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

Maman, David; Ben‐Farhat, Jihane; Chilima, Ben; Masiku, Charles; Salumu, Leon; Ford, Nathan; Mendiharat, Pierre; Szumilin, Elisabeth; Masson, Sophie; Étard, Jean-François

doi:10.1111/tmi.12772

Cited by 28 publications

(42 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Sub‐Saharan Africa, between 20 and 55% of the PLWHIV has been described to be unaware of their HIV‐status . Nevertheless, our results suggest that this proportion may include individuals who are in fact aware of their HIV‐status but prefer not to disclose and to repeat the test.…”

Section: Discussionmentioning

confidence: 69%

“…Awareness of HIV infection is the first critical step in the continuum of HIV care. However, it goes far beyond HIV serological testing and includes an understanding of the implications, acceptance of the diagnosis, willingness to disclose their status to health providers, family members and close community and enrol and start in HIV care and treatment. Little is known about the extent and causes of non‐disclosure in different epidemic settings although it has an important impact both at an individual and at a public health level.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

et al. 2018

View full text Add to dashboard Cite

IntroductionAwareness of HIV‐infection goes beyond diagnosis, and encompasses understanding, acceptance, disclosure and initiation of the HIV‐care. We aimed to characterize the HIV‐positive population that underwent repeat HIV‐testing without disclosing their serostatus and the impact on estimates of the first UNAIDS 90 target.MethodsThis analysis was nested in a prospective cohort established in southern Mozambique which conducted three HIV‐testing modalities: voluntary counselling and testing (VCT), provider‐initiated counselling and testing (PICT) and home‐based testing (HBT). Participants were given the opportunity to self‐report their status to lay counsellors and HIV‐positive diagnoses were verified for previous enrolment in care. This study included 1955 individuals diagnosed with HIV through VCT/PICT and 11,746 participants of a HBT campaign. Those who did not report their serostatus prior to testing, and were found to have a previous HIV‐diagnosis, were defined as non‐disclosures. Venue‐stratified descriptive analyses were performed and factors associated with non‐disclosure were estimated through log‐binomial regression.ResultsIn the first round of 2500 adults randomized for HBT, 1725 were eligible for testing and 18.7% self‐reported their HIV‐positivity. Of those tested with a positive result, 38.9% were found to be non‐disclosures. Similar prevalence of non‐disclosures was found in clinical‐testing modalities, 29.4% (95% CI 26.7 to 32.3) for PICT strategy and 13.0% (95% CI 10.9 to 15.3) for VCT. Prior history of missed visits (adjusted prevalence ratio (APR) 4.2, 95% CI 2.6 to 6.8), younger age (APR 2.5, 95% CI 1.4 to 4.4) and no prior history of treatment ((APR) 1.4, 95% CI 1.0 to 2.1) were significantly associated with non‐disclosure as compared to patients who self‐reported. When considering non‐disclosures as people living with HIV (PLWHIV) aware of their HIV‐status, the proportion of PLWHIV aware increased from 78.3% (95% CI 74.2 to 81.6) to 86.8% (95% CI 83.4 to 89.6).ConclusionMore than one‐third of individuals testing HIV‐positive did not disclose their previous positive HIV‐diagnosis to counsellors. This proportion varied according to testing modality and age. In the absence of an efficient and non‐anonymous tracking system for HIV‐testers, repeat testing of non‐disclosures leads to wasted resources and may distort programmatic indicators. Developing interventions that ensure appropriate psychosocial support are needed to encourage this population to disclose their status and optimize scarce resources.

show abstract

Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

et al. 2018

View full text Add to dashboard Cite

show abstract

“…To explore observed heterogeneity in preferences, the model examined interaction effects between the attributes, the countries, and socio-demographic and HIV-related variables. Sex and age were included to understand the systematic failure to link and underutilization of HIV services among men, young and old groups (6,(19)(20)(21). We evaluated the effect of direct/indirect costs as a demand-side barrier (21)(22)(23)(24) to linkage to care by including a proxy for household socioeconomic status (25).…”

Section: Discussionmentioning

confidence: 99%

Preferences for linkage to HIV care services following a reactive self-test

d’Elbée

Indravudh

Mwenge

et al. 2018

Aids

View full text Add to dashboard Cite

show abstract

“…18,40−45 However, other reports showed high linkage-to-care proportions for HBT (47.5-70.0%). [46][47][48][49][50] Although de nitions of linkage to care were inconsistent in the literature, Kiene et al highlighted an obvious but important trend: HBT programs that facilitate linkage perform better than those that do not. 51 Sharma et al's systematic review of 126 studies con rmed this trend, showing high linkages to care for strategies that facilitated linkages.…”

Section: Discussionmentioning

confidence: 99%

Costs and Cost-Effectiveness of HIV Counselling and Testing Modalities in Southern Mozambique

Choo

López-Varela

Fuente-Soro

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective: Despite the high HIV associated burden, Mozambique lacks data on HIV counselling and testing (HCT) costs. To help guide national HIV/AIDS programs, we estimated the cost per test for voluntary counselling and testing (VCT) from the patient’s perspective and the costs per person tested and per HIV-positive individual linked to care to the healthcare provider for VCT, provider-initiated counselling and testing (PICT) and home-based testing (HBT). We also assessed the cost-effectiveness of these strategies for linking patients to care.Methods: Data from a cohort study conducted in the Manhiça District were used to derive costs and linkage-to-care outcomes of the three HCT strategies. A decision tree was used to model HCT costs according to the likelihood of HCT linking individuals to care and to obtain the incremental cost-effectiveness ratios (ICERs) of PICT and HBT with VCT as the comparator. Sensitivity analyses were performed to assess robustness of base-case findings. Findings: Average and median VCT costs to the patient per individual tested were US$1.34 and US$1.08, respectively. Costs per individual tested were greatest for HBT (US$11.07), followed by VCT (US$7.79), and PICT (US$7.14). The costs per HIV-positive individual linked to care followed a similar trend. PICT was not cost-effective in comparison with VCT at a willingness-to-accept threshold of US$4.53, but only marginally given a corresponding base-case ICER of US$4.15, while HBT was dominated, with higher costs and lower impact than VCT. Base-case results for the comparison between PICT and VCT presented great uncertainty, whereas findings for HBT were robust.Conclusion: PICT and VCT are likely equally cost-effective in Manhiça. We recommend that VCT be offered as the predominant HCT strategy in Mozambique, but expansion of PICT could be considered in limited-resource areas. HBT without facilitated linkage or reduced costs is unlikely to be cost-effective.

show abstract

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

Cited by 28 publications

References 26 publications

Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

Preferences for linkage to HIV care services following a reactive self-test

Costs and Cost-Effectiveness of HIV Counselling and Testing Modalities in Southern Mozambique

Contact Info

Product

Resources

About