Home-based voluntary HIV counselling and testing found highly acceptable and to reduce inequalities

Wilbroad Mutale,Knut Fylkesnes,Charles Michelo,Marte Jürgensen

doi:10.1186/1471-2458-10-347

Wilbroad Mutale, Knut Fylkesnes + Show 2 more

Open Access

https://doi.org/10.1186/1471-2458-10-347

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Journal: BMC Public Health	Publication Date: Jun 17, 2010
Citations: 112	License type: cc-by

Affiliation: University of Bergen, University of Zambia

Abstract

BackgroundLow uptake of voluntary HIV counselling and testing (VCT) in sub-Saharan Africa is raising acceptability concerns which might be associated with ways by which it is offered. We investigated the acceptability of home-based delivery of counselling and HIV testing in urban and rural populations in Zambia where VCT has been offered mostly from local clinics.MethodsA population-based HIV survey was conducted in selected communities in 2003 (n = 5035). All participants stating willingness to be HIV tested were offered VCT at home and all counselling was conducted in the participants' homes. In the urban area post-test counselling and giving of results were done the following day whereas in rural areas this could take 1-3 weeks.ResultsOf those who indicated willingness to be HIV tested, 76.1% (95%CI 74.9-77.2) were counselled and received the test result. Overall, there was an increase in the proportion ever HIV tested from 18% before provision of home-based VCT to 38% after. The highest increase was in rural areas; among young rural men aged 15-24 years up from 14% to 42% vs. for urban men from 17% to 37%. Test rates by educational attainment changed from being positively associated to be evenly distributed after home-based VCT.ConclusionsA high uptake was achieved by delivering HIV counselling and testing at home. The highest uptakes were seen in rural areas, in young people and groups with low educational attainment, resulting in substantial reductions in existing inequalities in accessing VCT services.

Highlights

Low uptake of voluntary HIV counselling and testing (VCT) in sub-Saharan Africa is raising acceptability concerns which might be associated with ways by which it is offered
Routine testing seems to be based on the belief that testing is the key tool for HIV prevention, and concerns have been raised from a preventive perspective due to the low emphasis being placed on counseling for risk reduction [22]
We offered home-based VCT to all participants in a population-based HIV survey conducted in selected urban and rural areas, and we investigated the intention of being tested for HIV, acceptability and to what extent home-based VCT affected inequalities in HIV test rates in rural and urban settings

Summary

Introduction

Low uptake of voluntary HIV counselling and testing (VCT) in sub-Saharan Africa is raising acceptability concerns which might be associated with ways by which it is offered. It has been shown that in many settings uptake of VCT has been positively correlated with factors such as male gender, higher educational attainment, and urban residence [1,2,3,8,9,10]. Such differences in use of HIV testing and counselling might be indicative of inequalities in access. Routine testing seems to be based on the belief that testing is the key tool for HIV prevention, and concerns have been raised from a preventive perspective due to the low emphasis being placed on counseling for risk reduction [22]

Methods

Results

Conclusion