The use of home-based HIV testing and counseling in low-and-middle income countries: a scoping review

Moshoeu Prisca Moshoeu,Nonjabulo Gwala,Tivani P Mashamba-Thompson,Desmond Kuupiel

doi:10.1186/s12889-019-6471-4

Moshoeu Prisca Moshoeu, Nonjabulo Gwala + Show 2 more

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https://doi.org/10.1186/s12889-019-6471-4

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Abstract

BackgroundKnowledge of HIV status is crucial for both prevention and treatment of HIV infection. However, according to the Joint United Nations Programme on HIV/AIDS in low-and-middle-income countries (LMICs), only 10% of the population has access to HIV testing services. Home-based HIV testing and counseling (HTC) is one of the approaches which have been shown to be effective in improving access to HIV testing in LMICs. The objective of this review was to map evidence on the use of home-based HTC in LMICs.MethodsWe searched PubMed, EBSCOhost, Google Scholar, Science Direct, World Health Organization library database and UNAIDS databases from January 2013 to October 2017. Eligibility criteria included articles pertaining to the use of home-based HTC in LMICs. Two reviewers independently reviewed the articles for eligibility. The following themes were extracted from the included studies: use, feasibility and effectiveness of home-based HTC on patient-centered outcomes in LMICs. The risk of bias for the included studies was assessed using mixed methods appraisal tool -version 2011.ResultsA total of 855,117 articles were identified from all the databases searched. Of this, only 17 studies met the inclusion criteria after full article screening and were included for data extraction. All included studies presented evidence on the use of Home-based HTC by most age groups (18 months to 70 years) comprising of both males and females. The included studies were conducted in the following countries: Zambia, Uganda, South Africa, Kenya, Ethiopia, Malawi, Swaziland, Pakistan, and Botswana. This study demonstrated that home-based HTC was used in LMICs alongside supervised HTC intervention using different types of HTC tests kits produced by different manufacturers. This study also showed that home-based HTC was feasible, highly effective, and increased uptake of HIV testing and counseling. This study further demonstrated a highly successful usage of supervised home-based HTC by most age groups in LMICs, with majority of users being females (89.1%).ConclusionWe therefore recommend primary studies in other LMICs to determine the feasibility and use of HTC to help achieve the UNAIDS 90:90:90 targets. Interventions to improve the use of home-based HTC by males are also recommended.Trial registrationPROSPERO registration number: CRD42017056478.

Highlights

Knowledge of HIV status is crucial for both prevention and treatment of HIV infection
The Joint United Nations Programme on HIV/AIDS (UNAIDS) 2017 global report on HIV indicated that there are over 36 million persons living with HIV, and millions of individuals have died as a results of HIV/ AIDS-associated causes since the start of the epidemic [1, 2]
Of the 38 excluded studies following full article screening, 1 study was conducted in a high-income country (33); 5 studies were conduct before 2013 (9, 34–37), 11 Studies were conducted in low-and-middle-income countries (LMICs)’s but did not report on our intervention which was home-based HIV testing and counseling (HTC) (38–48) and 21 studies reported no evidence of primary outcome of this study (7, 10, 34, 49–65)

Summary

Introduction

Knowledge of HIV status is crucial for both prevention and treatment of HIV infection. According to the Joint United Nations Programme on HIV/AIDS in low-and-middle-income countries (LMICs), only 10% of the population has access to HIV testing services. Home-based HIV testing and counseling (HTC) is one of the approaches which have been shown to be effective in improving access to HIV testing in LMICs. The objective of this review was to map evidence on the use of home-based HTC in LMICs. The Joint United Nations Programme on HIV/AIDS (UNAIDS) 2017 global report on HIV indicated that there are over 36 million persons living with HIV, and millions of individuals have died as a results of HIV/ AIDS-associated causes since the start of the epidemic [1, 2]. The UNAIDS estimates shows that, only 10% of the population have access to HIV testing services in low-and-middle income countries (LMICs) [6]. Previous studies have indicated that home-based HTC greatly increases uptake of HTC and helps identify new HIV cases at earlier stages of the disease [17,18,19]

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