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Trop Med Int Health. 2018 Jun;23(6):678-690. doi: 10.1111/tmi.13055. Epub 2018 Apr 16.

Is home-based HIV testing universally acceptable? Findings from a case-control study nested within the HPTN 071 (PopART) trial.

Author information

1
London School of Hygiene and Tropical Medicine, London, UK.
2
Zambia AIDS Related TB Project, Lusaka, Zambia.
3
Desmond Tutu TB Centre, Department of Paediatric and Child Health, Stellenbosch University.

Abstract

OBJECTIVE:

The HPTN 071 (PopART) trial is examining the impact of a package including universal testing and treatment on community-level HIV incidence in Zambia and South Africa. We conducted a nested case-control study to examine factors associated with acceptance of home-based HIV testing and counselling (HB-HTC) delivered by community HIV-care providers (CHiPs) in PopART intervention communities.

METHODS:

Of 295 447 individuals who were offered testing, random samples of individuals who declined HB-HTC (cases) and accepted HB-HTC (controls), stratified by gender and community, were selected. Odds ratios comparing cases and controls were estimated using multivariable logistic regression.

RESULTS:

Data from 642 participants (313 cases, 329 controls) were analysed. There were no differences between cases and controls by demographic or behavioural characteristics including age, marital or socio-economic position. Participants who felt they could be open with CHiPs (AOR: 0.46, 95% CI: 0.30-0.71, P < 0.001); self-reported as not previously tested (AOR: 0.64; 95% CI: 0.43-0.95, P = 0.03); considered HTC at home to be convenient (AOR: 0.38, 95% CI: 0.27-0.54, P = 0.001); knowing others who had accepted HB-HTC from the CHiPs (AOR: 0.49, 95% CI: 0.31-0.77, P = 0.002); or were motivated to get treatment without delay (AOR: 0.60, 95% CI: 0.43-0.85, P = 0.004) were less likely to decline the offer of HB-HCT. Those who self-reported high-risk sexual behaviour were also less likely to decline HB-HCT (AOR: 0.61, 95% CI: 0.39-0.93, P = 0.02). Having stigmatising attitudes about HB-HTC was not an important barrier to HB-HCT uptake. Men who reported fear of HIV were more likely to decline HB-HCT (AOR: 2.68, 95% CI: 1.33-5.38, P = 0.005).

CONCLUSION:

Acceptance of HB-HTC was associated with lack of previous HIV testing, positive attitudes about HIV services/treatment and perception of high sexual risk. Uptake of HB-HCT among those offered it was similar across a range of demographic and behavioural subgroups suggesting it was 'universally' acceptable.

KEYWORDS:

Afrique subsaharienne; case-control study; dépistage du VIH à domicile; dépistage et traitement universels; home-based HIV testing; sub-Saharan Africa; universal test and treat; étude cas-témoins

PMID:
29608231
PMCID:
PMC6001569
DOI:
10.1111/tmi.13055
[Indexed for MEDLINE]
Free PMC Article

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