Home-Based Versus Mobile Clinic HIV Testing and Counseling in Rural Lesotho: A Cluster-Randomized Trial


Background:
The success of HIV programs relies on widely accessible HIV testing and counseling (HTC) services at health facilities as well as in the community. Home-based HTC (HB-HTC) is a popular community-based approach to reach persons who do not test at health facilities. Data comparing HB-HTC to other community-based HTC approaches are very limited. This trial compares HB-HTC to mobile clinic HTC (MC-HTC).

Methods and Findings:
The trial was powered to test the hypothesis of higher HTC uptake in HB-HTC campaigns than in MC-HTC campaigns. Twelve clusters were randomly allocated to HB-HTC or MC-HTC. The six clusters in the HB-HTC group received 30 1-d multi-disease campaigns (five villages per cluster) that delivered services by going door-to-door, whereas the six clusters in MC-HTC group received campaigns involving community gatherings in the 30 villages with subsequent service provision in mobile clinics. Time allocation and human resources were standardized and equal in both groups. All individuals accessing the campaigns with unknown HIV status or whose last HIV test was >12 wk ago and was negative were eligible. All outcomes were assessed at the individual level. Statistical analysis used multivariable logistic regression. Odds ratios and p-values were adjusted for gender, age, and cluster effect.

Out of 3,197 participants from the 12 clusters, 2,563 (80.2%) were eligible (HB-HTC: 1,171; MC-HTC: 1,392). The results for the primary outcomes were as follows. Overall HTC uptake was higher in the HB-HTC group than in the MC-HTC group (92.5% versus 86.7%; adjusted odds ratio [aOR]: 2.06; 95% CI: 1.18–3.60; p = 0. 011). Among adolescents and adults ≥12 y, HTC uptake did not differ significantly between the two groups; however, in children <12 y, HTC uptake was higher in the HB-HTC arm (87.5% versus 58.7%; aOR: 4.91; 95% CI: 2.41–10.0; p<0.001). Out of those who took up HTC, 114 (4.9%) tested HIV-positive, 39 (3.6%) in the HB-HTC arm and 75 (6.2%) in the MC-HTC arm (aOR: 0.64; 95% CI: 0.48–0.86; p = 0.002). Ten (25.6%) and 19 (25.3%) individuals in the HB-HTC and in the MC-HTC arms, respectively, linked to HIV care within 1 mo after testing positive. Findings for secondary outcomes were as follows: HB-HTC reached more first-time testers, particularly among adolescents and young adults, and had a higher proportion of men among participants. However, after adjusting for clustering, the difference in male participation was not significant anymore.

Age distribution among participants and immunological and clinical stages among persons newly diagnosed HIV-positive did not differ significantly between the two groups. Major study limitations included the campaigns' restriction to weekdays and a relatively low HIV prevalence among participants, the latter indicating that both arms may have reached an underexposed population.

Conclusions:
This study demonstrates that both HB-HTC and MC-HTC can achieve high uptake of HTC. The choice between these two community-based strategies will depend on the objective of the activity: HB-HTC was better in reaching children, individuals who had never tested before, and men, while MC-HTC detected more new HIV infections. The low rate of linkage to care after a positive HIV test warrants future consideration of combining community-based HTC approaches with strategies to improve linkage to care for persons who test HIV-positive.

Trial registration:
ClinicalTrials.gov NCT01459120

Please see later in the article for the Editors' Summary


Vyšlo v časopise: Home-Based Versus Mobile Clinic HIV Testing and Counseling in Rural Lesotho: A Cluster-Randomized Trial. PLoS Med 11(12): e32767. doi:10.1371/journal.pmed.1001768
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pmed.1001768

Souhrn

Background:
The success of HIV programs relies on widely accessible HIV testing and counseling (HTC) services at health facilities as well as in the community. Home-based HTC (HB-HTC) is a popular community-based approach to reach persons who do not test at health facilities. Data comparing HB-HTC to other community-based HTC approaches are very limited. This trial compares HB-HTC to mobile clinic HTC (MC-HTC).

Methods and Findings:
The trial was powered to test the hypothesis of higher HTC uptake in HB-HTC campaigns than in MC-HTC campaigns. Twelve clusters were randomly allocated to HB-HTC or MC-HTC. The six clusters in the HB-HTC group received 30 1-d multi-disease campaigns (five villages per cluster) that delivered services by going door-to-door, whereas the six clusters in MC-HTC group received campaigns involving community gatherings in the 30 villages with subsequent service provision in mobile clinics. Time allocation and human resources were standardized and equal in both groups. All individuals accessing the campaigns with unknown HIV status or whose last HIV test was >12 wk ago and was negative were eligible. All outcomes were assessed at the individual level. Statistical analysis used multivariable logistic regression. Odds ratios and p-values were adjusted for gender, age, and cluster effect.

Out of 3,197 participants from the 12 clusters, 2,563 (80.2%) were eligible (HB-HTC: 1,171; MC-HTC: 1,392). The results for the primary outcomes were as follows. Overall HTC uptake was higher in the HB-HTC group than in the MC-HTC group (92.5% versus 86.7%; adjusted odds ratio [aOR]: 2.06; 95% CI: 1.18–3.60; p = 0. 011). Among adolescents and adults ≥12 y, HTC uptake did not differ significantly between the two groups; however, in children <12 y, HTC uptake was higher in the HB-HTC arm (87.5% versus 58.7%; aOR: 4.91; 95% CI: 2.41–10.0; p<0.001). Out of those who took up HTC, 114 (4.9%) tested HIV-positive, 39 (3.6%) in the HB-HTC arm and 75 (6.2%) in the MC-HTC arm (aOR: 0.64; 95% CI: 0.48–0.86; p = 0.002). Ten (25.6%) and 19 (25.3%) individuals in the HB-HTC and in the MC-HTC arms, respectively, linked to HIV care within 1 mo after testing positive. Findings for secondary outcomes were as follows: HB-HTC reached more first-time testers, particularly among adolescents and young adults, and had a higher proportion of men among participants. However, after adjusting for clustering, the difference in male participation was not significant anymore.

Age distribution among participants and immunological and clinical stages among persons newly diagnosed HIV-positive did not differ significantly between the two groups. Major study limitations included the campaigns' restriction to weekdays and a relatively low HIV prevalence among participants, the latter indicating that both arms may have reached an underexposed population.

Conclusions:
This study demonstrates that both HB-HTC and MC-HTC can achieve high uptake of HTC. The choice between these two community-based strategies will depend on the objective of the activity: HB-HTC was better in reaching children, individuals who had never tested before, and men, while MC-HTC detected more new HIV infections. The low rate of linkage to care after a positive HIV test warrants future consideration of combining community-based HTC approaches with strategies to improve linkage to care for persons who test HIV-positive.

Trial registration:
ClinicalTrials.gov NCT01459120

Please see later in the article for the Editors' Summary


Zdroje

1. Joint United Nations Programme on HIV/AIDS (2010) Getting to zero: 2011–2015 strategy. Geneva: Joint United Nations Programme on HIV/AIDS.

2. Joint United Nations Programme on HIV/AIDS (2012) UNAIDS report on the global AIDS epidemic 2012. Geneva: Joint United Nations Programme on HIV/AIDS.

3. 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.

4. FonnerVA, DenisonJ, KennedyCE, O'ReillyK, SweatM (2012) Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries. Cochrane Database Syst Rev 9: CD001224.

5. CohenMS, ChenYQ, McCauleyM, GambleT, HosseinipourMC, et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365: 493–505.

6. KieneSM, BateganyaM, WanyenzeR, LuleH, NantabaH, et al. (2010) Initial outcomes of provider-initiated routine HIV testing and counseling during outpatient care at a rural Ugandan hospital: risky sexual behavior, partner HIV testing, disclosure, and HIV care seeking. AIDS Patient Care STDS 24: 117–126.

7. ChirawuP, LanghaugL, MavhuW, PascoeS, DirawoJ, et al. (2010) Acceptability and challenges of implementing voluntary counselling and testing (VCT) in rural Zimbabwe: evidence from the Regai Dzive Shiri Project. AIDS Care 22: 81–88.

8. SnowRC, MadalaneM, PoulsenM (2010) Are men testing? Sex differentials in HIV testing in Mpumalanga Province, South Africa. AIDS Care 22: 1060–1065.

9. BwambaleFM, SsaliSN, ByaruhangaS, KalyangoJN, KaramagiCA (2008) Voluntary HIV counselling and testing among men in rural western Uganda: implications for HIV prevention. BMC Public Health 8: 263.

10. BaidenF, AkanluG, HodgsonA, AkweongoP, DebpuurC, et al. (2007) Using lay counsellors to promote community-based voluntary counselling and HIV testing in rural northern Ghana: a baseline survey on community acceptance and stigma. J Biosoc Sci 39: 721–733.

11. 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.

12. SutharAB, FordN, BachanasPJ, WongVJ, RajanJS, et al. (2013) Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med 10: e1001496.

13. Rausch D, Gray G, Celentano D, Chariyalertsak S (2013) Mobile versus clinic-based HIV testing: results of the Project Accept RCT [presentation]. 7th Conference on HIV Pathogenesis, Treatment and Prevention; 30 Jun–3 July 2013; Kuala Lumpur, Malaysia. Available: http://pag.ias2013.org/session.aspx?s=79. Accessed 19 November 2014.

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 7 November 2014.

15. SabapathyK, Van den BerghR, FidlerS, HayesR, FordN (2012) Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med 9: e1001351.

16. 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.

17. 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.

18. NjauB, WattMH, OstermannJ, ManongiR, SikkemaKJ (2012) Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania. AIDS Care 24: 413–419.

19. DohertyT, TabanaH, JacksonD, NaikR, ZembeW, et al. (2013) Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial. BMJ 346: f3481.

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

21. 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.

22. 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.

23. BateganyaM, AbdulwadudOA, KieneSM (2010) Home-based HIV voluntary counselling and testing (VCT) for improving uptake of HIV testing. Cochrane Database Syst Rev 2010: CD006493.

24. Lesotho Ministry of Health and Social Welfare (2010) Lesotho Demographic and Health Survey 2009. Available: http://www.measuredhs.com/publications/publication-fr241-dhs-final-reports.cfm. Accessed 7 November 2014.

25. Lesotho Ministry of Health and Social Welfare (2012) LESOTHO—global AIDS response country progress report. January 2010–December 2011. Available: http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_LS_Narrative_Report%5B1%5D.pdf. Accessed 7 November 2014.

26. Lesotho Ministry of Health and Social Welfare (2008) The know your status campaign review report: 13 March–4 April 2008. Available: http://www.aidstar-one.com/sites/default/files/Lesotho%20Min%20of%20Soc%20Welfare%20Know%20Your%20Status%20Report.pdf). Accessed 7 November 2014.

27. Lesotho Ministry of Health and Social Welfare (2009) National guidelines for HIV testing and counselling. Maseru: Lesotho Ministry of Health and Social Welfare.

28. HayesRJ, BennettS (1999) Simple sample size calculation for cluster-randomized trials. Int J Epidemiol 28: 319–326.

29. 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.

30. KranzerK, van SchaikN, KarmueU, MiddelkoopK, SebastianE, et al. (2011) High prevalence of self-reported undiagnosed HIV despite high coverage of HIV testing: a cross-sectional population based sero-survey in South Africa. PLoS ONE 6: e25244.

31. KranzerK, GovindasamyD, van SchaikN, ThebusE, DaviesN, et al. (2012) Incentivized recruitment of a population sample to a mobile HIV testing service increases the yield of newly diagnosed cases, including those in need of antiretroviral therapy. HIV Med 13: 132–137.

32. BassettI, ReganS, LuthuliP, MbonambiH, BearnotB, et al. (2014) Linkage to care following community-based mobile HIV testing compared with clinic-based testing in Umlazi Township, Durban, South Africa. HIV Med 15: 367–372.

33. GovindasamyD, KranzerK, van SchaikN, NoubaryF, WoodR, et al. (2013) Linkage to HIV, TB and non-communicable disease care from a mobile testing unit in Cape Town, South Africa. PLoS ONE 8: e80017.

34. van RooyenH, McGrathN, ChirowodzaA, JosephP, FiammaA, et al. (2013) Mobile VCT: reaching men and young people in urban and rural South African pilot studies (NIMH Project Accept, HPTN 043). AIDS Behav 17: 2946–2953.

35. HoodJE, MacKellarD, SpauldingA, NelsonR, MosiakgaboB, et al. (2012) Client characteristics and gender-specific correlates of testing HIV positive: a comparison of standalone center versus mobile outreach HIV testing and counseling in Botswana. AIDS Behav 16: 1902–1916.

36. MeekersD (2000) Going underground and going after women: trends in sexual risk behaviour among gold miners in South Africa. Int J STD AIDS 11: 21–26.

37. van RooyenH, BarnabasRV, BaetenJM, PhakathiZ, JosephP, et al. (2013) High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr 64: e1–e8.

38. GovindasamyD, van SchaikN, KranzerK, WoodR, MathewsC, et al. (2011) Linkage to HIV care from a mobile testing unit in South Africa by different CD4 count strata. J Acquir Immune Defic Syndr 58: 344–352.

39. HatcherAM, TuranJM, LeslieHH, KanyaLW, KwenaZ, et al. (2012) Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya. AIDS Behav 16: 1295–1307.

40. World Health Organization (2013) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Available: http://www.who.int/hiv/pub/guidelines/arv2013/en/. Accessed 7 November 2014.

41. MaherD (2013) The ethics of feedback of HIV test results in population-based surveys of HIV infection. Bull World Health Organ 91: 950–956.

42. GiraudeauB, RavaudP (2009) Preventing bias in cluster randomised trials. PLoS Med 6: e1000065.

43. TabanaH, DohertyT, SwanevelderS, LombardC, JacksonD, et al. (2012) Knowledge of HIV status prior to a community HIV counseling and testing intervention in a rural district of South Africa: results of a community based survey. BMC Infect Dis 12: 73.

44. PeltzerK, MatsekeG, MzoloT, MajajaM (2009) Determinants of knowledge of HIV status in South Africa: results from a population-based HIV survey. BMC Public Health 9: 174.

45. ChamieG, KwarisiimaD, ClarkTD, KabamiJ, JainV, et al. (2012) Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda. PLoS ONE 7: e43400.

46. GovindasamyD, MeghijJ, Kebede NegussiE, Clare BaggaleyR, FordN, et al. (2014) Interventions to improve or facilitate linkage to or retention in pre-ART (HIV) care and initiation of ART in low- and middle-income settings—a systematic review. J Int AIDS Soc 17: 19032.

47. Joint United Nations Programme on HIV/AIDS (2014) 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Available: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Accessed 7 November 2014.

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