Date Published: February 20, 2018
Publisher: Taylor & Francis
Author(s): Eugene Ruzagira, Kathy Baisley, Anatoli Kamali, Heiner Grosskurth.
We investigated uptake of home-based HIV counselling and testing (HBHCT) and HIV care services post-HBHCT in order to inform the design of future HBHCT programmes. We used data from an open-label cluster-randomised controlled trial which had demonstrated the effectiveness of a post-HBHCT counselling intervention in increasing linkage to HIV care. HBHCT was offered to adults (≥18 years) from 28 rural communities in Masaka, Uganda; consenting HIV-positive care naïve individuals were enrolled and referred for care. The trial’s primary outcome was linkage to HIV care (clinic-verified registration for care) six months post-HBHCT. Random effects logistic regression was used to investigate factors associated with HBHCT uptake, linkage to care, CD4 count receipt, and antiretroviral therapy (ART) initiation; all analyses of uptake of post-HBHCT services were adjusted for trial arm allocation. Of 13,455 adults offered HBHCT, 12,100 (89.9%) accepted. HBHCT uptake was higher among men [adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI) = 1.07–1.36] than women, and decreased with increasing age. Of 551 (4.6%) persons who tested HIV-positive, 205 (37.2%) were in care. Of those not in care, 302 (87.3%) were enrolled in the trial and of these, 42.1% linked to care, 35.4% received CD4 counts, and 29.8% initiated ART at 6 months post-HBHCT. None of the investigated factors was associated with linkage to care. CD4 count receipt was lower in individuals who lived ≥30 min from an HIV clinic (aOR 0.60, 95%CI = 0.34–1.06) versus those who lived closer. ART initiation was higher in older individuals (≥45 years versus <25 years, aOR 2.14, 95% CI = 0.98–4.65), and lower in single (aOR 0.60, 95% CI = 0.28–1.31) or divorced/separated/widowed (aOR 0.47, 95% CI = 0.23–0.93) individuals versus those married/cohabiting. HBHCT was highly acceptable but uptake of post-HBHCT care was low. Other than post-HBHCT counselling, this study did not identify specific issues that require addressing to further improve linkage to care.
HIV counselling and testing (HCT) is essential for expanding HIV prevention and treatment services (Matovu & Makumbi, 2007). Although access to HCT in sub-Saharan Africa (SSA) has increased significantly, its uptake remains low (WHO, 2015). For instance, only 60% of HIV-positive adults know their HIV status (UNAIDS, 2016). Consequently, many HIV-positive people present late for care (Siedner et al., 2015) and AIDS-related morbidity and mortality remain high (UNAIDS, 2014). In order to expand HCT coverage, WHO recommends the use of facility-based and community-based HCT models (WHO, 2015).
We observed high (>80%) levels of HBHCT uptake in this rural population. These findings are consistent with those from other settings (Sharma et al., 2015), and reaffirm the potential of HBHCT to complement other HCT approaches in SSA (Sabapathy et al., 2012). Although more women than men were found at home in this study, men were more likely than women to accept HBHCT. A possible reason for this finding may be that compared to men, women are more likely to attend health care facilities and consequently to learn their HIV status through facility-based HCT programmes (Sekandi et al., 2011).