Comparison of Home and Clinic-Based HIV Testing Among Household Members of Persons Taking Antiretroviral Therapy in Uganda: Results From a Randomized Trial

Lugada, Eric; Levin, Jonathan; Abang, Betty; Mermin, Jonathan; Mugalanzi, Emmanuel; Namara, Geoffrey; Gupta, Sundeep; Grosskurth, Heiner; Jaffar, Shabbar; Coutinho, Alex; Bunnell, Rebecca

doi:10.1097/qai.0b013e3181e9e069

Cited by 97 publications

(116 citation statements)

References 40 publications

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“…Coverage was reported in 19 home HTC studies 15,18,29–45 , one mobile 13 , two campaign 46,47 , three index partner/family member 48–50 , five facility VCT 51–55 , and five facility PITC studies 56–61 . Overall, community HTC modalities achieved higher coverage than facility, with home (70%, 95% CI = 58–79) and campaign (76%, 95% CI = 49–95%) having the highest population coverage (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Uptake was reported in 31 home HTC studies 5,14,15,18,27,29–38,40–45,53,62–74 , two home with self-testing 11,75 , two mobile 10,68 , three index partner or family member 48–50 , four campaign 46,47,76,77 , three workplace 78–80 , three facility VCT 54,56,81 , and 11 facility PITC studies 56,57,59,60,81–87 . Overall, community modalities had high uptake (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

449

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

449

532

View full text Add to dashboard Cite

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“…No contacts that we tested were found to be infected with HIV. Because access to household contacts, including family members and partners, has surfaced as one of the strengths of home-based HIV testing, 46 future studies should focus contact testing on high-risk household contacts and include in-depth qualitative data to understand HIV knowledge and factors influencing testing acceptance. Furthermore, as shown by our population's self-reported low use of condoms (77.3% reported never using condoms during sexual intercourse), future studies and interventions should also investigate cultural and socioeconomic factors influencing sexual practices and sexual risk behavior.…”

Section: Discussionmentioning

confidence: 99%

Community-Based Rapid Oral Human Immunodeficiency Virus Testing for Tuberculosis Patients in Lima, Peru

Nelson

Caldas

Sebastián

et al. 2012

The American Society of Tropical Medicine and Hygiene

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“…Home-based HIV Counselling and Testing (HB-HCT) has been highly acceptable with improved HCT coverage and uptake in low and middle-income countries (Matovu et al 2006; Doherty et al 2013; Lugada et al 2010). A randomized controlled trial in Uganda comparing home-based and health facility testing found that 93 % of community members agreed to test in home sites; with 54.6 % of HIV infections identified compared to 27.3 % in villages with health facility-based HIV Counselling and Testing (HCT) (Yoder et al 2006).…”

Section: Results: Proposed Model To Enhance Treatment Accessmentioning

confidence: 99%

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings

Goga

Singh

et al. 2016

Matern Child Health J

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Introduction Increasing access to HIV-related care and treatment for children aged 0–18 years in resource-limited settings is an urgent global priority. In 2011–2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. Discussion and Conclusion We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.

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Comparison of Home and Clinic-Based HIV Testing Among Household Members of Persons Taking Antiretroviral Therapy in Uganda: Results From a Randomized Trial

Abstract: Home-based VCT for household members of HIV-infected persons was feasible, associated with lower prevalence, higher uptake, and increased identification of HIV-infected persons than clinic-based provision.

Cited by 97 publications

References 40 publications

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Community-Based Rapid Oral Human Immunodeficiency Virus Testing for Tuberculosis Patients in Lima, Peru

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings

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