieved high HTC uptake, coverage and diagnosed HIV in individuals who believed they are HIV free. This novel approach provides baseline for measuring HTC coverage in a community. A major reason that hinders individuals from accessing HIV testing and counseling services in Kenya is low HIV risk perception [3]. Low HTC coverage has been associated with stigma [6, 7], lack of transport to testing sites and lack of time for testing and counseling [8, 9]
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