HIV Counseling And Testing Uptake Research Articles

Factors associated with HIV counseling and testing and correlations with sexual behavior of teachers in primary and secondary schools in Addis Ababa, Ethiopia.

BackgroundThe HIV/AIDS pandemic is a global crisis that affects the lives of millions of people. Although HIV counseling and testing (HCT) serves as the entry point for HIV prevention, treatment, and care, it remains a low priority in many settings. The aim of this study, therefore, was to assess the factors associated with HCT and their correlation with the sexual behavior of primary and secondary school teachers in Addis Ababa.MethodsA comparative cross-sectional study was conducted among primary and secondary school teachers in Addis Ababa, Ethiopia. A multistage sampling technique was used to select a representative sample of 1,136 teachers. HCT and sexual health behavior-related data were collected using a self-administered questionnaire. Binary logistic regression was employed to examine the relationships between HCT, sociodemographics, and risky sexual behavior-related variables.ResultsOf the 1,136 eligible study participants, 1,034 (91.0%) teachers completed the self-administered anonymous questionnaire. The proportion of teachers who had ever tested for HIV was 739/1,034 (71.5%; 95% confidence interval [CI] 69.1–74.2). Multivariate logistic regression analyses showed that being male (adjusted odds ratio [AOR] 0.63; 95% CI 0.44–0.90) was associated with a 37% decrease in odds of being ever tested for HIV compared with being female. Married teachers were less likely to have had HIV testing (AOR 0.30; 95% CI 0.19–0.47) compared with unmarried teachers. Being aged ≥45 years (AOR 4.05; 95% CI 1.82–9.03), having high HCT-related knowledge (AOR 3.56; 95% CI 1.73–7.32), and having a perceived risk of HIV (AOR 1.43; 95% CI 1.04–1.96) were positively associated with HCT. Moreover, regarding the correlation of HCT with the sexual behavior of teachers, those teachers who never had HCT were more likely to have multiple sexual partners than those who had ever had HCT (AOR 1.85; 95% CI 1.08–3.15). In contrast, teachers who had ever been tested for HIV were less likely to have used condoms consistently than those who had never been tested (AOR 0.55; 95% CI 0.32–0.96).ConclusionNo significant differences were observed between primary and secondary school teachers regarding factors associated with HCT and its correlation with sexual behavior. Gender, age, marital status, knowledge of HCT, and perceived risk were found to be factors associated with HCT uptake. Correlations between being faithful to a partner, inconsistent use of condoms, and HCT uptake of teachers were also observed. Thus, strengthening the current practice of HCT services in the education sector with due emphasis on the observed factors could play a pivotal role in bringing about positive changes in the sexual behavior of school community.

Piloting a Social Networks Strategy to Increase HIV Testing and Counseling Among Men Who Have Sex with Men in Greater Accra and Ashanti Region, Ghana.

The 2011 Ghana Men's Study identified a high prevalence of HIV among men who have sex with men (MSM) in Accra/Tema (34.4%) and in Kumasi (13.6%), whereas the HIV rate among MSM referred through peer educators (PEs) to HIV testing and counseling (HTC) services in these two sites was substantially lower (8.4%). These findings raised questions about possible limitations of the peer-education strategy to reach high-risk MSM. Therefore, a pilot study was conducted to assess the feasibility of using a social network strategy (SNS) to identify and refer MSM to HTC services. Within 3months, 166 MSM were reached and referred to HTC services: 62.7% reported no recent exposure to PEs; 61.5% were unaware of their recent HIV serostatus; and 32.9% were newly diagnosed HIV positive. This pilot study suggests that an SNS could be an important strategy to reach MSM and to increase the uptake of HTC.

"Students want HIV testing in schools" a formative evaluation of the acceptability of HIV testing and counselling at schools in Gauteng and North West provinces in South Africa.

BackgroundThe proposal by the South African Health Ministry to implement HIV testing and counselling (HTC) at schools in 2011 generated debates about the appropriateness of such testing. However, the debate has been between the Ministries of Education and Health, with little considerations of the students. The main aim of the study was to assess the students’ opinions and uptake of HIV testing and counselling in general, and the acceptability of the provision of HIV testing and counselling in schools. The study also determined the association between socio-demographic characteristics, sexual behaviour, and HIV testing behaviour of the students.MethodsA survey was conducted among grade 10–12 high school students in North West and Gauteng provinces, South Africa. Seventeen high schools (nine rural and eight urban) were randomly selected for the administration of a researcher-assisted, self-administered, semi-structured questionnaire.ResultsA total of 2970 students aged 14–27 years participated in the study; 1632 (55%) were girls, 1810 (61%) ever had sex, and 1271 (49.8%) had more than one sex partner. The mean age of first sexual activity was 15.6. Half (n = 1494, 50.1%) had been tested for HIV. Having multiple sexual partners, age, and gender were significantly associated with increased odds of having had a HIV test. Fear, being un-informed about HTC, and low HIV risk perceptions were the reasons for not getting tested. The acceptability of HTC at school was high (n = 2282, 76.9%) and 2129 (71.8%) were willing to be tested at school. Appropriateness, privacy, and secrecy were the main arguments for and against HTC at school. One-third (n = 860, 29%) had intentions to disclose their HIV status to students versus 1258 (42.5%) for teachers. Stigma, discrimination and secrecy were the primary reasons students did not intend to disclose.ConclusionsA high acceptability of HTC and willingness to be tested at school suggest that HIV prevention programs tailored to youth have a high potential of success given the readiness of students to uptake HTC. Bringing HIV testing to the school setting will increase the uptake of HTC among youth and contribute towards efforts to scale up HTC in South Africa.

Acceptability of HIV Testing and Counseling by Antenatal Clients of a Tertiary Institution in Northern Nigeria

Background: HIV testing and counseling (HTC) plays a central role in specific prevention of mother-to-child transmission (PMTCT) interventions, as these interventions depend on the woman knowing her HIV status. Over ninety percent of HIV infection in children is acquired through mother-to-child transmission. Objectives: This study assessed pregnant women’s knowledge of HIV/AIDS, their awareness of HIV testing and counseling, and compared the uptake of HTC to the previously practiced voluntary counseling and testing (VCT) in a teaching hospital in northern Nigeria. Materials and Methods: A pre-tested, structured interview questionnaire was administered on a cross-section survey of 270 antenatal clients in Ahmadu Bello University Teaching Hospital (ABUTH), Nigeria. Information about knowledge of HIV/AIDS and attitude towards HTC was elicited among respondents. Results: Eighty-nine percent of respondents were aware of HIV/AIDS. The knowledge of route of disease transmission was high, with 87.4% and 81.1% of studyparticipants mentioning sexual activity and mother-to-child transmission, respectively. Majority of respondents (98.9%) were aware of HTC and approved of it (91.1%) while 7.8% declined and the remaining 1.1% were undecided. Fourteen percent of respondents didn’t approve of retesting in labour. Sixty-eight percent of respondents were aware of interventions to prevent mother-to-child transmission of HIV. Switching from VCT to HTC has dramatically improved the uptake of testing from 78.9% in 2006 to 91.1% in 2012. Conclusion: Routine HIV testing and counseling is more acceptable than voluntary counseling and testing among antenatal clients. Although the awareness and uptake of HTC were quite high among the antenatal clients, there is still a need to intensify health education and incorporate husbands into the counseling session when necessary to convince the remaining minority who are still ignorant of the benefits of HTC.

Home-based versus mobile clinic HIV testing and counseling in rural Lesotho: a cluster-randomized trial.

The success of HIV programs relies on widely accessible HIV testing and counseling (HTC) services at health facilities as well as in the community. Home-based HTC (HB-HTC) is a popular community-based approach to reach persons who do not test at health facilities. Data comparing HB-HTC to other community-based HTC approaches are very limited. This trial compares HB-HTC to mobile clinic HTC (MC-HTC). The trial was powered to test the hypothesis of higher HTC uptake in HB-HTC campaigns than in MC-HTC campaigns. Twelve clusters were randomly allocated to HB-HTC or MC-HTC. The six clusters in the HB-HTC group received 30 1-d multi-disease campaigns (five villages per cluster) that delivered services by going door-to-door, whereas the six clusters in MC-HTC group received campaigns involving community gatherings in the 30 villages with subsequent service provision in mobile clinics. Time allocation and human resources were standardized and equal in both groups. All individuals accessing the campaigns with unknown HIV status or whose last HIV test was >12 wk ago and was negative were eligible. All outcomes were assessed at the individual level. Statistical analysis used multivariable logistic regression. Odds ratios and p-values were adjusted for gender, age, and cluster effect. Out of 3,197 participants from the 12 clusters, 2,563 (80.2%) were eligible (HB-HTC: 1,171; MC-HTC: 1,392). The results for the primary outcomes were as follows. Overall HTC uptake was higher in the HB-HTC group than in the MC-HTC group (92.5% versus 86.7%; adjusted odds ratio [aOR]: 2.06; 95% CI: 1.18-3.60; p = 0. 011). Among adolescents and adults ≥ 12 y, HTC uptake did not differ significantly between the two groups; however, in children <12 y, HTC uptake was higher in the HB-HTC arm (87.5% versus 58.7%; aOR: 4.91; 95% CI: 2.41-10.0; p<0.001). Out of those who took up HTC, 114 (4.9%) tested HIV-positive, 39 (3.6%) in the HB-HTC arm and 75 (6.2%) in the MC-HTC arm (aOR: 0.64; 95% CI: 0.48-0.86; p = 0.002). Ten (25.6%) and 19 (25.3%) individuals in the HB-HTC and in the MC-HTC arms, respectively, linked to HIV care within 1 mo after testing positive. Findings for secondary outcomes were as follows: HB-HTC reached more first-time testers, particularly among adolescents and young adults, and had a higher proportion of men among participants. However, after adjusting for clustering, the difference in male participation was not significant anymore. Age distribution among participants and immunological and clinical stages among persons newly diagnosed HIV-positive did not differ significantly between the two groups. Major study limitations included the campaigns' restriction to weekdays and a relatively low HIV prevalence among participants, the latter indicating that both arms may have reached an underexposed population. This study demonstrates that both HB-HTC and MC-HTC can achieve high uptake of HTC. The choice between these two community-based strategies will depend on the objective of the activity: HB-HTC was better in reaching children, individuals who had never tested before, and men, while MC-HTC detected more new HIV infections. The low rate of linkage to care after a positive HIV test warrants future consideration of combining community-based HTC approaches with strategies to improve linkage to care for persons who test HIV-positive. ClinicalTrials.gov NCT01459120. Please see later in the article for the Editors' Summary.

Barriers to HIV counselling and testing uptake by health workers in three public hospitals in Free State Province, South Africa

Recent WHO/ILO/UNAIDS guidelines recommend priority access to HIV services for health care workers (HCWs), in order to retain and support HCWs, especially those at risk of occupationally acquired tuberculosis (TB). The purpose of this study was to identify barriers to uptake of HIV counselling and testing (HCT) services for HCWs receiving HCT within occupational health units (OHUs). Questions were included within a larger occupational health survey of a 20% quota sample of HCWs from three public hospitals in Free State Province, South Africa. Of the 978 respondents, nearly 65% believed that their co-workers would not want to know their HIV status. Barriers to accessing HCT at the OHU included ambiguity over whether antiretroviral treatment was available at the OHU (only 51.1% knew), or whether TB treatment was available (55.5% knew). Nearly 40% of respondents perceived that stigma as a barrier. When controlling for age and race, the odds of perceiving HIV stigma in the workplace among patient-care health care workers (PCHWs) were 2.4 times that for non-PCHWs [95% confidence interval (CI): 1.80–3.15]. Of the 692 survey respondents who indicated a reason for not using HIV services at the OHU, 38.9% felt that confidentiality was the reason cited. Among PCHWs, the adjusted odds of expressing concern that confidentiality may not be maintained in the OHU were 2.4 times (95% CI: 1.8–3.2) that of non-PCHWs and were higher among Black [odds ratio (OR): 2.7, CI: 1.7–4.2] and Coloured HCWs (OR: 3.0, 95% CI: 1.6–5.6) as compared to White HCWs, suggesting that stigma and confidentiality concerns are still barriers to uptake of HCT. Campaigns to improve awareness of HCT and TB services offered in the OHUs, address stigma and ensure that the workforce is aware of the confidentiality provisions that are in place are warranted.

HIV testing preferences in Tanzania: a qualitative exploration of the importance of confidentiality, accessibility, and quality of service.

BackgroundHIV counseling and testing (HCT), an effective preventive strategy and an entry point for care, remains under-utilized in Tanzania. Limited uptake of HCT, despite the widespread availability of varied testing options, suggests that existing options may not align well with population preferences for testing.MethodsBetween October and December 2011, we conducted an exploratory study in the Kilimanjaro Region to develop a conceptual framework for understanding which characteristics of HIV testing are associated with preferences for testing. Forty individuals (55% women, 53% never having tested) participated in in-depth interviews and focus groups to identify factors that influence whether and where people test for HIV.ResultsA variety of discrete characteristics of testing venues, test providers, and testing procedures (e.g. distance to testing, counselor experience, type of HIV test, and availability of antiretroviral therapy) mapped conceptually to three domains: confidentiality of testing and test results, quality of HCT, and accessibility and availability of ancillary services. We noted heterogeneous preferences and demonstrate that while some test characteristics overlap and reinforce across multiple domains, others demand clients to make trade-offs between domains.ConclusionTesting decisions appear to be influenced by an array of often inter-linked factors across multiple domains, including quality, confidentiality, and accessibility; perceptions of these factors varied greatly across participants and across available testing options. HCT interventions that jointly target barriers spanning the three domains have the potential to increase uptake of HIV testing and deserve further exploration.

Determinants of HIV counseling and testing uptake among individuals in long-term sexual relationships in Uganda.

Studies show that HIV counseling and testing (HCT) can improve linkage to HIV prevention, care and treatment services. However, uptake of HCT among couples remains low in most settings. We investigated the determinants of HCT uptake among individuals in long-term relationships in two districts in Uganda. This case-control study was conducted among 787 (400 in Kampala and 387 in Soroti) individuals in long-term sexual relationships, aged 18-54 years, using interviewer-administered questionnaires. Cases were individuals who had ever tested for HIV (selected from health facility records and traced in the community for interview) while controls were individuals who had never tested for HIV, identified from the same community as the cases. Data were collected on sociodemographic and behavioral characteristics; entered into FoxPro and analyzed using STATA version 12.1. We performed multivariable logistic regression to estimate the odds ratio (OR) and 95% Confidence Intervals (95%CI) associated with prior HCT and couples' HCT uptake, controlling for suspected confounders. Of the 787 participants, 522 had ever tested for HIV (cases) while 265 had never tested for HIV (controls). Compared to those that had never tested for HIV, those that had ever tested for HIV were significantly more likely to be females (Adj. OR=3.23, 95%CI: 2.27, 4.60), to be 25-29 years old (Adj. OR=2.15, 95%CI: 1.32, 3.50), to report exposure to a couples' HCT promotional campaign (Adj. OR=2.01, 95%CI: 1.30, 3.10) and to believe that HIV discordance is possible among married couples (Adj. OR=1.77, 95%CI: 1.20, 2.63). Compared to individuals that had ever received individual HCT, those that had ever received couples' HCT were significantly more likely to report prior discussion of HIV testing with partner (Adj. OR=4.35, 95%CI: 2.61, 7.28) and to be residents of Soroti district (Adj. OR=6.01, 95%CI: 3.74, 9.65). Prior HCT was significantly associated with female gender and exposure to a couples' HCT promotional campaign while prior couples' HCT was significantly associated with prior discussion of HIV testing with partner. To increase HIV testing among couples, these findings suggest a need for HCT promotional campaigns that promote communication about HCT between partners.

Effect of health education on the uptake of HIV counseling and testing among long distance drivers in Jos North Local Government Areas of Plateau State.

The impact of HIV/AIDS has been felt in virtually all aspects of life. Long distance drivers are of particular concern to HIV prevention and care programs because they constitute a high risk group. HIV Counseling and Testing (HCT) is an intervention, which gives the client an opportunity to confidentially discuss his or her HIV risks and be assisted to learn his/her HIV status for purposes of prevention, treatment, care and support. The objective of this study was to determine the effect of health education on the uptake of HCT among Long Distance Drivers (LDDs) in Plateau State. This was a quasi-experimental study with a pre and post intervention phase carried out among 161 LDDs in Jos North Local Government Areas. Health education intervention was provided using a structured health education guide in the form of lecture and discussion. Epi-info™ statistical software version 3.5.4 developed by Centre for Disease and Control and Prevention (CDC) 1600 Clifton Rd. Atlanta, GA 30333 usa was used for data analysis and 95% confidence interval was used for the study and P ≤ 0.05 was considered as statistically significant. The mean age of the respondent in this study was 41.0 ± 7.9 years with majority (92.5%) of the LDDs married and 91.3% resident within the state. Knowledge and uptake of HCT among LDDs improved significantly from 4.17 ± 1.43 to 6.70 ± 1.55 and 18.6-57.2% following the intervention (P < 0.001) respectively. This study has shown that health education is an effective tool in improving the uptake of HCT among long distance drivers. Therefore, it should be used to improve HCT uptake among high risk groups.

HIV Preventive Measures among Adolescents Attending Secondary Schools in an Urban Community in Southwestern Nigeria

Many studies carried out among adolescents in Nigeria generally report the practice of preventive measures against HIV to be poor. This study was carried out to assess the HIV/AIDS preventive measures among adolescents attending secondary schools in an urban community in Southwestern Nigeria. This was a descriptive cross sectional study, carried out among in-school adolescents in Osogbo metropolis, Southwestern Nigeria. The multi-stage sampling technique was used to select the respondents and data was collected with pre-tested, semi-structured questionnaires which were self administered and supervised by trained research assistants. A total of 370 questionnaires were administered and analysed using Statistical Package for Social Sciences (SPSS) version 16. Majority knew that HIV/AIDS could be prevented by not sharing sharp objects (305, 82.4%) and the use of condom (277, 74.9%). Three hundred and twenty nine (88.9%) of the respondents were aware of condom while 205 (55.4%) were aware of HIV Counselling and Testing (HCT). Seventy four (20.0%) respondents were sexually exposed, and only 21 (5.7%) of the respondents had ever used condoms before. Only 15 (4.1%) of the respondents had had HCT before and 189 (51.1%) had had sex education before. Most of the respondents were aware of the disease called AIDS, but their comprehensive knowledge about the disease and its prevention was not correspondingly high. Twenty percent of the respondents were sexually exposed but their HIV preventive practice was generally poor; there was poor and inconsistent condom usage, poor uptake of HCT and sex education and a poor perceived self efficacy among nearly half of the respondents. The stakeholders in adolescent reproductive health should work towards the provision of straightforward and elemental information about sex, and related practical issues that normally affect adolescents, like contraception, abortion and sexually transmitted infections to adolescents.

Factors influencing HIV counselling and testing uptake among corps members in Osun State, Nigeria

The prevalence of HIV infection among Nigerian youths has been persistently high and HIV Counselling and Testing (HCT) is a major intervention that can help to reduce the transmission of HIV. This study was carried out to determine the uptake of HCT and identify the factors affecting the uptake among National Youth Service Corps (NYSC) members in Osun State, Nigeria. The study employed a cross-sectional analytical design. A pre-tested, self-administered, semi-structured questionnaire was used to elicit information from 1000 corps members who were recruited by systematic random sampling at the NYSC orientation camp Osun State. Factors affecting HCT uptake were evaluated using binary logistic regression analysis, confidence intervals and odd ratios. The results showed that 59.0% of the respondents had HCT while 41.0% had never accessed HCT before. The factors influencing uptake among the respondents were risk perception (p = 0.002) and partner's screening status (p < 0.001). HCT uptake among the respondents was fair. Personal and partner factors predicted HCT uptake. Health education to make people appreciate their risk of HIV and importance of

Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches.

Effective national and global HIV responses require a significant expansion of HIV testing and counselling (HTC) to expand access to prevention and care. Facility-based HTC, while essential, is unlikely to meet national and global targets on its own. This article systematically reviews the evidence for community-based HTC. PubMed was searched on 4 March 2013, clinical trial registries were searched on 3 September 2012, and Embase and the World Health Organization Global Index Medicus were searched on 10 April 2012 for studies including community-based HTC (i.e., HTC outside of health facilities). Randomised controlled trials, and observational studies were eligible if they included a community-based testing approach and reported one or more of the following outcomes: uptake, proportion receiving their first HIV test, CD4 value at diagnosis, linkage to care, HIV positivity rate, HTC coverage, HIV incidence, or cost per person tested (outcomes are defined fully in the text). The following community-based HTC approaches were reviewed: (1) door-to-door testing (systematically offering HTC to homes in a catchment area), (2) mobile testing for the general population (offering HTC via a mobile HTC service), (3) index testing (offering HTC to household members of people with HIV and persons who may have been exposed to HIV), (4) mobile testing for men who have sex with men, (5) mobile testing for people who inject drugs, (6) mobile testing for female sex workers, (7) mobile testing for adolescents, (8) self-testing, (9) workplace HTC, (10) church-based HTC, and (11) school-based HTC. The Newcastle-Ottawa Quality Assessment Scale and the Cochrane Collaboration's "risk of bias" tool were used to assess the risk of bias in studies with a comparator arm included in pooled estimates. 117 studies, including 864,651 participants completing HTC, met the inclusion criteria. The percentage of people offered community-based HTC who accepted HTC was as follows: index testing, 88% of 12,052 participants; self-testing, 87% of 1,839 participants; mobile testing, 87% of 79,475 participants; door-to-door testing, 80% of 555,267 participants; workplace testing, 67% of 62,406 participants; and school-based testing, 62% of 2,593 participants. Mobile HTC uptake among key populations (men who have sex with men, people who inject drugs, female sex workers, and adolescents) ranged from 9% to 100% (among 41,110 participants across studies), with heterogeneity related to how testing was offered. Community-based approaches increased HTC uptake (relative risk [RR] 10.65, 95% confidence interval [CI] 6.27-18.08), the proportion of first-time testers (RR 1.23, 95% CI 1.06-1.42), and the proportion of participants with CD4 counts above 350 cells/µl (RR 1.42, 95% CI 1.16-1.74), and obtained a lower positivity rate (RR 0.59, 95% CI 0.37-0.96), relative to facility-based approaches. 80% (95% CI 75%-85%) of 5,832 community-based HTC participants obtained a CD4 measurement following HIV diagnosis, and 73% (95% CI 61%-85%) of 527 community-based HTC participants initiated antiretroviral therapy following a CD4 measurement indicating eligibility. The data on linking participants without HIV to prevention services were limited. In low- and middle-income countries, the cost per person tested ranged from US$2-US$126. At the population level, community-based HTC increased HTC coverage (RR 7.07, 95% CI 3.52-14.22) and reduced HIV incidence (RR 0.86, 95% CI 0.73-1.02), although the incidence reduction lacked statistical significance. No studies reported any harm arising as a result of having been tested. Community-based HTC achieved high rates of HTC uptake, reached people with high CD4 counts, and linked people to care. It also obtained a lower HIV positivity rate relative to facility-based approaches. Further research is needed to further improve acceptability of community-based HTC for key populations. HIV programmes should offer community-based HTC linked to prevention and care, in addition to facility-based HTC, to support increased access to HIV prevention, care, and treatment. International Prospective Register of Systematic Reviews CRD42012002554 Please see later in the article for the Editors' Summary.

Trends in HIV counseling and testing uptake among married individuals in Rakai, Uganda

BackgroundDespite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda.MethodsWe analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples’ HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used χ2 tests to assess linear trends in individual and couples’ HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) associated with individual and couples’ HCT uptake. Analysis was done using STATA version 11.0.ResultsUptake of couples’ HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (χ2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (χ2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (χ2 for trend = 18.16; P < 0.0001). Uptake of couples’ HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95% CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95% CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95% CI: 1.26, 4.80).ConclusionUptake of couples’ HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples’ HCT, particularly among younger couples and those with no prior HCT.

Grassroots community organizations' contribution to the scale-up of HIV testing and counselling services in Zimbabwe.

Objective:To investigate whether community engagement (participation in grassroots organizations) contributed to increases in HIV testing in Zimbabwe.Methods:Prospective data on membership of local community organizations (e.g. women's groups and burial societies) and uptake of HIV testing and counselling (HTC) and prevention-of-mother-to-child transmission (PMTCT) services were collected from 5260 adults interviewed in two consecutive rounds of a general-population cohort survey in eastern Zimbabwe between 2003 and 2008. The effects of community engagement on uptake of services during the follow-up period were measured using logistic regression to adjust for observed confounding factors.Results:Sixteen percent of men and 47% of women were consistent members of community organizations; 58 and 35% of these people discussed HIV in their meetings and were members of externally sponsored organizations, respectively. Fewer men (10.1%) than women (32.4%) took up HTC during follow-up [adjusted odds ratio (aOR) = 4.08, 95% confidence interval (CI) 3.43–4.86, P < 0.001]. HTC uptake was higher for members of community organizations than for nonmembers: men, 15.0 versus 9.2% (1.67, 1.15–2.43, P = 0.007); women, 35.6 versus 29.6% (1.26, 1.06–1.49, P = 0.008). Membership of community organizations showed a nonsignificant association with PMTCT uptake amongst recently pregnant women (42.3 versus 34.2%; 1.30, 0.94–1.78, P = 0.1). The most consistent positive associations between community participation and HTC and PMTCT uptake were found in organizations that discussed HIV and when external sponsorship was absent.Conclusion:Grassroots organizations contributed to increased uptake of HTC services in eastern Zimbabwe in the mid-2000s. Partnerships with these organizations could harness community support for the further increases in HIV testing needed in sub-Saharan Africa.

Evaluating the impact of three HIV counselling and testing strategies on male most-at-risk population in Nigeria: a segmented regression analysis

BackgroundAlternative HIV counselling and testing (HCT) delivery models, such as mobile HTC, have been shown to increase access to and uptake of HCT. We evaluated the effects of three strategies in increasing uptake of HCT among male most-at-risk population (M-MARPS). MethodsThree HCT strategies implemented between July, 2009, and July, 2012, among men who have sex with men and injecting drug users in three states in Nigeria were evaluated in a longitudinal analysis. The first strategy (S1) was facility based with a community mobilisation component using key opinion leaders (KOLs). The second strategy (S2) involved KOLs referring M-MARPS to nearby mobile HCT teams, while the third (S3) involved mobile M-MARPS peers conducting the HCT. Segmented linear regression was used to assess the effect of different strategies on uptake of HCT among M-MARPS. FindingsA total of 1988, 14 726, and 14 895 M-MARPS received HCT through S1, S2, and S3 methods, respectively. Overall, S3 (12·7%; 1853 of 14 622) identified the highest proportion of HIV-positive M-MARPS compared with S1 (9·0%; 177 of 1956) and S2 (3·3%; 480 of 14 671; p<0·0001). Also S3 (13·2%; 1729 of 13 074) identified the highest proportion of new HIV diagnosis compared with S1 (8·2%; 132 of 1618) and S2 (2·9%; 355 of 12 034), respectively (p<0·0001). For the total number of M-MARPS reached by each strategy, there was no immediate (271; p=0·539) or long-term change (53; p=0·334) in the total number of clients reached by S2 compared with S1. Compared with S2, S3 showed a significant immediate decrease (3068; p=0·029) but a sustained long-term increase (822; p=0·007) in the total number of M-MARPS reached with HCT. InterpretationPeer-mediated HCT (S3) had the highest impact on the total number of M-MARPS reached, identifying HIV-positive M-MARPS and new testers. Since HCT is a key intervention strategy for effective HIV/AIDS control, training M-MARPS peers to provide HCT is a high-impact approach in delivering HCT to M-MARPS. FundingThis study was supported by the Population Council's Men's Health Network Nigeria project with funds from the Centers for Disease Control and Prevention (CDC) through CDC Cooperative Agreement No.1U2GPS001066-01. The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The funders had no role in data collection, interpretation, writing, or decision to submit this article for publication. None of the authors has been paid to write this article by a pharmaceutical company or other agency. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Client Characteristics and Gender-Specific Correlates of Testing HIV Positive: A Comparison of Standalone Center Versus Mobile Outreach HIV Testing and Counseling in Botswana

Using data from Botswana's largest HIV testing and counseling (HTC) provider, Tebelopele, we evaluate populations served and gender-specific correlates of testing HIV-positive among clients of two programs: standalone centers and outreach testing. Client records from January to June 2007 (n=47,890) were evaluated by HTC program and gender. Bivariate and multivariate analyses were performed to identify demographic, testing, and risk-behavior variables associated with testing HIV-positive. Compared to outreach testing, standalone centers served proportionally more clients who were young, well-educated, unmarried, and HIV-infected; outreach testing reached an older, less-educated population. Age, educational attainment, marital status, couples testing, testing because of illness or discordant relationship, and nonuse of condoms (among young clients only) were consistently associated with testing HIV-positive, by HTC program and gender. Our evaluation suggests that Tebelopele standalone and outreach HTC programs serve different populations, and identifies strategies to reduce HIV infection risk and to improve uptake of HTC by HIV-infected, undiagnosed Batswana.

Stigmatising Attitudes among People Offered Home-Based HIV Testing and Counselling in Blantyre, Malawi: Construction and Analysis of a Stigma Scale

BackgroundHIV/AIDS related stigma is a major barrier to uptake of HIV testing and counselling (HTC). We assessed the extent of stigmatising attitudes expressed by participants offered community-based HTC, and their anticipated stigma from others to assess relationship with HIV test uptake. From these data, we constructed a brief stigma scale for use around the time of HIV testing.Methods and FindingsAdult members of 60 households in urban Blantyre, Malawi, were selected using population-weighted random cluster sampling and offered HTC with the option to self-test before confirmatory HTC. Prior to HTC a 15-item HIV stigma questionnaire was administered. We used association testing and principal components analysis (PCA) to construct a scale measure of stigma. Of 226 adults invited to participate, 216 (95.6%) completed questionnaires and 198/216 (91.7%) opted to undergo HTC (all self-tested). Stigmatising attitudes were uncommon, but anticipated stigma was common, especially fearing verbal abuse (22%) or being abandoned by their partner (11%). Three questions showed little association or consistency with the remaining 12 stigma questions and were not included in the final scale. For the 12-question final scale, Cronbach's alpha was 0.75. Level of stigma was not associated with previously having tested for HIV (p = 0.318) or agreeing to HTC (p = 0.379), but was associated with expressed worry about being or becoming HIV infected (p = 0.003).ConclusionsAnticipated stigma prior to HTC was common among both men and women. However, the high uptake of HTC suggests that this did not translate into reluctance to accept community-based testing. We constructed a brief scale to measure stigma at the time of HIV testing that could rapidly identify individuals requiring additional support following diagnosis and monitor the impact of increasing availability of community-based HTC on prevalence of stigma.

The role of HIV counselling and testing in sexual health behaviour change among undergraduates in Lagos, Nigeria

In developing countries risky sexual behaviour among young people is on the increase. This study examined the likelihood of HIV counselling and testing (HCT) in reducing risky sexual behaviour among undergraduates in Lagos Metropolis in Nigeria. The main hypothesis tested in the study was the uptake of HCT is likely to reduce risky sexual behaviour among young undergraduates. A multistage sampling procedure was adopted to select a sample of 625 undergraduates in the study setting. A structured questionnaire was administered to respondents to elicit information on previous participation in HCT and sexual behaviour before and after participation. Result indicates that 26.1% of males and 28.9% of females ever participated in HCT. The average number of heterosexual partners kept by the respondents declined among males and females from 3.17 and 2.36, respectively before they participated in HCT to 2.27 and 1.6 after they participated in HCT. The differences in the average number of sexual partners by the respondents before and after they participated in HCT were statistically significant (P=0.000). The proportion of male respondents who engaged in frequent sex also declined from 35.8% (before participating in HCT) to 24.1% (after participating in HCT) and from 25% (before participating in HCT) to 24.7% (after participating in HCT) among females. In conclusion, participation in HCT is likely to reduce the prevalence of risky sexual behaviour among undergraduates in the study setting. Therefore, HCT is an intervention that should be emphasized.

High Uptake of Home-Based, District-Wide, HIV Counseling and Testing in Uganda

More than 80% of the people infected with HIV in low-income countries of sub-Saharan Africa do not know their HIV serostatus. Innovative measures of increasing access to HIV counseling and testing (HCT) are urgently needed so as to improve care and prevention. We implemented a home-based HCT program in Bushenyi District from September 2004 to March 2007, in Uganda where approximately 90% of people aged older than 14 years had never tested for HIV to gauge whether it was acceptable and increased uptake of HCT. Twenty-nine teams comprising a counselor and a laboratory assistant systematically visited homes offering HCT for all people older than 14 years of age and at-risk children (mother deceased or HIV infected) using a rapid HIV testing three-test algorithm. HIV-infected people received cotrimoxazole prophylaxis, were supplied with long-lasting insecticide-treated bed nets and equipment for treatment of drinking water at home, and were referred for assessment for antiretroviral therapy. The program reached 92,984 (63%) of all the homes in the district. Of these, 32,3621 people were eligible for HCT, and 28,2857 (87%) were present at home and were offered pretest counseling. A total of 264,966 (94%) accepted testing and received their results, of whom 11,359 (4.3%) were HIV-infected. Ninety percent of those testing had never tested before. The cost of testing was $7.83 per previously untested client. Ninety-seven percent of HIV-infected people initiated cotrimoxazole prophylaxis, 74% received bed nets, 70% received water treatment equipment, and 11% began antiretroviral therapy. Forty-four percent of people who were in an HIV-discordant relationship were infected. These results demonstrate that home-based HCT was well-accepted, feasible, and effective in identifying HIV-infected individuals who did not know their HIV status in rural Uganda.

Effect of Multi-Faceted Health Education Campaign on Attitude and Uptake of HIV Counselling and Testing (HCT) among Antenatal Clients attending Primary Health Care Facilities in Kano State, Nigeria

Setting: This study tests the effect of health education on the attitude and uptake of HIV Counselling and Testing among Antenatal clinic (ANC) clients in Primary Health Care (PHC) setting. Aim and Objectives: To determine the combined effect of health education intervention in the clinic and community on the attitude and uptake of HCT among newly booked antenatal clients at PHC setting Method: An intervention study design was implored for the study. Data generated were analyzed using Epi info 3.2.03 and Minitab 12.01 computer statistical softwares. Respondents’ attitude towards HCT was scored and graded using methods adapted from past studies. Percentage difference in attitude and uptake of HCT were summarized and “t”-test was used to compare mean attitude scores. Results: The results show no remarkable difference in the clients’ attitude and their uptake of HCT at baseline, but a marked difference in attitude and uptake parameters in the intervention group at post-intervention. Conclusion and Recommendation: The findings suggest that multifaceted health education campaign is a formidable strategy for improving attitude and uptake of HCT in PHC setting and should be adopted for PHC systems.Key words: Health education; Antenatal clients; HIV Counselling and Testing; PHC setting