Facility and home based HIV Counseling and Testing: a comparative analysis of uptake of services by rural communities in southwestern Uganda

Abstract

BackgroundIn Uganda, public human immunodeficiency virus (HIV) Voluntary Counseling and Testing (VCT) services are mainly provided through the facility based model, although the home based approach is being promoted as a strategy for improving access to VCT. However the uptake of VCT varies according to service delivery model and is influenced by a number of factors. The aim of this study therefore, was to compare predictors for uptake of facility and home based VCT in a rural context.MethodsA longitudinal study with cross-sectional investigative phases was conducted at two sites (Rugando and Kabingo) in southwestern Uganda between November 2007 (baseline) and March 2008 (follow up). During the baseline visit, facility based VCT was offered at the main health centre in Rugando while home based VCT was offered at the household level in Kabingo and a mixed survey questionnaire administered to the respondents. The results presented in this paper are derived from only the baseline data.ResultsNine hundred ninety four (994) respondents were interviewed, of whom 500 received facility based VCT in Rugando and 494 home based VCT in Kabingo during the baseline visit. The respondents had a mean age of 32.2 years (SD 10.9) and were mainly female (68 percent). Clients who received facility based VCT were less likely to be residents of the more rural households (adjusted Odds Ratio (aOR) = 0.14, 95% CI 0.07, 0.22). The clients who received home based VCT were less likely to report having an STI symptom (aOR = 0.63, 95% CI 0.46, 0.86), and more likely to be worried about discrimination if they contracted AIDS (aOR = 1.78, 95% CI 1.22, 2.61).ConclusionThe uptake of VCT provided through either the facility or home based models is influenced by client characteristics such as proximity to service delivery points, HIV related symptoms, and fear of discrimination in rural Uganda. Interventions that seek to improve uptake of VCT should provide potential clients with both facility and home based VCT options within a given setting. The clients are then able to select a model for VCT that best fits their characteristics. This is likely to have positive implications for both service coverage and uptake by different sub-groups within particular communities.

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

“…The percentage of men out of total persons tested was reported in 25 home HTC studies 5,14,18,29,31,32,37,38,41–45,63,64,66,68–72,88–90 , two home with self-testing 11,75 , 10 mobile 10,13,68,72,91–99 , 3 index partner 47,49,88 , 3 campaign 46,47,76 , 2 workplace 100,101 , 20 facility VCT 52,54,61,64,81,88,89,92,93,95,96,98,102–107 , and 13 facility PITC 58,60,82–84,86,99,108–113 (Fig. 2).…”

“…The percentage of testers who were young adults testers <age 25 or <30 years) was reported in 17 home HTC studies 5,18,29–31,35,37,38,45,63,64,68–70,73,74,90,117 , one home with self-testing 11 , 13 mobile 10,12,13,68,91,93,95–97,103,107,114 , two index partner 48,88 , two campaign 47,77 , 20 facility VCT 12,51,52,54,64,88,89,91–93,95,104–107,114,118–120 , and six facility PITC 58,82,86,88,110,113 . Results varied considerably by study (Supplementary Figures S29–S35).…”

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

“…Studies show that men are less likely to undergo HCT and more likely to present late for ART in part because they are less likely to undergo HCT [37, 38]. Home-visits for couple HCT during pregnancy may accelerate male partner HIV diagnosis, and increase access to HIV care, reduce HIV mortality and morbidity, lower community HIV viral load, and further reduce the risk of HIV transmission [22, 31, 39]. …”

“…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]. …”

Cost effectiveness of facility and home based HIV voluntary counseling and testing strategies in rural Uganda

“…During the study, facilitybased VCT was offered to clients at a health centre level IV in Rugando while home based VCT was offered at the household level in Kabingo sub-county. A detailed description of the study setting and the intervention is given elsewhere 26 . The facility-based and home-based strategies are briefly described below.…”