Abstract
We investigated how follow-up counselling had increased linkage to HIV care in a trial of referral to care and follow-up counseling, compared to referral to care only, for participants diagnosed as HIV-positive through home-based HIV counseling and testing. We carried out a cross-sectional qualitative study. Using random stratified sampling, we selected 43 trial participants (26 [60%] in the intervention arm). Sample stratification was by sex, distance to an ART facility, linkage, and nonlinkage to HIV care. Twenty-six in-depth interviews were conducted with participants in the intervention arm: 17 people who had linked to HIV care and 9 who had not linked after 6 months of follow-up. Home-based follow-up counseling helped to overcome worries resulting from an HIV-positive test result. In addition, the counseling offered an opportunity to address questions on HIV treatment side effects, share experiences of intimate partner violence or threats, and general problems linking to care. The counselling encouraged early linkage to HIV care and use of biomedical medicines, discouraging alternative medicine usage. Home-based follow-up counseling also helped to promote HIV sero-status disclosure, facilitating linkage to, retention in and adherence to HIV care and treatment. This study successfully demonstrated that home-based follow-up counselling increased linkage to care through encouragement to seek care, provision of accurate information about HIV care services and supporting the person living with HIV to disclose and manage stigma.
Highlights
IntroductionHome-based HIV counselling and testing (HBHCT) have been shown to achieve high HIV testing uptake in several settings in sub-Saharan Africa (Armstrong-Hough et al, 2018; Doherty et al, 2013; Fylkesnes et al, 2013; Hensen et al, 2014; Mutale et al, 2010; Sabapathy et al, 2012; Sekandi et al, 2011; Shanaube et al, 2017; Tumwesigye et al, 2010)
A total of 149 people living with HIV (PLHIV) participants were enrolled in the intervention arm of the trial
Our findings show that home-based follow-up counselling improved linkage to care through promotion of positive living for the persons that tested HIV positive, provision of accurate information about HIV and HIV care services including ART
Summary
Home-based HIV counselling and testing (HBHCT) have been shown to achieve high HIV testing uptake in several settings in sub-Saharan Africa (Armstrong-Hough et al, 2018; Doherty et al, 2013; Fylkesnes et al, 2013; Hensen et al, 2014; Mutale et al, 2010; Sabapathy et al, 2012; Sekandi et al, 2011; Shanaube et al, 2017; Tumwesigye et al, 2010). In the absence of interventions to facilitate referral uptake, nearly 70% of the people living with HIV (PLHIV) identified through HBHCT do not link to care (Fox et al, 2010, 2016; Hensen et al, 2014; Sharma et al, 2015; Tumwesigye et al, 2010). A systematic review published in 2015 reported that linkage to HIV care ranged from between 18% and 36% of the individuals diagnosed HIV positive when HBHCT was not accompanied by interventions, such as community-based counselling (Sharma et al, 2015). We report on a qualitative study, conducted in the context of a cluster-randomized trial in Masaka District, southern
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