Home-based HIV voluntary counselling and testing

The HIV/AIDS epidemic remains a significant global health problem, especially in developing countries. The rate of uptake of voluntary counselling and testing (VCT) is low, and only about one in 10 eligible people have access to VCT in developing countries. Challenges of HIV testing include the difficulty of getting to testing sites and the cost of being tested. Researchers assumed that providing HIV testing or results or both in homes compared to in a healthcare facility would lead to higher uptake of HIV testing. This review attempted to evaluate this assumption. We found only one published study from developing countries and none from developed countries. The only study included in the review showed an increase in VCT uptake after home-based VCT intervention. Because of the limited evidence to date, however, further research is needed to evaluate if home-based VCT is better than facility-based VCT or other testing methods.

Authors' conclusions: 

Although home-based HIV VCT has the potential to enhance VCT uptake in developing countries, insufficient data exist to recommend large-scale implementation of home-based HIV testing. Further studies are needed to determine if home-based VCT is better than facility-based VCT in improving VCT uptake.

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Background: 

The low uptake of HIV voluntary counselling and testing (VCT) has hindered global attempts to prevent new HIV infections and has limited scale-up of HIV care and treatment. Globally, only 10% of HIV-infected individuals are aware of their HIV status. One approach to increase uptake is home-based HIV VCT, which may be effective in increasing the number of patients on treatment and preventing new infections.

Objectives: 

To establish the effect of home-based HIV VCT on uptake of HIV testing

Search strategy: 

We searched MEDLINE (February 2007), EMBASE (February 2007), CENTRAL (February 2007), AIDSearch (February 2007), LILACS, CINAHL and Sociofile. We also contacted relevant researchers. The original review search strategy was updated in 2008.

Selection criteria: 

Randomised controlled trials comparing home-based HIV VCT with other testing models

Data collection and analysis: 

Two review authors independently selected studies, assessed methodological quality, and extracted data. We planned to conduct statistical analysis using the Review Manager software and calculate summary statistics (relative risks (RRs) with 95% confidence intervals (CI)) for primary outcomes.

Main results: 

Only one study from developing countries met the inclusion criteria and was included in the review. The study, a cluster randomised trial (10 clusters, n=849) compared VCT uptake between an optional location (including home-based) and a local clinic location in a population-based HIV survey. The study showed a higher uptake of VCT among participants in the optional-location group. Uptake was significantly greater in the optional-location group in those who were pre-test counselled only (RR=4.6; 95% CI 3.58 to 5.91); pretest counselled and tested (RR=4.6; 95% CI 3.51 to 5.92); and post-test counselled and received the test result (RR=4.8; 95% CI 3.62 to 6.21). This study, however, had significant methodological problems limiting further analysis and interpretation.

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