Uptake of Home-Based Voluntary HIV Testing in Sub-Saharan Africa: A Systematic Review and Meta-Analysis


Introduction:
Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.

Methods and Findings:
We conducted a systematic review and random-effects meta-analysis of studies published between 1 January 2000 and 24 September 2012 that reported on uptake of HBT in sub-Saharan Africa, to assess the proportion of individuals accepting HBT and receiving their test result.

Our initial search yielded 1,199 articles; 114 were reviewed as full-text articles, and 19 publications involving 21 studies (n = 524,867 individuals offered HBT) were included for final review and meta-analysis. The studies came from five countries: Uganda, Malawi, Kenya, South Africa, and Zambia.

The proportion of people who accepted HBT (n = 474,377) ranged from 58.1% to 99.8%, with a pooled proportion of 83.3% (95% CI: 80.4%–86.1%). Heterogeneity was high (τ2 = 0.11). Sixteen studies reported on the number of people who received the result of HBT (n = 432,835). The proportion of individuals receiving their results out of all those offered testing ranged from 24.9% to 99.7%, with a pooled proportion of 76.7% (95% CI: 73.4%–80.0%) (τ2 = 0.12). HIV prevalence ranged from 2.9% to 36.5%. New diagnosis of HIV following HBT ranged from 40% to 79% of those testing positive. Forty-eight percent of the individuals offered testing were men, and they were just as likely to accept HBT as women (pooled odds ratio = 0.84; 95% CI: 0.56–1.26) (τ2 = 0.33). The proportion of individuals previously tested for HIV among those offered a test ranged from 5% to 66%. Studies in which <30% of individuals had been previously tested, local HIV prevalence was <10%, incentives were provided, or HBT was offered to household members of HIV-positive individuals showed higher uptake of testing. No evidence was reported of negative consequences of HBT.

Conclusions:
HBT could substantially increase awareness of HIV status in previously undiagnosed individuals in sub-Saharan Africa, with over three-quarters of the studies in this review reporting >70% uptake. It could be a valuable tool for treatment and prevention efforts.



Please see later in the article for the Editors' Summary


Vyšlo v časopise: Uptake of Home-Based Voluntary HIV Testing in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. PLoS Med 9(12): e32767. doi:10.1371/journal.pmed.1001351
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pmed.1001351

Souhrn

Introduction:
Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.

Methods and Findings:
We conducted a systematic review and random-effects meta-analysis of studies published between 1 January 2000 and 24 September 2012 that reported on uptake of HBT in sub-Saharan Africa, to assess the proportion of individuals accepting HBT and receiving their test result.

Our initial search yielded 1,199 articles; 114 were reviewed as full-text articles, and 19 publications involving 21 studies (n = 524,867 individuals offered HBT) were included for final review and meta-analysis. The studies came from five countries: Uganda, Malawi, Kenya, South Africa, and Zambia.

The proportion of people who accepted HBT (n = 474,377) ranged from 58.1% to 99.8%, with a pooled proportion of 83.3% (95% CI: 80.4%–86.1%). Heterogeneity was high (τ2 = 0.11). Sixteen studies reported on the number of people who received the result of HBT (n = 432,835). The proportion of individuals receiving their results out of all those offered testing ranged from 24.9% to 99.7%, with a pooled proportion of 76.7% (95% CI: 73.4%–80.0%) (τ2 = 0.12). HIV prevalence ranged from 2.9% to 36.5%. New diagnosis of HIV following HBT ranged from 40% to 79% of those testing positive. Forty-eight percent of the individuals offered testing were men, and they were just as likely to accept HBT as women (pooled odds ratio = 0.84; 95% CI: 0.56–1.26) (τ2 = 0.33). The proportion of individuals previously tested for HIV among those offered a test ranged from 5% to 66%. Studies in which <30% of individuals had been previously tested, local HIV prevalence was <10%, incentives were provided, or HBT was offered to household members of HIV-positive individuals showed higher uptake of testing. No evidence was reported of negative consequences of HBT.

Conclusions:
HBT could substantially increase awareness of HIV status in previously undiagnosed individuals in sub-Saharan Africa, with over three-quarters of the studies in this review reporting >70% uptake. It could be a valuable tool for treatment and prevention efforts.



Please see later in the article for the Editors' Summary


Zdroje

1. World Health Organization (2011) WHO consultation: the strategic use of antiretrovirals for treatment and prevention of HIV—Geneva, Switzerland, 14–16 November 2011. Executive summary. Available: http://www.who.int/hiv/pub/meetingreports/consultation_20111116.pdf. Accessed 29 October 2012.

2. Joint United Nations Programme on HIV/AIDS (2010) Getting to zero: 2011–2015 strategy. Available: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2010/jc2034_unaids_strategy_en.pdf. Accessed 29 October 2012.

3. De CockKM, BunnellR, MerminJ (2006) Unfinished business—expanding HIV testing in developing countries. N Engl J Med 354: 440–442.

4. WalenskyRP, BassettIV (2011) HIV self-testing and the missing linkage. PLoS Med 8: e1001101 doi:10.1371/journal.pmed.1001101

5. World Health Organization (2011) Global HIV/AIDS response: epidemic update and health sector progress towards universal access—progress report 2011. Available: http://whqlibdoc.who.int/publications/2011/9789241502986_eng.pdf. Accessed 29 October 2012.

6. CherutichP, KaiserR, GalbraithJ, WilliamsonJ, ShiraishiRW, et al. (2012) Lack of knowledge of HIV status a major barrier to HIV prevention, care and treatment efforts in Kenya: results from a nationally representative study. PLoS ONE 7: e36797 doi:10.1371/journal.pone.0036797

7. SweatM, MorinS, CelentanoD, MulawaM, SinghB, et al. (2011) Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. Lancet Infect Dis 11: 525–532.

8. GrabbeKL, MenziesN, TaegtmeyerM, EmukuleG, AngalaP, et al. (2010) Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization, and cost-effectiveness. J Acquir Immune Defic Syndr 54: 317–323.

9. FelleyFG, CollierAC, RichardsSC, Van der BorghtSFM, Rinke de WitTF (2007) A successful workplace program for voluntary counseling and testing and treatment of HIV/AIDS at Heineken, Rwanda. Int J Occup Environ Health 13: 99–106.

10. CorbettEL, DauyaE, MatamboR, CheungYB, MakamureB, et al. (2006) Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe. PLoS Med 3: e238 doi:10.1371/journal.pmed.0030238

11. MatovuJK, MakumbiFE (2007) Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007. Trop Med Int Health 12: 1315–1322.

12. Joint United Nations Programme on HIV/AIDS (2011) How to get to zero: faster. smarter. better. UNAIDS World AIDS Day report. Available: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/JC2216_WorldAIDSday_report_2011_en.pdf. Accessed 29 October 2012.

13. WachiraJ, KimaiyoS, NdegeS, MamlinJ, BraitsteinP (2012) What is the impact of home-based HIV counseling and testing on the clinical status of newly enrolled adults in a large HIV care program in Western Kenya? Clin Infect Dis 54: 275–281.

14. World Health Organization (2012) Planning, implementation and monitoring home-based HIV testing and counselling. A practical handbook for Sub-saharan Africa. Available: http://apps.who.int/iris/bitstream/10665/75366/1/9789241504317_eng.pdf. Accessed 29 October 2012.

15. GanguliI, BassettIV, DongKL, WalenskyRP (2009) Home testing for HIV infection in resource-limited settings. Curr HIV/AIDS Rep 6: 217–223.

16. TuranJM, BukusiEA, OnonoM, HolzemerWL, MillerS, et al. (2011) HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS Behav 15: 1111–1120.

17. Human Rights Watch (2008) A testing challenge: the experience of Lesotho's universal HIV counseling and testing campaign. Available: http://www.hrw.org/sites/default/files/reports/lesotho1108.pdf. Accessed 29 October 2012.

18. StroupDF, BerlinJA, MortonSC, OlkinI, WilliamsonGD, et al. (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283: 2008–2012.

19. Borenstein M, Hedges L, Higgins J, Rothstein H (2009) Introduction to meta-analysis. Chichester (United Kingdom): Wiley. 312 p.

20. FreemanM (1950) Transformations related to the angular and the square root. Ann Inst Stat Math 21: 607–611.

21. RuckerG, SchwarzerG, CarpenterJ, SchumacherM (2008) Undue reliance on I(2) in assessing heterogeneity may mislead. BMC Med Res Methodol 8: 79.

22. MatovuJK, GrayRH, MakumbiF, WawerMJ, SerwaddaD, et al. (2005) Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS 19: 503–511.

23. MutaleW, MicheloC, JurgensenM, FylkesnesK (2010) Home-based voluntary HIV counselling and testing found highly acceptable and to reduce inequalities. BMC Public Health 10: 347.

24. ObareF, FlemingP, AnglewiczP, ThorntonR, MartinsonF, et al. (2009) Acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi. Sex Transm Infect 85: 139–144.

25. VreemanRC, NyandikoWM, BraitsteinP, WereMC, AyayaSO, et al. (2010) Acceptance of HIV testing for children ages 18 months to 13 years identified through voluntary, home-based HIV counseling and testing in western Kenya. J Acquir Immune Defic Syndr 55: e3–e10.

26. AngottiN, BulaA, GaydoshL, KimchiEZ, ThorntonRL, et al. (2009) Increasing the acceptability of HIV counseling and testing with three C's: convenience, confidentiality and credibility. Soc Sci Med 68: 2263–2270.

27. WelzT, HosegoodV, JaffarS, Batzing-FeigenbaumJ, HerbstK, et al. (2007) Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population-based longitudinal study. AIDS 21: 1467–1472.

28. LugadaE, LevinJ, AbangB, MerminJ, MugalanziE, et al. (2010) Comparison of home and clinic-based HIV testing among household members of persons taking antiretroviral therapy in Uganda: results from a randomized trial. J Acquir Immune Defic Syndr 55: 245–252.

29. MatovuJK, KigoziG, NalugodaF, Wabwire-MangenF, GrayRH (2002) The Rakai Project counselling programme experience. Trop Med Int Health 7: 1064–1067.

30. MenziesN, AbangB, WanyenzeR, NuwahaF, MugishaB, et al. (2009) The costs and effectiveness of four HIV counseling and testing strategies in Uganda. AIDS 23: 395–401.

31. SekandiJN, SempeeraH, ListJ, MugerwaMA, AsiimweS, et al. (2011) High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda. BMC Public Health 11: 730.

32. TumwesigyeE, WanaG, KasasaS, MuganziE, NuwahaF (2010) High uptake of home-based, district-wide, HIV counseling and testing in Uganda. AIDS Patient Care STDS 24: 735–741.

33. WereWA, MerminJH, WamaiN, AworAC, BechangeS, et al. (2006) Undiagnosed HIV infection and couple HIV discordance among household members of HIV-infected people receiving antiretroviral therapy in Uganda. J Acquir Immune Defic Syndr 43: 91–95.

34. WolffB, NyanziB, KatongoleG, SsesangaD, RuberantwariA, et al. (2005) Evaluation of a home-based voluntary counselling and testing intervention in rural Uganda. Health Policy Plan 20: 109–116.

35. WereW, MerminJ, BunnellR, EkwaruJP, KaharuzaF (2003) Home-based model for HIV voluntary counselling and testing. Lancet 361: 1569.

36. ChokoAT, DesmondN, WebbEL, ChavulaK, Napierala-MavedzengeS, et al. (2011) The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi. PLoS Med 8: e1001102 doi:10.1371/journal.pmed.1001102

37. HelleringerS, KohlerHP, FrimpongJA, MkandawireJ (2009) Increasing uptake of HIV testing and counseling among the poorest in sub-Saharan countries through home-based service provision. J Acquir Immune Defic Syndr 51: 185–193.

38. KranzerK, McGrathN, SaulJ, CrampinAC, JahnA, et al. (2008) Individual, household and community factors associated with HIV test refusal in rural Malawi. Trop Med Int Health 13: 1341–1350.

39. MolesworthAM, NdhlovuR, BandaE, SaulJ, NgwiraB, et al. (2010) High accuracy of home-based community rapid HIV Testing in rural Malawi. J Acquir Immune Defic Syndr 55: 625–630.

40. KimaiyoS, WereMC, ShenC, NdegeS, BraitsteinP, et al. (2010) Home-based HIV counselling and testing in Western Kenya. East Afr Med J 87: 100–108.

41. NeginJ, WarieroJ, MutuoP, JanS, PronykP (2009) Feasibility, acceptability and cost of home-based HIV testing in rural Kenya. Trop Med Int Health 14: 849–855.

42. ShisanaO, StokerD, SimbayiLC, OrkinM, BezuidenhoutF, et al. (2004) South African national household survey of HIV/AIDS prevalence, behavioural risks and mass media impact—detailed methodology and response rate results. S Afr Med J 94: 283–288.

43. MicheloC, SandoyIF, DzekedzekeK, SiziyaS, FylkesnesK (2006) Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995–2003). BMC Public Health 6: 279.

44. MaheswaranH, ThulareH, StanistreetD, TanserF, NewellML (2012) Starting a home and mobile HIV testing service in a rural area of South Africa. J Acquir Immune Defic Syndr 59: e43–e46.

45. MacphersonP, LallooDG, ChokoAT, MannGH, SquireSB, et al. (2012) Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi. Trop Med Int Health 17: 507–517.

46. NuwahaF, KasasaS, WanaG, MuganziE, TumwesigyeE (2012) Effect of home-based HIV counselling and testing on stigma and risky sexual behaviours: serial cross-sectional studies in Uganda. J Int AIDS Soc 15: 17423.

47. MayM, BoulleA, PhiriS, MessouE, MyerL, et al. (2010) Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet 376: 449–457.

48. MillsEJ, FordN (2012) Home-based HIV counseling and testing as a gateway to earlier initiation of antiretroviral therapy. Clin Infect Dis 54: 282–284.

49. GranichRM, GilksCF, DyeC, De CockKM, WilliamsBG (2009) Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 373: 48–57.

50. HayesR, SabapathyK, FidlerS (2011) Universal testing and treatment as an HIV prevention strategy: research questions and methods. Curr HIV Res 9: 429–445.

51. Barnabas R, Van Rooyen H, Baeten J, Tumwesigye E, Phakathi Z, et al.. (2012) Significant decrease in community viral load six months after a program of home-based HIV counseling and testing and facilitated referral to HIV care in KwaZulu-Natal, South Africa [abstract]. International HIV Treatment as Prevention Workshop; 22–25 April 2012; Vancouver, Canada.

52. BraitsteinP, BoulleA, NashD, BrinkhofMW, DabisF, et al. (2008) Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration. J Womens Health (Larchmt) 17: 47–55.

53. Ochieng-OokoV, OchiengD, SidleJE, HoldsworthM, Wools-KaloustianK, et al. (2010) Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya. Bull World Health Organ 88: 681–688.

54. US Food and Drug Administration (2012) Consumer update: first rapid home-use HIV kit approved for self-testing. Available: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm310545.htm. Accessed 29 October 2012.

Štítky
Interné lekárstvo

Článok vyšiel v časopise

PLOS Medicine


2012 Číslo 12

Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Eozinofilní granulomatóza s polyangiitidou
nový kurz

Betablokátory a Ca antagonisté z jiného úhlu
Autori: prof. MUDr. Michal Vrablík, Ph.D., MUDr. Petr Janský

Autori: doc. MUDr. Petr Čáp, Ph.D.

Farmakoterapie akutní a chronické bolesti

Získaná hemofilie - Povědomí o nemoci a její diagnostika

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Nemáte účet?  Registrujte sa

Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa