Is Home-based HIV Testing Universally Acceptable? Findings from a Case-control Study Nested Within the HPTN 071 (PopART) Trial

Overview

Journal Trop Med Int Health

Specialties Public Health
Tropical Medicine

Date 2018 Apr 3

PMID 29608231

Citations 4

Authors

K Sabapathy

C Mulubwa

H Mathema

C Mubekapi-Musadaidzwa

A Schaap

G Hoddinott

J Hargreaves

S Floyd

H Ayles

R Hayes

Affiliations

Soon will be listed here.

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.

Citing Articles

Zambia's battle against cholera outbreaks and the path to public health resilience: a narrative review.

Gulumbe B, Chishimba K, Shehu A, Chibwe M J Water Health. 2024; 22(12):2257-2275.

PMID: 39733354 DOI: 10.2166/wh.2024.094.

Progress towards controlling the HIV epidemic in urban Ethiopia: Findings from the 2017-2018 Ethiopia population-based HIV impact assessment survey.

Lulseged S, Melaku Z, Habteselassie A, West C, Gelibo T, Belete W PLoS One. 2022; 17(2):e0264441.

PMID: 35213668 PMC: 8880883. DOI: 10.1371/journal.pone.0264441.

Intimate Partner Violence (IPV) and Associated Factors in HPTN 071 (PopART) Study Communities in Zambia and South Africa-A Comparison by HIV Status.

Sabapathy K, Stockl H, Mulubwa C, Mubekapi-Musadaidzwa C, Hoddinott G, Floyd S AIDS Behav. 2022; 26(5):1355-1365.

PMID: 35165795 PMC: 9001629. DOI: 10.1007/s10461-021-03492-6.

Enthusiasm for Introducing and Integrating HIV Self-Testing but Doubts About Users: A Baseline Qualitative Analysis of Key Stakeholders' Attitudes and Perceptions in Côte d'Ivoire, Mali and Senegal.

Ky-Zerbo O, Desclaux A, Kouadio A, Rouveau N, Vautier A, Sow S Front Public Health. 2021; 9:653481.

PMID: 34733811 PMC: 8558355. DOI: 10.3389/fpubh.2021.653481.

References

Hayes R, Floyd S, Schaap A, Shanaube K, Bock P, Sabapathy K . A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial. PLoS Med. 2017; 14(5):e1002292. PMC: 5412988. DOI: 10.1371/journal.pmed.1002292. View

Sharma M, Ying R, Tarr G, Barnabas R . Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015; 528(7580):S77-85. PMC: 4778960. DOI: 10.1038/nature16044. View

Sabapathy K, Van den Bergh R, Fidler S, Hayes R, Ford N . Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2012; 9(12):e1001351. PMC: 3514284. DOI: 10.1371/journal.pmed.1001351. View

Lundgren J, Babiker A, Gordin F, Emery S, Grund B, Sharma S . Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015; 373(9):795-807. PMC: 4569751. DOI: 10.1056/NEJMoa1506816. View

Danel C, Moh R, Gabillard D, Badje A, Le Carrou J, Ouassa T . A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa. N Engl J Med. 2015; 373(9):808-22. DOI: 10.1056/NEJMoa1507198. View

Cori A, Ayles H, Beyers N, Schaap A, Floyd S, Sabapathy K . HPTN 071 (PopART): a cluster-randomized trial of the population impact of an HIV combination prevention intervention including universal testing and treatment: mathematical model. PLoS One. 2014; 9(1):e84511. PMC: 3893126. DOI: 10.1371/journal.pone.0084511. View

Weine S, Kashuba A . Labor migration and HIV risk: a systematic review of the literature. AIDS Behav. 2012; 16(6):1605-21. PMC: 3780780. DOI: 10.1007/s10461-012-0183-4. View

Lugada E, Levin J, Abang B, Mermin J, Mugalanzi E, Namara G . 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. 2010; 55(2):245-52. DOI: 10.1097/QAI.0b013e3181e9e069. View

Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N . Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365(6):493-505. PMC: 3200068. DOI: 10.1056/NEJMoa1105243. View

10.

Naik R, Tabana H, Doherty T, Zembe W, Jackson D . Client characteristics and acceptability of a home-based HIV counselling and testing intervention in rural South Africa. BMC Public Health. 2012; 12:824. PMC: 3487909. DOI: 10.1186/1471-2458-12-824. View

11.

Iwuji C, Orne-Gliemann J, Larmarange J, Okesola N, Tanser F, Thiebaut R . Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial. PLoS Med. 2016; 13(8):e1002107. PMC: 4978506. DOI: 10.1371/journal.pmed.1002107. View

12.

Suthar A, Ford N, Bachanas P, Wong V, Rajan J, Saltzman A . Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med. 2013; 10(8):e1001496. PMC: 3742447. DOI: 10.1371/journal.pmed.1001496. View

13.

Hayes R, Ayles H, Beyers N, Sabapathy K, Floyd S, Shanaube K . HPTN 071 (PopART): rationale and design of a cluster-randomised trial of the population impact of an HIV combination prevention intervention including universal testing and treatment - a study protocol for a cluster randomised trial. Trials. 2014; 15:57. PMC: 3929317. DOI: 10.1186/1745-6215-15-57. View

14.

Granich R, Gilks C, Dye C, De Cock K, Williams B . Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2008; 373(9657):48-57. DOI: 10.1016/S0140-6736(08)61697-9. View

15.

Helleringer S, Kohler H, Frimpong J, Mkandawire J . Increasing uptake of HIV testing and counseling among the poorest in sub-Saharan countries through home-based service provision. J Acquir Immune Defic Syndr. 2009; 51(2):185-93. PMC: 3068048. DOI: 10.1097/QAI.0b013e31819c1726. View