Uptake of Workplace HIV Counselling and Testing: A Cluster-Randomised Trial in Zimbabwe

Abstract

BackgroundHIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT).Methods and FindingsThe study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees.HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8).ConclusionsHigh-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.

Acceptability and challenges of implementing voluntary counselling and testing (VCT) in rural Zimbabwe: evidence from the Regai Dzive Shiri Project

“…Several studies in Zimbabwe have demonstrated failure of participants to access VCT when remote from the research setting. In a study where workplaces were randomised to either onsite VCT or vouchers for offsite testing, there was 51.1% uptake when VCT was offered onsite compared to 19.2% when offered offsite (Corbett et al, 2006). Offering VCT at the survey site did not add substantially to our research costs.…”

Who to test and how to test for chronic hepatitis C infection – 2016 WHO testing guidance for low- and middle-income countries

“…The self-testing approach offers distinct advantages. By giving people the opportunity to test discreetly and conveniently, self-testing may increase the uptake of testing among people not reached by other existing testing services many whom are first-time testers [204][205][206][207]. The experience with hepatitis self-testing is currently very limited, but it represents a potentially important approach to expand access to hepatitis testing in the future.…”

An overview of HIV/AIDS workplace policies and programmes in southern Africa

“…Other factors associated with improved uptake include personal or professional interaction with an individual living with HIV/AIDS and having the choice to undergo VCTat the workplace or an offsite location [29,30]. In a study randomly assigning small and medium-sized companies in Zimbabwe to either on-site rapid HIV testing or vouchers for off-site VCT at a chain of freestanding centers, the mean uptake of workplace VCT by site was 51.1% compared with 19.2% mean uptake of offsite VCT over 2 years [34].…”