Effect and cost of two successive home visits to increase HIV testing coverage: a prospective study in Lesotho, Southern Africa

Niklaus Daniel Labhardt, Isaac Ringera, Thabo Ishmael Lejone, Alain Amstutz, Thomas Klimkait, Josephine Muhairwe, Tracy Renee Glass, Niklaus Daniel Labhardt, Isaac Ringera, Thabo Ishmael Lejone, Alain Amstutz, Thomas Klimkait, Josephine Muhairwe, Tracy Renee Glass

Abstract

Background: Home-based HIV testing and counselling (HB-HTC) is frequently used to increase awareness of HIV status in sub-Saharan Africa. Whereas acceptance of HB-HTC is usually high, testing coverage may remain low due to household members being absent during the home visits. This study assessed whether two consecutive visits, one during the week, one on the weekend, increase coverage.

Methods: The study was a predefined nested-study of the CASCADE-trial protocol and conducted in 62 randomly selected villages and 17 urban areas in Butha-Buthe district, Lesotho. HB-HTC teams visited each village/urban area twice: first during a weekday, followed by a weekend visit to catch-up for household members absent during the week. Primary outcome was HTC coverage after first and second visit. Coverage was defined as all individuals who knew their HIV status out of all household members (present and absent).

Results: HB-HTC teams visited 6665 households with 18,286 household members. At first visit, 69.2 and 75.4% of household members were encountered in rural and urban households respectively (p < 0.001) and acceptance for testing was 88.5% in rural and 79.5% in urban areas (p < 0.001), resulting in a coverage of 61.8 and 61.5%, respectively. After catch-up visit, the HTC coverage increased to 71.9% in rural and 69.4% in urban areas. The number of first time testers was higher at the second visit (47% versus 35%, p < 0.001). Direct cost per person tested and per person tested HIV positive were lower during weekdays (10.50 and 335 USD) than during weekends (20 and 1056 USD).

Conclusions: A catch-up visit on weekends increased the proportion of persons knowing their HIV status from 62 to 71% and reached more first-time testers. However, cost per person tested during catch-up visits was nearly twice the cost during first visit.

Trial registration: NCT02692027 (prospectively registered on February 21, 2016).

Keywords: Community-based testing; Coverage; Door-to-door; HIV; Home-based; Testing.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Testing coverage after first and second visit

References

    1. UNAIDS . On the Fast-Track to end AIDS: UNAIDS 2016–2021 Strategy. 2016.
    1. Iwuji C, Newell M-L. Public health action. HIV test “front door” to UNAIDS 90-90-90 target 7:79. 2017.
    1. Unaids . UNAIDS DATA 2018. 2018.
    1. World Health Organization Planning, implementation and monitoring home-based HIV testing and counselling. A practical handbook for Sub-saharan Africa. Available at: .
    1. WHO . Consolidated guidelines on HIV testing services. 2015.
    1. 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:S77–S85. doi: 10.1038/nature16044.
    1. Molesworth AM, Ndhlovu R, Banda E, Saul J, Ngwira B, Glynn JR, Crampin AC, French N. High accuracy of home-based community rapid HIV testing in rural Malawi. J Acquir Immune Defic Syndr. 2010;55:625–630. doi: 10.1097/QAI.0b013e3181f98628.
    1. Wachira J, Ndege S, Koech J, Vreeman RC, Ayuo P, Braitstein P. HIV testing uptake and prevalence among adolescents and adults in a large home-based HIV testing program in Western Kenya. J Acquir Immune Defic Syndr. 2014;65:e58–e66. doi: 10.1097/QAI.0b013e3182a14f9e.
    1. Petersen M, Balzer L, Kwarsiima D, et al. Association of implementation of a universal testing and treatment intervention with HIV diagnosis, receipt of antiretroviral therapy, and viral suppression in East Africa. JAMA. 2017;317:2196–2206. doi: 10.1001/jama.2017.5705.
    1. UNAIDS . UNAIDS DATA 2019. 2019.
    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) UNAIDS Data 2017. 2017.
    1. Labhardt ND, Motlomelo M, Cerutti B, Pfeiffer K, Kamele M, Hobbins MA, Ehmer J. Home-based versus Mobile clinic HIV testing and counseling in rural Lesotho: a cluster-randomized trial. PLoS Med. 2014. 10.1371/journal.pmed.1001768.
    1. Labhardt ND, Ringera I, Lejone TI, Klimkait T, Muhairwe J, Amstutz A, Glass TR. Effect of offering same-day ART vs usual health facility referral during home-based HIV testing on linkage to care and viral suppression among adults with HIV in Lesotho: the CASCADE randomized clinical trial. JAMA - J Am Med Assoc. 2018. 10.1001/jama.2018.1818.
    1. Labhardt ND, Ringera I, Lejone TI, et al. Same day ART initiation versus clinic-based pre-ART assessment and counselling for individuals newly tested HIV-positive during community-based HIV testing in rural Lesotho - a randomized controlled trial (CASCADE trial). BMC Public Health. 2016. 10.1186/s12889-016-2972-6.
    1. Ministry of Health L . Lesotho population-based HIV impact assessment (LePHIA) summary sheet: preliminary findings. 2017. pp. 1–6.
    1. Bemelmans M, Baert S, Negussie E, Bygrave H, Biot M, Jamet C, Ellman T, Banda A, van den Akker T, Ford N. Sustaining the future of HIV counselling to reach 90-90-90: a regional country analysis. J Int AIDS Soc. 2016;19:20751. doi: 10.7448/IAS.19.1.20751.
    1. Government of Lesotho . National guidelines on the use of antiretroviral therapy for HIV prevention and treatment. 5 2016.
    1. Chamie G, Clark TD, Kabami J, et al. A hybrid mobile approach for population-wide HIV testing in rural East Africa: an observational study. Lancet HIV. 2016;3:e111–e119. doi: 10.1016/S2352-3018(15)00251-9.
    1. Kadede K, Ruel T, Kabami J, et al. Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya. AIDS. 2016;30:2121–2126. doi: 10.1097/QAD.0000000000001180.
    1. Asiimwe S, Ross JM, Arinaitwe A, Tumusiime O, Turyamureeba B, Roberts DA, O’Malley G, Barnabas RV. Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers. J Int AIDS Soc. 2017;20:80–87. doi: 10.7448/IAS.20.5.21633.
    1. Chang W, Chamie G, Mwai D, et al. Implementation and operational research: cost and efficiency of a hybrid Mobile multidisease testing approach with high HIV testing coverage in East Africa. J Acquir Immune Defic Syndr. 2016;73:e39–e45. doi: 10.1097/QAI.0000000000001141.
    1. Pegurri E, Fox-Rushby JA, Damian W. The effects and costs of expanding the coverage of immunisation services in developing countries: a systematic literature review. Vaccine. 2005;23:1624–1635. doi: 10.1016/j.vaccine.2004.02.029.
    1. Lugada E, Millar D, Haskew J, et al. Rapid implementation of an integrated large-scale HIV counseling and testing, malaria, and diarrhea prevention campaign in rural Kenya. PLoS One. 2010;5:e12435. doi: 10.1371/journal.pone.0012435.
    1. Chamie G, Kwarisiima D, Clark TD, et al. Leveraging rapid community-based HIV testing campaigns for non-communicable diseases in rural Uganda. PLoS One. 2012;7:e43400. doi: 10.1371/journal.pone.0043400.
    1. Chamie G, Kwarisiima D, Clark TD, et al. Uptake of community-based HIV testing during a multi-disease health campaign in rural Uganda. PLoS One. 2014;9:e84317. doi: 10.1371/journal.pone.0084317.
    1. Lewis L, Maughan-Brown B, Grobler A, Cawood C, Khanyile D, Glenshaw M, Kharsany ABM. Impact of home-based HIV testing services on Progress toward the UNAIDS 90-90-90 targets in a Hyperendemic area of South Africa. JAIDS J Acquir Immune Defic Syndr. 2019;80:135–144. doi: 10.1097/QAI.0000000000001900.
    1. Camlin CS, Ssemmondo E, Chamie G, et al. Men “missing” from population-based HIV testing: insights from qualitative research. AIDS Care. 2016;28(Suppl 3):67–73. doi: 10.1080/09540121.2016.1164806.
    1. Yamanis TJ, Dervisevic E, Mulawa M, Conserve DF, Barrington C, Kajula LJ, Maman S. Social network influence on HIV testing among urban men in Tanzania. AIDS Behav. 2017;21:1171–1182. doi: 10.1007/s10461-016-1513-8.
    1. PEPFAR Male-Friendly Clinics in Lesotho: Demand Creation Targeting HIV-Infected Men to Access Comprehensive Health Services — PEPFAR Solutions Platform (BETA). . Accessed 1 Jul 2019.
    1. Amstutz A, Lejone TI, Khesa L. The HOSENG trial – effect of the provision of oral self-testing for absent and refusing individuals during a door-to-door HIV-testing campaign on testing coverage: protocol of a cluster-randomized clinical trial in rural Lesotho. 2019.
    1. Madiba S, Mokgatle M. Parents support implementation of HIV testing and counseling at school: cross-sectional study with parents of adolescent attending high School in Gauteng and North West Provinces, South Africa. AIDS Res Treat. 2016;2016:4842814.
    1. De Cock KM, Barker JL, Baggaley R, El Sadr WM. Where are the positives? HIV testing in sub-Saharan Africa in the era of test and treat. AIDS. 2019;33:349–352. doi: 10.1097/QAD.0000000000002096.
    1. Sulat JS, Prabandari YS, Sanusi R, Hapsari ED, Santoso B. The impacts of community-based HIV testing and counselling on testing uptake. J Heal Res. 2018;32:152–163. doi: 10.1108/JHR-01-2018-015.

Source: PubMed

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