Mobile Voluntary Counseling Research Articles

Comparison of HIV-Positive Incidence Among Transgender Women and Men Who Have Sex with Men at Stand-Alone and Mobile Voluntary Counseling and Testing Facilities in Chiang Mai Province, Thailand

Human immunodeficiency virus (HIV) infection is still a major cause of death in Thais and new cases of infection are still emerging among the key population comprising men who have sex with men (MSM), sex workers and their clients, and transgender women (TGW) and people who inject drugs. The objective of this study was to compare the incidence of HIV infection between MSM and TGW who were tested at stand-alone and mobile HIV voluntary counseling and testing (VCT) centers and to identify factors associated with HIV-positive individuals from the two services. We conducted an observational study using MSM and TGW individuals with unknown HIV status from the databases at a stand-alone center and a mobile VCT belonging to the MPlus in Chiang Mai province, Thailand. Factors associated with HIV-positive status were identified using logistic regression model. HIV VCT data were obtained for 6971 individuals at both MPlus center and mobile care unit. Among 3033 and 3938 clients tested at each facility, respectively, 168 (5.6%) and 101 (2.6%) clients were HIV positive. Individuals tested at the stand-alone centers were at a 1.91-fold higher risk of being HIV positive compared with those tested at the mobile VCT unit. Individuals who were 20-24 or >24 years old, sex workers, or sexually transmitted infection positive were more likely to be HIV positive. Our results show the beneficial effect of mobile HIV VCT facilities that enable testing of more of the at-risk population. Developing mobile VCT activities that attract a particular target population is needed to be able to reach the 90-90-90 goals. This study was approved by the Ethics Committee of the Faculty of Medicine, Chiang Mai University (0BG-2562-06418).

Determinants of Mobile Voluntary Counselling and Testing of HIV Use among Gay in Surakarta, Central Java

Background : HIV infection remains a major global health problem, especially among bisexuals, men who have sex with men (MSM), and homosexuals. The number of AIDS patients in Indonesia from January to March 2017 was 673 people, the number of HIV infections was 10,376 people, and number of AIDS death was 61 people. The purpose of this study was to analyze the determinants of the use of mobile VCT of HIV in MSM community in Surakarta, Central Java. Subjects and Method : A cross-sectional study was conducted in Surakarta, Central Java, from October to November 2018. A sample of 200 MSM was selected by fixed disease sampling, including 50 MSM who used mobile VCT service and 150 MSM who did not use mobile VCT service. The dependent variable was mobile VCT of HIV use. The independent variables were intention, attitude, cues to action, perceived benefit, perceived barrier, and perceived susceptibility. The data were collected by questionnaire and analyzed by path analysis. Results : Mobile VCT of HIV use was directly and positively affected by intention (b= 1.67; 95% CI= 0.73 to 2.56; p<0.001), attitude (b= 1.47; 95% CI= 0.43 to 2.52; p= 0.006), cues to action (b= 1.22; 95% CI= 0.29 to 2.14; p= 0.009), and perceived benefit (b= 1.99; 95% CI= 1.04 to 2.95; p<0.001). It was negatively affected by perceived barrier (b= -1.58; 95% CI= -2.49 to -0.67; p= 0.001). Mobile VCT use was indirectly affected by cues to action, perceived seriousness, and perceived susceptibility. Conclusion : Mobile VCT of HIV use is directly and positively affected by intention, attitude, cues to action, and perceived benefit, but is negatively affected by perceived barrier. Keywords : mobile VCT use, HIV infection, determinants, men who have sex with men, Health Belief Model Correspondence : Nadia Ayu Irma Nindiyastuti. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36A, Surakarta, Central Java 57216. Email: nadiaayu21051992@gmail.com.Mobile: 081252097440. Journal of Health Promotion and Behavior (2019), 3(3): 155-165 https://doi.org/10.26911/thejhpb.2018.03.03.03

The Roles of Batang Public Hospital, HIV Case Manager, People Living with HIV, Partners, and Peer Support Group, in the Prevention of HIV/AIDS Transmission

Background: Batang Public Hospital is one of the referal hospitals for People Living with HIV (PLHIV). It provides outpatient and inpatient care service for PLHIV. Batang Public Hospital is expected to play its role as a referal hospital in collaboration with the HIV case manager to provide a comprehensive care to PLHIV, including mobile Voluntary Counseling and Test (VCT), and facilitating HIV/ AIDS peer support group. The study aimed to investigate the dynamic interaction between Batang Public Hospital, HIV case manager, VCT nurse, HIV/ AIDS peer support group, and PLHIV, to prevent and control HIV/ AIDS.Subjects and Method: This was a qualitative study with phenomenology approach, conducted in Batang District, Central Java, Indonesia. Study subjects were selected purposively, which included PLHIV, VCT nurses, Batang Public Hospital administrators, and HIV case manager. The data were collected by in-depth interview.Result: Batang Public Hospital provides health services with VCT clinics, mobile VCT, PICT (Provider Initiative Counselling and Test), PMTCT (Preventive Mother to Child Transmission). However, PMTCT implementation for birthing mothers with HIV/AIDS is referred to Dr. Karyadi Hospital in Semarang. Batang Public Hospital cooperated with HIV case manager in the implementation of mobile VCT. PLHIV have been participating in the prevention of HIV/AIDS program by using condom.Conclusion: Batang Public Hospital and HIV case manager have been collaborating in the provision of and health social services for PLHIV. Peer support group provide assistant to PLHIV to improve the quality of life. PLHIV have been participating in the prevention of HIV/AIDS transmission program by using condom and playing their role in the PMTCT program.Keywords: PLHIV, health care, peer support group, health behavior, HIV/AIDS case managerCorrespondence: Dian Kusumawardani. Academy of Midwifery Harapan Ibu, Pekalongan, Central Java.Journal of Health Promotion and Behavior(2016), 1(2): 79-86https://doi.org/10.26911/thejhpb.2016.01.02.03

Assessing the costs of mobile voluntary counseling and testing at the work place versus facility based voluntary counseling and testing in Namibia

Bophelo! is a mobile voluntary counseling and testing (VCT) and wellness screening program operated by PharmAccess at workplaces in Namibia, funded from both public and private resources. Publicly funded fixed site New Start centers provide similar services in Namibia. At this time of this study, no comparative information on the cost effectiveness of mobile versus fixed site service provision was available in Namibia to inform future programming for scale-up of VCT. The objectives of the study were to assess the costs of mobile VCT and wellness service delivery in Namibia and to compare the costs and effectiveness with fixed site VCT testing in Namibia. The full direct costs of all resources used by the mobile and fixed site testing programs and data on people tested and outcomes were obtained from PharmAccess and New Start centers in Namibia. Data were also collected on the source of funding, both public donor funding and private funding through contributions from employers. The data were analyzed using Microsoft Excel to determine the average cost per person tested for HIV. In 2009, the average cost per person tested for HIV at the Bophelo! mobile clinic was an estimated US$60.59 (US$310,451 for the 5124 people tested). Private employer contributions to the testing costs reduced the public cost per person tested to US$37.76. The incremental cost per person associated with testing for conditions other than HIV infection was US$11.35, an increase of 18.7%, consisting of the costs of additional tests (US$8.62) and staff time (US$2.73). The cost of testing one person for HIV in 2009 at the New Start centers was estimated at US$58.21 (US$4,082,936 for the 70 143 people tested). Mobile clinics can provide cost-effective wellness testing services at the workplace and have the potential to mobilize local private funding sources. Providing wellness testing in addition to VCT can help address the growing issue of non-communicable diseases.

Séroprévalence de l'infection à VIH en conseil et dépistage volontaire par stratégie mobile en Zone rurale en Côte d'Ivoire

In Côte d'Ivoire, HIV testing and counselling has been identified as a priority in the National 2006-2010 AIDS Strategic Plan, which is designed to evaluate the prevalence of HIV in rural areas measured by means of a mobile strategy. We conducted a cross-sectional descriptive and analytical study from 1st April, 2007 to 31st March 2008 in six rural areas of Côte d'Ivoire: Dabou, San Pedro, Abengourou, Tanda, Daloa, and Soubré*. The study population consisted of subjects attending the mobile voluntary counselling and testing units. The mean prevalence of HIV infection in this study was 5.30%. The mean prevalence rate in men was 5.26%, with a peak of 7.55% in the 30-34 years age-group. The mean prevalence rate in women was 5.35%, with a peak of 6.59% in the same age-group. Type HIV-1 was predominant (84.2% of the total). The most affected area was Dabou, with a rate three times higher (15.83%) than the average rate observed during the study. More educated people (university level) presented 3.5-fold (for men) or 6-fold (for women) higher infection rates than illiterate people. Although 100% of people who tested positive received a medical or community referral according to their specific needs, only 62.1% were first-line referred for medical care. In the light of the results of this study, we believe that community mobilization must be redirected to the most severely affected populations to facilitate earlier diagnosis. Actions such as training and prevention based on communication to encourage changes of behaviour should therefore be priorities in the national counselling and testing programme.

Mobile VCT: Reaching Men and Young People in Urban and Rural South African Pilot Studies (NIMH Project Accept, HPTN 043)

Mounting evidence exists that mobile voluntary counselling and testing (VCT) is able to extend coverage to new localities and populations. We describe two feasibility and acceptability pilot studies conducted in rural and urban South Africa in preparation for the larger NIMH Project Accept HIV prevention trial. A total of 1,015 individuals participated in the pilot studies. Participants in rural Vulindlela were younger (median 22 years) compared to urban Soweto (p < 0.001). Young people were more likely to be first time testers in both sites (p = 0.01 in Vulindlela, p < 0.001 in Soweto), with significantly more men likely to be first time testers than women (p = 0.01 in Vulindlela, p < 0.001 in Soweto). User satisfaction with mobile VCT was extremely high in both sites. Our study shows that providing mobile, high-quality and easy to access services in a high prevalence context is a feasible way to engage youth, men and more rural populations in HIV counselling and testing.

NIMH Project Accept (HPTN 043) HIV/AIDS Community Mobilization (CM) to Promote Mobile HIV Voluntary Counseling and Testing (MVCT) in Rural Communities in Northern Thailand: Modifications by Experience

Project Accept is a RCT designed to test the efficacy of community mobilization (CM), mobile voluntary counseling and testing (MVCT), and post-test support services (PTSS) in reducing HIV incidence in three African countries and Thailand. The intervention started in rural areas, northern Thailand in January 2006. CM initially included door-to-door visits during the daytime, small group discussions and joining organized meetings and followed by MVCT. In February 2007, CM strategy using HIV/AIDS "edutainment" (education and entertainment) during evening hours was introduced. After edutainment was initiated, the number of participants increased substantially. VCT uptake increased from 18 to 28 persons/day on average (t test; t = 7.87 P < 0.0001). Edutainment especially motivated younger people, as the median age of VCT clients decreased from 38 to 35 years old (median test; z = 6.74, P < 0.0001). Providing free MVCT in community settings along with edutainment during evening hours increased VCT uptake and was particularly attractive to younger adults.

No “Magic Bullet”: Exploring Community Mobilization Strategies Used in a Multi-site Community Based Randomized Controlled Trial: Project Accept (HPTN 043)

As community-level interventions become more common in HIV prevention, processes such as community mobilization (CM) are increasingly utilized in public health programs and research. Project Accept, a multi-site community randomized controlled trial, is testing the hypothesis that CM coupled with community-based mobile voluntary counseling and testing and post-test support services will alter community norms and reduce the incidence of HIV. By using a multiple-case study approach, this qualitative study identifies seven major community mobilization strategies used in Project Accept, including stakeholder buy-in, formation of community coalitions, community engagement, community participation, raising community awareness, involvement of leaders, and partnership building, and describes three key elements of mobilization success.

Who Tests, Who Doesn't, and Why? Uptake of Mobile HIV Counseling and Testing in the Kilimanjaro Region of Tanzania

BackgroundOptimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania.MethodsBetween December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who did not access MVCT. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing, between the two groups.ResultsMVCT clients reported greater HIV exposure risk (OR 1.20 [1.04 to 1.38] for males; OR 1.11 [1.03 to 1.19] for females). Female MVCT clients were more likely to report low household expenditures (OR 1.47 [1.04 to 2.05]), male clients reported higher rates of unstable income sources (OR 1.99 [1.22 to 3.24]). First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested (OR 2.17 [1.05 to 4.48] for males; OR 5.95 [2.85 to 12.45] for females). HIV-related stigma, fears of testing or test disclosure, and not being able to leave work were strongly associated with non-participation in MVCT (ORs from 0.11 to 0.84).ConclusionsMVCT attracted clients with increased exposure risk and fewer economic resources; HIV related stigma and testing-related fears remained barriers to testing. MVCT did not disproportionately attract either first-time or frequent repeat testers. Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk populations.

Recruiting heterosexual couples from the general population for studies in rural South Africa – challenges and lessons (Project Accept, HPTN 043)

Couples should be included in HIV prevention research, but their recruitment in southern Africa is challenging given high levels of migration and non-cohabitation. We describe the recruitment strategies and experiences of a pilot study in rural South Africa. With the aim of recruiting 20 couples at mobile voluntary counselling and testing (VCT) caravans and community venues, 75 index partners were screened with an average of 4 additional contacts required to schedule interviews. Recruiting and interviewing couples is feasible, but requires substantial resources.

Project Accept (HPTN 043): A Community-Based Intervention to Reduce HIV Incidence in Populations at Risk for HIV in Sub-Saharan Africa and Thailand

Changing community norms to increase awareness of HIV status and reduce HIV-related stigma has the potential to reduce the incidence of HIV-1 infection in the developing world. We developed and implemented a multilevel intervention providing community-based HIV mobile voluntary counseling and testing, community mobilization, and posttest support services. Forty-eight communities in Tanzania, Zimbabwe, South Africa, and Thailand were randomized to receive the intervention or clinic-based standard voluntary counseling and testing (VCT), the comparison condition. We monitored utilization of community-based HIV mobile voluntary counseling and testing and clinic-based standard VCT by community of residence at 3 sites, which was used to assess differential uptake. We also developed quality assurance procedures to evaluate staff fidelity to the intervention. In the first year of the study, a 4-fold increase in testing was observed in the intervention versus comparison communities. We also found an overall 95% adherence to intervention components. Study outcomes, including prevalence of recent HIV infection and community-level HIV stigma, will be assessed after 3 years of intervention. The provision of mobile services, combined with appropriate support activities, may have significant effects on utilization of voluntary counseling and testing. These findings also provide early support for community mobilization as a strategy for increasing testing rates.

HIV Risk Behaviors in Sub-Saharan Africa and Northern Thailand: Baseline Behavioral Data From Project Accept

Of 2.5 million new HIV infections worldwide in 2007, most occurred in sub-Saharan Africa and southeast Asia. We present the baseline data on HIV risk behaviors and HIV testing in sub-Saharan Africa and northern Thailand from Project Accept, a community-randomized controlled trial of community mobilization, mobile voluntary counseling and testing (VCT), and posttest support services. A random household probability sample of individuals aged 18-32 years yielded a sample of 14,657, with response rates ranging from 84%-94% across the 5 sites (Thailand, Zimbabwe, Tanzania, and 2 in South Africa). Individuals completed an interviewer-administered survey on demographic characteristics, HIV risk behaviors, and history of VCT. In multivariate analysis, females, married individuals, less educated with 1 sexual partner in the past 6 months were more likely to have had unprotected intercourse in the previous 6 months. Rates of lifetime HIV testing ranged from 5.4% among males in Zimbabwe to 52.6% among females in Soweto. Significant risk of HIV acquisition in Project Accept communities exists despite 2 decades of prevention efforts. Low levels of recent HIV testing suggest that increasing awareness of HIV status through accessible VCT services may reduce HIV transmission.