Abstract
BackgroundThough home-based human immunodeficiency virus (HIV) counseling and testing (HBHCT) is implemented in many sub-Saharan African countries as part of their HIV programs, linkage to HIV care remains a challenge. The purpose of this study is to test an intervention to enhance linkage to HIV care and improve HIV viral suppression among individuals testing HIV positive during HBHCT in rural Uganda.MethodsThe PATH (Providing Access To HIV Care)/Ekkubo Study is a cluster-randomized controlled trial which compares the efficacy of an enhanced linkage to HIV care intervention vs. standard-of-care (paper-based referrals) at achieving individual and population-level HIV viral suppression, and intermediate outcomes of linkage to care, receipt of opportunistic infection prophylaxis, and antiretroviral therapy initiation following HBHCT. Approximately 600 men and women aged 18-59 who test HIV positive during district-wide HBHCT in rural Uganda will be enrolled in this study. Villages (clusters) are pair matched by population size and then randomly assigned to the intervention or standard-of-care arm. Study teams visit households and participants complete a baseline questionnaire, receive HIV counseling and testing, and have blood drawn for HIV viral load and CD4 testing. At baseline, standard-of-care arm participants receive referrals to HIV care including a paper-based referral and then receive their CD4 results via home visit 2 weeks later. Intervention arm participants receive an intervention counseling session at baseline, up to three follow-up counseling sessions at home, and a booster session at the HIV clinic if they present for care. These sessions each last approximately 30 min and consist of counseling to help clients: identify and reduce barriers to HIV care engagement, disclose their HIV status, identify a treatment supporter, and overcome HIV-related stigma through links to social support resources in the community. Participants in both arms complete interviewer-administered questionnaires at six and 12 months follow-up, HIV viral load and CD4 testing at 12 months follow-up, and allow access to their medical records.DiscussionThe findings of this study can inform the integration of a potentially cost-effective approach to improving rates of linkage to care and HIV viral suppression in HBHCT. If effective, this intervention can improve treatment outcomes, reduce mortality, and through its effect on individual and population-level HIV viral load, and decrease HIV incidence.Trial registrationNCT02545673
Highlights
Though home-based human immunodeficiency virus (HIV) counseling and testing (HBHCT) is implemented in many sub-Saharan African countries as part of their HIV programs, linkage to HIV care remains a challenge
The push towards universal access to antiretroviral treatment (ART) is reflected in the United Nations Joint Programme on HIV/Acquired Immunodeficiency Syndrome (AIDS) “90-90-90” goals, which aim to get 90% of people living with HIV (PLHIV) aware of their status, 90% of those diagnosed linked to care and receiving HIV treatment, and 90% of those receiving treatment virally suppressed by 2020 [1]
Significant challenges in getting PLHIV linked to HIV care and on ART remain, including in sub-Saharan Africa (SSA), the region most affected by the HIV epidemic
Summary
Though home-based human immunodeficiency virus (HIV) counseling and testing (HBHCT) is implemented in many sub-Saharan African countries as part of their HIV programs, linkage to HIV care remains a challenge. The push towards universal access to ART is reflected in the United Nations Joint Programme on HIV/Acquired Immunodeficiency Syndrome (AIDS) “90-90-90” goals, which aim to get 90% of people living with HIV (PLHIV) aware of their status, 90% of those diagnosed linked to care and receiving HIV treatment, and 90% of those receiving treatment virally suppressed by 2020 [1]. Strategies to facilitate linkage into HIV care in SSA are needed, especially as the number of people eligible for ART grows as countries implement “test and treat” recommendations throughout the region
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