Michael Carter for Aidsmap (25 August 2010)
Household members of HIV-positive individuals are more likely to test for the virus if their housemate is receiving home rather than clinic-based antiretroviral therapy, a Ugandan study has shown.
Published in the online edition of the Journal of Acquired Immune Deficiency Syndromes, the research indicated that 58% of household members of patients receiving home-based care were tested for HIV compared to just 11% of those living with patients who received their care at a clinic.
Voluntary counseling and testing (VCT) is the gateway to HIV treatment and care. However, most HIV infections in Africa are undiagnosed.
Novel ways of encouraging VCT are therefore needed. Investigators wished to see if providing free, home-based testing to the household members of patients receiving antiretroviral therapy boosted testing levels. Their study sample included 7184 household members of patients who were receiving either home- or clinic-based antiretroviral therapy in Jinja, Uganda.
Household members in the home-based arm were offered an HIV test when support workers visited the HIV-infected individual. Individuals living with patients in the clinic-based arm were given vouchers and encouraged to attend the clinic for a free and confidential HIV test.
“HIV testing offered at home to household members of HIV-infected adults initiating ART [antiretroviral therapy] was associated with a 10-fold increased likelihood of testing compared with HIV testing offered at clinics. Acceptance of home-based HIV testing was very high”, comment the investigators.
However, providing home testing was not without problems. These included the cost of hiring field officers, fuelling and maintaining a fleet of motorcycles “and mobilization of family members at their homes were effects of stigma against HIV/AIDS still persist.”
Nevertheless, these were not insurmountable and the investigators conclude, “home-based testing should be more widely available in Africa and be considered in national policies as a standard practice by health facilities serving populations affected by HIV.”
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 MD, PhD; Levin, Jonathan MSc, PhD; Abang, Betty BFST; Mermin, Jonathan MD, MPH; Mugalanzi, Emmanuel BASoc, Dip. Educ; Namara, Geoffrey BStat; Gupta, Sundeep MD, MPH; Grosskurth, Heiner MD, PhD; Jaffar, Shabbar PhD; Coutinho, Alex MBChB, MSc, MPH; Bunnell, Rebecca PhD, MEd.
Journal of Acquired Immune Deficiency Syndromes online 13 August 2010 doi: 10.1097/QAI.0b013e3181e9e069
Link to JAIDS abstract