HIV testing rate increased if screening offered at home

Michael Carter
Published: 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 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 arm.

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 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 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.”

Reference

Lugada E et al. Comparison of home and clinic-based HIV testing among household members of persons taking antiretroviral therapy in Uganda: results from a randomized trial. J Acquire Immune Defic Syndr, online edition, 2010.