Abstract
BackgroundHIV voluntary counselling and testing (VCT) is an integral component of HIV prevention and treatment programmes. However, testing coverage in sub-Saharan Africa is still low, particularly among young people. As treatment becomes more widely available, strategies to expand VCT coverage are critically important. We compare VCT uptake using two delivery strategies (opt-in and opt-out) within the MEMA kwa Vijana trial in 20 communities in northwest Tanzania.MethodsWe analysed data from 12,590 young persons (median (IQR) age 22 years (20–23)) to assess the effect of delivery strategy on VCT uptake. Ten communities used an opt-in approach and 10 used opt-out, balanced across intervention and control. Conditional logistic regression was used to examine factors associated with uptake within each strategy.ResultsVCT uptake was significantly higher with the opt-out approach (90.9% vs 60.5%, prevalence ratio = 1.51, CI = 1.41–1.62). Among females, uptake in the opt-out approach was associated with decreased knowledge of HIV acquisition, sex with a casual partner, and being HSV-2 seronegative; among males, uptake was associated with lower education and increasing lifetime partners. In contrast, uptake using the opt-in approach varied by ethnic group, religion and marital status, and increased with increasing knowledge of STI acquisition (males) or pregnancy prevention (females).ConclusionVCT uptake among young people was extremely high when offered an opt-out strategy. Sociodemographic and knowledge factors affected uptake in different ways depending on delivery strategy. Increased knowledge may increase young persons' self-efficacy, which may have a different impact on testing uptake, depending on the approach used.
Highlights
As access to antiretroviral therapy (ART) becomes more widely available for the treatment of HIV infection, expanding access to, and use of, voluntary counselling and testing (VCT) is critically important.‘Client-initiated’ VCT, where individuals proactively seek HIV testing, remains the primary VCT model in many sub-Saharan African countries
‘Provider-initiated’ testing and counselling (PITC) is an alternative approach to VCT, where individuals are informed that they will receive an HIV test as part of general medical screening or clinical management unless they opt out. This model has been promoted by WHO and United Nations Joint Programme on HIV/AIDS (UNAIDS) to increase opportunities for HIV diagnosis, and by 2009, two-thirds of countries in sub-Saharan Africa had introduced policies supporting PITC [4]
Additional written consent was obtained from parents for participants under the age of 18 years
Summary
As access to antiretroviral therapy (ART) becomes more widely available for the treatment of HIV infection, expanding access to, and use of, VCT is critically important.‘Client-initiated’ VCT, where individuals proactively seek HIV testing, remains the primary VCT model in many sub-Saharan African countries. As access to antiretroviral therapy (ART) becomes more widely available for the treatment of HIV infection, expanding access to, and use of, VCT is critically important. ‘Provider-initiated’ testing and counselling (PITC) is an alternative approach to VCT, where individuals are informed that they will receive an HIV test as part of general medical screening or clinical management unless they opt out. This model has been promoted by WHO and UNAIDS to increase opportunities for HIV diagnosis, and by 2009, two-thirds of countries in sub-Saharan Africa had introduced policies supporting PITC [4]. As treatment becomes more widely available, strategies to expand VCT coverage are critically important. We compare VCT uptake using two delivery strategies (opt-in and opt-out) within the MEMA kwa Vijana trial in 20 communities in northwest Tanzania
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