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J Acquir Immune Defic Syndr. 2018 Apr 1;77(4):400-404. doi: 10.1097/QAI.0000000000001617.

Brief Report: "Give Me Some Time": Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda.

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Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA.
Department of Medicine, Massachusetts General Hospital Global Health, Harvard Medical School, Boston, MA.
Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.
Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT.



Integrating home-based HIV counseling and testing (HCT) with tuberculosis (TB) evaluation could improve the uptake of HIV testing among household contacts of patients with active TB. We sought to identify the facilitators of and barriers to HCT during household contact investigation for TB in Kampala, Uganda.


We nested semi-structured interviews with 28 household contacts who were offered home-based HCT in a household-randomized trial of home-based strategies for TB contact investigation. Respondents reflected on their experiences of the home visit, the social context of the household, and their decision to accept or decline HIV testing. We used content analysis to identify and evaluate facilitators of and barriers to testing, then categorized the emergent themes using the Capability, Opportunity, Motivation, and Behavior (COM-B) model.


Facilitators included a preexisting desire to confirm HIV status or to show support for the index TB patient; a perception that home-based services are convenient; and positive perceptions of lay health workers. Key barriers included fear of results and feeling psychologically unprepared to receive results. The social influence of other household members operated as both a facilitator and a barrier.


Preexisting motivation, psychological readiness to test, and the social context of the household are major contributors to the decision to test for HIV at home. Uptake might be improved by providing normalizing information about HCT before the visit, by offering a second HCT opportunity, by offering self-tests with follow-up counseling, or by introducing HCT using "opt-out" language.

[Available on 2019-04-01]

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