Abstract
ObjectivesTo investigate the relative effectiveness of different HIV testing and counselling (HTC) services in improving HIV diagnosis rates and increasing HTC coverage in African settings.MethodsPatient records from three HTC services [community outreach HTC during cohort study rounds (CO‐HTC), walk‐in HTC at the local health centre (WI‐HTC) and antenatal HIV testing (ANC‐HTC)] were linked to records from a community cohort study using a probabilistic record linkage algorithm. Characteristics of linked users of each HTC service were compared to those of cohort participants who did not use the HTC service using logistic regression. Data from three cohort study rounds between 2003 and 2010 were used to assess trends in the proportion of persons testing at different service types.ResultsThe adjusted odds ratios for HTC use among men with increasing numbers of sexual partners in the past year, and among HIV‐positive men and women compared to HIV‐negative men and women, were higher at WI‐HTC than at CO‐HTC and ANC‐HTC. Among sero‐survey participants, the largest numbers of HIV‐positive men and women learned their status via CO‐HTC. However, we are likely to have underestimated the numbers diagnosed at WI‐HTC and ANC‐HTC, due to low sensitivity of the probabilistic record linkage algorithm.ConclusionsCompared to CO‐HTC or ANC‐HTC, WI‐HTC was most likely to attract HIV‐positive men and women, and to attract men with greater numbers of sexual partners. Further research should aim to optimise probabilistic record linkage techniques, and to investigate which types of HTC services most effectively link HIV‐positive people to treatment services relative to the total cost per diagnosis made.
Highlights
The traditional model of HIV testing and counselling (HTC) service delivery in many countries in sub-Saharan Africa has been at voluntary counselling and testing (VCT) centres, provided either as stand-alone services or at clinics attached to health facilities
Men and women living in roadside villages or in the trading centre had significantly higher odds of using all types of testing services compared to those living in rural villages, with the exception of walk-in HTC at the local health centre (WI-HTC) use among women, where the association did not quite reach statistical significance (Tables 1–3)
Our results revealed that WI-HTC was more likely to attract men with greater numbers of sexual partners in the last year than community outreach HTC during cohort study rounds (CO-HTC)
Summary
The traditional model of HIV testing and counselling (HTC) service delivery in many countries in sub-Saharan Africa has been at voluntary counselling and testing (VCT) centres, provided either as stand-alone services or at clinics attached to health facilities. In response to a need to increase HTC uptake in sub-Saharan Africa [1] and in recognition that alternative models of service delivery may help to reach different population groups, there has been a drive to diversify strategies for HTC service provision [2,3,4]. These include HTC services offered routinely to pregnant women at antenatal clinics (ANC), or to attendees of outpatient departments such as sexually transmitted infection or tuberculosis clinics (provider-initiated testing and counselling or PITC) [2, 5].
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