Uptake of HIV testing and counselling

Uptake of HIV testing and counselling is lower among members of the poorest households in sub-Saharan countries, thereby creating significant inequalities in access to HIV testing and counselling and possibly antiretroviral treatment. Helleringer and colleagues set out to measure uptake of home-based HIV testing and counselling and estimate HIV prevalence among members of the poorest households in a sub-Saharan population. Residents of 6 villages of Likoma Island ( Malawi) aged 18-35 and their spouses were offered home-based HIV testing and counselling services. Socioeconomic status, HIV testing history, and HIV risk factors were assessed. Differences in uptake of HIV testing and counselling and in HIV infection prevalence between members of households in the lowest income quartile and the rest of the population were estimated using logistic regression. Members of households in the lowest income quartile were significantly less likely to have ever used facility-based HIV testing and counselling services than the rest of the population (odds ratio = 0.60, 95% confidence interval (CI): 0.36 to 0.97). In contrast, they were significantly more likely to use home-based HIV testing and counselling services provided during the study (adjusted odds ratio = 1.70, 95% CI: 1.04 to 2.79). Socioeconomic differences in uptake of home-based HIV testing and counselling were not due to underlying differences in socioeconomic characteristics or HIV risk factors. The prevalence of HIV was significantly lower among members of the poorest households tested during home-based HIV testing and counselling than among the rest of the population (adjusted odds ratio = 0.37, 95% CI: 0.14 to 0.96). HIV testing and counselling uptake was high during a home-based HIV testing and counselling campaign on Likoma Island, particularly among the poorest. Home-based HIV testing and counselling has the potential to significantly reduce existing socioeconomic gradients in HIV testing and counselling uptake and help mitigate the impact of AIDS on the most vulnerable households.

Editors’ note: Less than a quarter of this study population had participated in facility-based HIV testing and counselling but more than 75% accepted to be tested and immediately retrieved their test results at home. HIV prevalence overall was 8%. This is the first study to document the impact that a home-based approach can have in increasing uptake of HIV testing and counselling among young adults in the poorest households. Young women from these households were the least likely to have used facility-based testing and were the second most likely to participate in home-based HIV testing and counselling after their male counterparts. Reaching out to poorer people in their homes can help ensure that access to HIV prevention and treatment services is more equitable.