Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jul 7;2010(7):CD006493.
doi: 10.1002/14651858.CD006493.pub4.

Home-based HIV voluntary counselling and testing (VCT) for improving uptake of HIV testing

Moses Bateganya  1 , Omar A Abdulwadud, Susan M Kiene
Affiliations

Home-based HIV voluntary counselling and testing (VCT) for improving uptake of HIV testing

Moses Bateganya et al. Cochrane Database Syst Rev. .

Abstract

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.

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.

PubMed Disclaimer

Conflict of interest statement

We declare that none of the authors has affiliation with or involvement in any organization or entity with a different financial interest in the subject matter of the review, for example, employment, consultancy, stock ownership, honoraria or expert testimony.

Figures

1
1
A housewife undergoing HIV testing in the comfort of her home (Gave permission to use photograph)
2
2
TASO Jinja counsellor & tester performing HIV rapid test at home and taking a dry blood spot for quality control (Gave permission to use photograph)
3
3
Flowchart: Study selection
4
4
Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages in included study
5
5
Methodological quality summary: review authors' judgments about each methodological quality item for included study
1.1
1.1. Analysis
Comparison 1 Clinic versus optional location, Outcome 1 Pre‐test counselled only.
1.2
1.2. Analysis
Comparison 1 Clinic versus optional location, Outcome 2 Pre‐test counselled and HIV tested.
1.3
1.3. Analysis
Comparison 1 Clinic versus optional location, Outcome 3 Post‐test counselled and received the test result.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Fylkesnes 2004 {published data only}
    1. Fylkesnes K, Siziya S. A randomised trial on acceptability of voluntary HIV counseling and testing. Tropical Medicine and International Health 2004;9:566‐72. - PubMed

References to studies excluded from this review

Bunnell 2006 {published data only}
    1. Bunnell R, Ekwaru JP, Solberg P, Wamai N, Kajura‐Bikako W, Were W, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS 2006;20:85‐92. - PubMed
Corbett 2007 {published data only}
    1. Corbett EL, Makamure B, Cheung YB, Dauya E, Matambo R, Bandason T, et al. HIV incidence during a cluster‐randomised trial of two strategies providing voluntary counseling and testing at the workplace, Zimbabwe. AIDS 2007;21:483‐89. - PubMed
Corbett 2006 {published data only}
    1. Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, et al. Uptake of workplace HIV counseling and testing: a cluster‐randomised trial in Zimbabwe. PLoS Med 2006;3(7):1005‐12. - PMC - PubMed
Fylkesnes 1999 {published data only}
    1. Fylkesnes K, Haworth A, Rosensvard C, Kwapa PM. HIV counseling and testing: overemphasizing high acceptance rates a threat to confidentiality and the right to know. AIDS 1999;13:2469‐74. - PubMed
Hutchison 2006 {published data only}
    1. Hutchison AB, Branson BM, Kim A, Farnham PG. A meta‐analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status. AIDS 2006;20:1597‐04. - PubMed
Kassler 1998 {published data only}
    1. Kassler WJ, Alwano‐Edyegu MG, Marum E, Biryahwaho B, Kataaha P, Dillon B. Rapid HIV testing with same‐day results: a field trial in Uganda. International Journal of STD & AIDS 1998;9:134‐8. - PubMed
Matovu 2002 {published data only}
    1. Matovu JKB, Kigozi G, Nalugoda F, Wabwire‐Mangeni F, Gray RH. The Rakai Project counseling programme experience. Tropical Medicine and International Health 2002;7(12):1064‐67. - PubMed
Spielberg 2000 {published data only}
    1. Spielberg F, Critchlow C, Vittinghoff E, Coletti AS, Sheppard H, Mayer KH, et al. Home collection for frequent HIV testing: acceptability of oral fluids, dried blood spots and telephone results. AIDS 2000;14:1819‐28. - PubMed
Suggaravetsiri 2003 {published data only}
    1. Suggaravetsiri P, Yanai H, Chongsuvivatwong V, Naimpasan O, Akarasewi. Integrated counseling and screening for tuberculosis and HIV among household contacts of tuberculosis patients in an endemic area of HIV infection: Chiang Rai, Thailand. International Journal Tuberculosis and Lung Disease 2003;7(12):S424‐31. - PubMed
Were 2003 {published data only}
    1. Were W, Mermin J, Bunnel R, Ekwaru JP, Kaharuza F. Home‐based model for HIV voluntary counseling and testing. Lancet 2003;361(9368):1569. - PubMed
Wolff 2005 {published data only}
    1. Wolff B, Nyanzi B, Katongole, Ssesanga D, Ruberantwari A, Whitworth J. Evaluation of a home‐based voluntary counseling and testing intervention in rural Uganda. Health Policy and Planning 2005;20(2):109‐16. - PubMed
Yoder 2006 {published data only}
    1. Yoder PS, Katahoire AR, Kyaddondo D, Akol Z, Bunnell R, Kaharuza F. Home‐based HIV testing and counseling In a survey context in Uganda. United States Agency for Intenational Development 2006.

References to ongoing studies

Charlebois 2007 {unpublished data only}
    1. Charlebois E. Family‐based HIV voluntary counselling and testing in patients at risk for tuberculosis, Uganda. Ongoing study.
Jaffar 2005 {published and unpublished data}
    1. Jaffar S. Comparison of facility and home‐based ART delivery systems in Uganda. Ongoing study.

Additional references

Alcorn 2006
    1. Alcorn K, Smart T. Routine opt‐out counseling and testing: findings from the 2006 PEPFAR meeting. Third Annual PEPFAR Meeting, Durban South Africa. http://hivinsite.ucsf.edu/InSite. (accessed 18‐09‐06).
Anderson 2005
    1. Anderson JE, Chandra A, Mosher WD. HIV testing in the United States, 2002. Adv Data 2005;363:1‐32. - PubMed
Botswana 2003
    1. Botswana National Strategic Framework for HIV/AIDS 2003‐2009. Gabarone: National AIDS Coordinating Agency. http://openlibrary.org/b/OL3739126M/Botswana_national_strategic_framewor... (Accessed August 2007).
CDC 2006
    1. US Centers for Disease Control and Prevention. CDC Recommends Routine, Voluntary HIV Screening in Health Care Settings. http://www.cdc.gov/od/oc/media/pressrel/r060921.htm (accessed 22‐09‐06).
Cochrane 2006
    1. The Cochrane Collaborative Review Group on HIV Infection and AIDS. Inclusion and appraisal of experimental and non‐experimental (observation) studies. www.igh.org/Cochrane (accessed 21 September 2006).
Coovadia 2000
    1. Coovadia, Hoosen M. Access to Voluntary Counseling and Testing for HIV in Developing Countries. Annals of New York Academy of Sciences 2000;918:57‐63. - PubMed
De Zoysa 1995
    1. Zoysa I, Phillips KA, Kamenga MC, O'Reilly KR, Sweat MD, White RA, et al. The role of HIV counseling and testing in changing risk behavior in developing countries. AIDS 1995;9 Suppl A:S95‐101. - PubMed
Fylkesnes 1999
    1. Fylkesnes K, Haworth A, Rosenvard C, Kwapa PM. HIV counseling and testing: over emphasizing high acceptance rates a threat to confidentiality and the right not to know. AIDS 1999;13:2469‐74. - PubMed
Gallo 2003
    1. Gallo RC, Montagnier L. The discovery of HIV as the cause of AIDS. New England Journal of Medicine 2003;349(24):2283‐5. - PubMed
Global Report 2007
    1. Global HIV Prevention Working Group. Bringing HIV Prevention to Scale: An Urgent Global Priority. Prevention Working Group. http://www.globalhivprevention.org/pdfs/PWG‐HIV_prevention_report_FINAL.pdf (Accessed Dec 2009). Prevention Working Group, 2007:8‐9.
Guyana 2005
    1. Guyana Ministry of Health. PMTCT Implementation. Personal communication 2005.
Higgins 2005
    1. Higgins JPT, Green S, Editors. Cochrane handbook for Systematic Reviews of Interventions 4.2.5 [updated may 2005]. www.cochrane.org/resources/handbook/hbook.htm. John Wiley & Sons, LTD, (accessed 31 May 2005); Vol. In The Cochrane Library, issue 3.
Kaiser 2005
    1. Kaiser Family Foundation. HIV testing in the United States. Kaiser Family Foundation Fact Sheet http://www.kff.org/hivaids/loader.cfm (accessed 19‐09‐06) 2005.
Kamya 2007
    1. Kamya MR, Wanyenze R, Namale A. Routine HIV testing: the right not to know versus the rights to care, treatment and prevention. Bulletin of the World Health Organization 2007;85:5.
Liechty 2004
    1. Liechty CA. The evolving role of HIV counseling and testing in resource‐limited settings: HIV prevention and linkage to expanding HIV care access. Curr HIV/AIDS Rep 2004;1(4):181‐85. - PubMed
Matovu 2002
    1. Matovu JK, Kigozi G, Nalugoda F, Wabwire‐Mangeni F, Gray RH. The Rakai project counseling program experience. Tropical Medicine and International Health 2002;7:1064‐7. - PubMed
Mermin 2005
    1. Mermin J. A Family‐Based Approach to Preventive Care and Antiretroviral Therapy in Africa. 12th Conference on Retroviruses and Opportunistic Infections, Boston http://www.retroconference.org/Search_Abstract_2005/Default.aspx (accessed 19‐09‐06). 2005.
MOH‐Uganda 2005
    1. MOH‐Uganda. Uganda National Policy Guidelines for HIV Counseling and Testing, 2005. http://www.aidsuganda.org/sero/HCT%20policy.pdf (Accessed August 2007) 2005.
Morin 2006
    1. Morin SF, Khumalo‐Sakutikwa G, Charlebois ED. Removing barriers to knowing HIV status. Same‐day Mobile HIV testing in Zimbabwe. Journal of Acquired Immune Deficiency Syndrome 2006;41(2):218‐24. - PubMed
Murana 2005
    1. Murana E, Okello BN. High uptake of Voluntary Counseling and Testing (VCT) services using the mobile and home‐to‐home (M&H‐H) approaches in 2 two districts in eastern Uganda, through the AIDS Information Centre (AIC). International AIDS Society (IAS) Conference on HIV Pathogenesis and Treatment , Rio de Janeiro July 24‐27, 2005. 2005; Vol. 3rd: Abstract No. TuPp0204, issue TuPp0204.
Nakchbandi 1998
    1. Nakchbandi IA, Longenecker JC, Ricksecker MA, Latta RA, Healton C, Smith DG. A decision analysis of mandatory compared with voluntary HIV testing in pregnant women. Annals of Internal Medicine 1998;128(9):760‐67. - PubMed
Prabhat 2002
    1. Prabhat Jha, Anne Mills, Kara Hanson, Lilani Kumaranayake, Lesong Conteh, Christoph Kurowski, et al. Improving the health of the global poor. Science 2002;295:2036‐39. - PubMed
RevMan 2003 [Computer program]
    1. The Nordic Cochrane centre, The Cochrane Collaboration. Review Manager (REVMan). Version 4.2 for Windows. Copenhagen: The Nordic Cochrane centre, The Cochrane Collaboration, 2003.
Summers 2000
    1. Summers T, Spielberg F, Collins C, Coates T. Voluntary counseling and testing and referral for HIV: new technologies, research findings create dynamic opportunities. Journal of Acquired Immune Deficiency Syndrome 2000;25(Suppl 2):128‐35. - PubMed
TASO 2005
    1. The AIDS Support Organisation. Home Based Testing at TASO Jinja Uganda. TASO Uganda Photo Archive 2005.
UBOS 2001
    1. Uganda Bureau of Statistics and ORC/Macro International Inc. Uganda Demographic and Health Survey 2000‐2001. Entebbe and Colverton, MD: UBOS and Macro International 2001.
UNAIDS 2004
    1. UNAIDS. UNAIDS/WHO Policy Statement on HIV Testing. http://www.who.int/hiv/pub/vct/en/hivtestingpolicy04.pdf (Accessed August 2007) 2004.
UNAIDS 2008
    1. UNAIDS. The Report on the Global HIV/AIDS Epidemic 2008. http://www.unaids.org/en/HIV_data/2008GlobalReport/default.asp (accessed 15 June 2010).
UNDP 2006
    1. UNDP. The Human Development Indices. United Nations Development Programme. Human Development Report. http://hdr.undp.org/hdr2006/statistics/documents/hdi2004.pdf 2006.
VCT Efficacy 2000
    1. Voluntary HIV‐1 Counseling and Testing Efficacy Study Group 2000. Efficacy of voluntary HIV‐1 counseling and testing in individuals and couple in Kenya, Tanzania, and Trinidad. A randomised trial. Lancet 2000;356:103‐12. - PubMed
Wanyenze 2004
    1. Wanyenze R, Kamya M, Liechty C, Guzman D, Ronald A, Wabwirw‐Mangeni. HIV testing practices in Mulago Hospital. www.retroconference.org/2004/cd/PDFs/578.pdf (accessed 12/09/06). 2004; Vol. V‐12.
Weiser 2006
    1. Weiser S, Heisler M, Leiter K, Korte F, Tlou S, DeMonner S, Phaladze N, Bangsberg D, Iacopino V. Routine HIV Testing in Botswana: A Population‐Based Study on Attitudes, Practices, and Human Rights Concerns.. PLoS Medicine July 18, 2006; Vol. 3, issue 7:1013‐22. - PMC - PubMed
Were 2003
    1. Were W, Mermin J, Bunnel R, Ekwaru JP, Kaharuza F. Home‐based model for HIV voluntary counseling and testing. Lancet 2003;361(9368):1569. - PubMed
Were 2006
    1. Were WA, Mermin JH, Wamai N, Awor AC, Bechange S, Moss S, et. Al. Undiagnosed HIV infection and couple HIV discordance among household members of HIV‐Infected people receiving antiretroviral therapy. Journal of Acquired Immune Deficiency Syndrome 2006;43(1):1‐5. - PubMed
WHO 2005
    1. WHO. Lesotho launches groundbreaking HIV campaign on World AIDS Day. http://www.who.int/mediacentre/news/releases/2005/pr64/en/index.html (accessed 10/09/06) Vol. 2005.
WHO 2007
    1. WHO. Guidance on provider‐initiated HIV testing and counselling in health facilities. Geneva, Switzerland: World Health Organization. http://whqlibdoc.who.int/publications/2007/9789241595568_eng.pdf (Accessed August 2007) 2007; Vol. NA:6‐8.
Wolff 2005
    1. Wolff B, Nyanzi B, Katongole, Ssesanga D, Ruberantwari A, Whitworth J. Evaluation of a home‐based voluntary counseling and testing intervention in rural Uganda. Health Policy and Planning 2005;20(2):109‐16. - PubMed

Publication types

MeSH terms