Is home-based HIV testing universally acceptable? Findings from a case-control study nested within the HPTN 071 (PopART) trial

K Sabapathy, C Mulubwa, H Mathema, C Mubekapi-Musadaidzwa, A Schaap, G Hoddinott, J Hargreaves, S Floyd, H Ayles, R Hayes, HPTN 071 (PopART) Study Team, K Sabapathy, C Mulubwa, H Mathema, C Mubekapi-Musadaidzwa, A Schaap, G Hoddinott, J Hargreaves, S Floyd, H Ayles, R Hayes, HPTN 071 (PopART) Study Team

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.

Keywords: Afrique subsaharienne; case-control study; dépistage du VIH à domicile; dépistage et traitement universels; home-based HIV testing; sub-Saharan Africa; universal test and treat; étude cas-témoins.

© 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
PopART trial schema.
Figure 2
Figure 2
(a) Case (non‐acceptor) selection process and sampling fraction. (b) Control (acceptor) selection process and sampling fraction.

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Source: PubMed

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