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 counselling 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.
Overall, 41% of household members were tested for HIV. This
included 58% in the home-based arm and 11% in the clinic arm.
After adjusting for potentially confounding factors, the
investigators found that household members of patients receiving home-based
care were significantly more likely to test for HIV (adjusted odds ration,
10.41; 95% CI: 7.89-13.73, p < 0.001).
Moreover, they found that 89% of household members who were
present at the time of a home visit accepted the offer of an HIV test.
Closer analysis of the home arm household member data showed
that they were less likely to have an HIV test if their HIV-positive housemate
had a CD4 cell count above 200 cells/mm3 (p = 0.012). Individuals in
the 15-24 age group were less likely to be tested than those in other age
strata, but women were more likely to test than men.
A CD4 cell count below 50 cells/mm3 or above 200
cells/mm3 for patients in the clinic arm was associated with reduced
likelihood of testing by household members. Once again, those aged 15-24 were
the least likely to test (p < 0. 001).
The investigators estimated that 18% of household members of
patients in the clinic arm were HIV-positive compared to 7% of those in the home
A total of 148 spouses of HIV-positive patients were tested,
and 69 (47%) were found to be HIV-negative.
The researchers calculated that they diagnosed 55% of all
HIV-positive household members in the home arm compared to 27% in the clinic arm.
“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
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 where
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.”