Abstract
BackgroundHIV testing is a key component of prevention and an entry point into HIV/AIDS treatment and care however, coverage and access to testing remains low in Uganda. Home-Based HIV Counseling and Testing (HBHCT) has potential to increase access and early identification of unknown HIV/AIDS disease. This study investigated the level of acceptance of Home-Based HIV Counseling and Testing (HBHCT), the HIV sero-prevalence and the factors associated with acceptance of HBHCT in an urban setting.MethodsA cross-sectional house-to-house survey was conducted in Rubaga division of Kampala from January-June 2009. Residents aged ≥ 15 years were interviewed and tested for HIV by trained nurse-counselors using the national standard guidelines. Acceptance of HBHCT was defined as consenting, taking the HIV test and receipt of results offered during the home visit. Multivariable logistic regression analysis was performed to determine significant factors associated with acceptance of HBHCT.ResultsWe enrolled 588 participants, 408 (69%, 95% CI: 66%-73%) accepted testing. After adjusting for confounding, being male (adj. OR 1.65; 95%CI 1.03, 2.73), age 25-34 (adj. OR 0.63; 95% CI 0.40, 0.94) and ≥35 years (adj. OR 0.30; 95%CI 0.17, 0.56), being previously married (adj. OR 3.22; 95%CI 1.49, 6.98) and previous HIV testing (adj. OR 0.50; 95%CI 0.30, 0.74) were significantly associated with HBHCT acceptance. Of 408 who took the test, 30 (7.4%, 95% CI: 4.8%- 9.9%) previously unknown HIV positive individuals were identified and linked to HIV care.ConclusionsAcceptance of home-based counseling and testing was relatively high in this urban setting. This strategy provided access to HIV testing for previously untested and unknown HIV-infected individuals in the community. Age, sex, marital status and previous HIV test history are important factors that may be considered when designing programs for home-based HIV testing in urban settings in Uganda.
Highlights
HIV testing is a key component of prevention and an entry point into HIV/AIDS treatment and care coverage and access to testing remains low in Uganda
Between January and June, 2009, 444 households comprising 698 potential participants were surveyed by the Acceptance of Home-Based HIV testing Among participants enrolled in the study, 408 (69%, 95% CI: 66%-73%) accepted home-based HIV counseling and testing
The distribution of baseline characteristics for participants who accepted and those who did not accept differed by age (p = 0.012), marital status (p = 0.017), education level (p = 0.043) and previous HIV test history (p ≤ 0.0001)
Summary
HIV testing is a key component of prevention and an entry point into HIV/AIDS treatment and care coverage and access to testing remains low in Uganda. HIV counseling and testing (HCT) is a key intervention for HIV prevention and a critical entry point into life-sustaining treatment and care programmes [1,2,3,4]. Home-Based HIV Counseling and Testing (HBHCT) has the potential to address the challenges of limited access to testing. It involves the use of mostly community health workers to provide door-to-door counseling and testing services to consenting members of the community [12]. Uganda relies heavily on the conventional facility-based HIV testing models in line with the national policy recommendations [14], but these approaches mostly reach patients visiting health facilities or individuals who seek voluntary HIV testing following known exposure to HIV infection [15,16]
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