Test for Triage: A New Approach to Community-based HIV Testing and Counselling

Purpose Community-based HIV testing and counselling (HTC) has been recommended for improving access to prevention, care, and treatment services in at-risk populations. Earlier systematic reviews and meta-analyses have been undertaken, but due to some methodological limitations, their findings do not yet provide a practical significance. The purpose of this paper is to re-examine the recent evidence of the efficacy of community-based HTC approaches on the uptake of HTC in at-risk populations. Design/methodology/approach The database of PubMed online, Science Direct, the Lancet Global Health, the Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to obtain empirical papers published between March 2013 and December 2015. Findings Of 600 collected papers, there were 6 cluster randomized trials papers which met the inclusion criteria. Compared to the health facilities-based HTC, community-based HTC approaches have been shown to improve the uptake of HIV testing from 5.8 to 37 per cent, and improve HIV testing in men and their partners together from 6.8 to 34 per cent. The community approaches also detected lower HIV-positive cases (0.29 per cent as compared to 4 per cent), improved access to treatment services from 0.3 to 25 per cent, demonstrated higher cluster differentiation 4 count in newly diagnosed patients (median of 400-438 cells/µl), and increased the rate of first-time HIV testing from 9 to 11.8 per cent. With respect to social and behavioural outcomes, community-based HTC increased social norms for HIV testing by 6 per cent (95 per cent CI 3-9), decreased multiple sex partners by 55 per cent (95 per cent CI 42-73), lowered casual sex by 45 per cent (95 per cent CI 33-62), increased knowledge about HIV (83.2 vs 28.9 per cent), improved positive attitudes towards HIV patients (73.0 vs 34.3 per cent), and increased the use of condoms (28.0 vs 12.3 per cent). Originality/value Community-based HTC combined with behavioural interventions have been found to be more effective in increasing the uptake of HIV testing as well as other outcomes as compared to the conventional health facilities-based testing and counselling approaches.

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Challenges to community-based voluntary HIV testing and counselling

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(11)70343-7 ◽

2012 ◽

Vol 12 (1) ◽

pp. 10-11 ◽

Cited By ~ 1

Author(s):

April L Buscher

Keyword(s):

Hiv Testing ◽

Community Based ◽

Hiv Testing And Counselling

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Towards Universal Voluntary HIV Testing and Counselling: A Systematic Review and Meta-Analysis of Community-Based Approaches

PLoS Medicine ◽

10.1371/journal.pmed.1001496 ◽

2013 ◽

Vol 10 (8) ◽

pp. e1001496 ◽

Cited By ~ 229

Author(s):

Amitabh B. Suthar ◽

Nathan Ford ◽

Pamela J. Bachanas ◽

Vincent J. Wong ◽

Jay S. Rajan ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Meta Analysis ◽

Community Based ◽

Hiv Testing And Counselling

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Social Influence and Uptake of Couples HIV Testing and Counselling in KwaZulu-Natal, South Africa

AIDS and Behavior ◽

10.1007/s10461-021-03435-1 ◽

2021 ◽

Author(s):

Matthew J. Johnson ◽

Lynae A. Darbes ◽

Victoria Hosegood ◽

Mallory O. Johnson ◽

Katherine Fritz ◽

...

Keyword(s):

Hiv Testing ◽

Peer Support ◽

Social Influences ◽

Controlled Trial ◽

Secondary Analysis ◽

Sub Saharan Africa ◽

Survival Models ◽

Hiv Testing And Counselling ◽

Randomised Controlled ◽

Support Score

AbstractSocial influences may create a barrier to couples HIV testing and counselling (CHTC) uptake in sub-Saharan Africa. This secondary analysis of data collected in the ‘Uthando Lwethu’ randomised controlled trial used discrete-time survival models to evaluate the association between within-couple average ‘peer support’ score and uptake of CHTC by the end of nine months’ follow-up. Peer support was conceptualised by self-rated strength of agreement with two statements describing friendships outside of the primary partnership. Eighty-eight couples (26.9%) took up CHTC. Results tended towards a dichotomous trend in models adjusted only for trial arm, with uptake significantly less likely amongst couples in the higher of four peer support score categories (OR 0.34, 95% CI 0.18, 0.68 [7–10 points]; OR 0.53, 95% CI 0.28, 0.99 [≥ 11 points]). A similar trend remained in the final multivariable model, but was no longer significant (AOR 0.59, 95% CI 0.25, 1.42 [7–10 points]; AOR 0.88, 95% CI 0.36, 2.10 [≥ 11 points]). Accounting for social influences in the design of couples-focused interventions may increase their success.

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Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018

BMC Public Health ◽

10.1186/s12889-021-10472-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aimé Bitakuya Heri ◽

Francesca L. Cavallaro ◽

Nurilign Ahmed ◽

Maurice Mubuyaeta Musheke ◽

Mitsuaki Matsui

Keyword(s):

Pregnant Women ◽

Hiv Testing ◽

Health Surveys ◽

Health Centre ◽

Demographic And Health Surveys ◽

Common Source ◽

Cross Sectional ◽

Government Health ◽

Hiv Testing And Counselling ◽

Testing Uptake

Abstract Introduction Zambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth. Methods We carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013–14, and 2018). We calculated the percentage of women and men ages 15–24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months. Results HIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20–24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30–1.84], among men; and aOR = 1.74 [1.40–2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32–1.88]) and in a union (aOR = 2.44 [1.83–3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82–17.19]). Education-based inequity was considerably widened among women than men by 2018. Conclusion HTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.

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REACHING THE UNREACHED: UNIVERSAL ACCESS TO HIV TESTING FOR PREGNANT WOMEN THROUGH COMMUNITY BASED TESTING IN WEST BENGAL, INDIA

10.36106/7012560 ◽

2021 ◽

pp. 14-16

Author(s):

Suman Ganguly ◽

Debjit Chakrab

Keyword(s):

Pregnant Women ◽

Hiv Testing ◽

West Bengal ◽

Universal Access ◽

Community Based

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HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya

BMC Geriatrics ◽

10.1186/s12877-018-0941-x ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 5

Author(s):

Jepchirchir Kiplagat ◽

Susann Huschke

Keyword(s):

Older Adults ◽

Qualitative Study ◽

Hiv Testing ◽

Western Kenya ◽

Hiv Testing And Counselling ◽

Living With Hiv

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Addressing the challenges and relational aspects of index-linked HIV testing for children and adolescents: insights from the B-GAP study in Zimbabwe

10.21203/rs.3.rs-33333/v3 ◽

2020 ◽

Author(s):

Chido Dziva Chikwari ◽

Sarah Bernays ◽

Stefanie Dringus ◽

Victoria Simms ◽

Helen A Weiss ◽

...

Keyword(s):

Hiv Testing ◽

Children And Adolescents ◽

Negative Impact ◽

Discrete Event ◽

Routine Care ◽

Focus Group Discussions ◽

Group Discussions ◽

Community Based ◽

Testing Uptake ◽

Sexual Contacts

Abstract Introduction Index-linked HIV testing, targeted at sexual contacts or children of individuals with HIV, may improve yield and efficiency. The B-GAP study evaluated index-linked testing approaches in health facility and community-based settings. This paper reports on a qualitative study to understand factors that affect uptake of index-linked HIV testing for children and adolescents. Methods We conducted four focus group discussions (FGDs) with caregivers who had their children tested through B-GAP and one FGD with providers who offered index-linked HIV testing to indexes. We aimed to understand enabling and inhibiting factors in the decision-making process. Translated and transcribed transcripts were read for familiarisation. Following initial coding, analytical memos were written to identify emerging key themes across the data. Results Our findings showed there was inadequate emphasis on paediatric HIV in routine care which had a negative impact on subsequent uptake of testing for children. Once the decision to test had been made, access to facilities was sometimes challenging, and alleviated by community-based testing. A key finding was that HIV testing is not a discrete event but a process that was influenced by relationships with other family members and children themselves. These relationships raised complex issues that could prevent or delay the testing process. Conclusion There is a need to improve messaging on the importance of HIV testing for children and adolescents and to provide support to caregivers and their families in order to improve testing uptake. Addressing access barriers through the provision of community-based testing and implementing a family centred approach can optimize index-linked testing.

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