Client characteristics and acceptability of a home-based HIV counselling and testing intervention in rural South Africa

Abstract

BackgroundHIV counselling and testing (HCT) is a critical gateway for addressing HIV prevention and linking people to treatment, care, and support. Since national testing rates are often less than optimal, there is growing interest in expanding testing coverage through the implementation of innovative models such as home-based HIV counselling and testing (HBHCT). With the aim of informing scale up, this paper discusses client characteristics and acceptability of an HBHCT intervention implemented in rural South Africa.MethodsTrained lay counsellors offered door-to-door rapid HIV testing in a rural sub-district of KwaZulu-Natal, South Africa. Household and client data were captured on cellular phones and transmitted to a web-based data management system. Descriptive analysis was undertaken to examine client characteristics, testing history, HBHCT uptake, and reasons for refusal. Chi-square tests were performed to assess the association between client characteristics and uptake.ResultsLay counsellors visited 3,328 households and tested 75% (5,086) of the 6,757 people met. The majority of testers (73.7%) were female, and 57% had never previously tested. With regard to marital status, 1,916 (37.7%), 2,123 (41.7%), and 818 (16.1%) were single, married, and widowed, respectively. Testers ranged in age from 14 to 98 years, with a median of 37 years. Two hundred and twenty-nine couples received couples counselling and testing; 87.8%, 4.8%, and 7.4% were concordant negative, concordant positive, and discordant, respectively. There were significant differences in characteristics between testers and non-testers as well as between male and female testers. The most common reasons for not testing were: not being ready/feeling scared/needing to think about it (34.1%); knowing his/her status (22.6%), being HIV-positive (18.5%), and not feeling at risk of having or acquiring HIV (10.1%). The distribution of reasons for refusal differed significantly by gender and age.ConclusionsThese findings indicate that HBHCT is acceptable in rural South Africa. However, future HBHCT programmes should carefully consider community context, develop strategies to reach a broad range of clients, and tailor intervention messages and services to meet the unique needs of different sub-groups. It will also be important to understand and address factors related to refusal of testing.

Home visits during pregnancy enhance male partner HIV counselling and testing in Kenya

“…The 85% rate of male partner access and couple HIV counseling and testing (HCT) found in this study is the highest reported for male partners of pregnant women and substantially higher than that reported in previous studies that used community mobilization, written invitations, couple-oriented post-test HIV counseling or home based door-to-door HCT [15, 18, 20, 28]. There was high acceptability of home-visits for couple HCT most likely due to couples HCT testing approach which provided for confidentiality and sharing of results between partners, experience and flexibility of the counsellors, and prior door-to-door home based HIV testing in the region[29].…”

“…However, in at least three studies, less than 30% of testers reached through door-to-door HBCT were men and few (~4%) of the tested men were partners of women who were pregnant at the time [20–22]. …”

Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi

“…Our study provides a further insight into the gender disparity in the early stages of the cascade of care. First, men were less likely than women inclined to get tested for HIV, mostly because of their absence due to labour migration, which was also found in other sites in subSaharan Africa [11,30,31]. We managed to reach 80% testing coverage among eligible men by repeating visits, including during weekends.…”

Human immunodeficiency virus screening in rural communities of Rivers State, Nigeria: Challenges and potential solutions

“…Earlier studies on home-based testing have proven to be acceptable and successful in rural settings. [47,48] The primary goal of HIV and AIDS prevention and control is to reduce new infections, morbidity, and mortality through early case detection and initiation of treatment. The hub of health services delivery in Rivers State has been through the formal health sector and its network of facilities.…”