Home-Based HIV Testing Reaches the Undiagnosed in Africa
The vast majority of sub-Saharan Africans who are offered home-based HIV testing and counseling accept.
-- by Heather Kathryn Ross
How best to reach the scores of men, women, and children in sub-Saharan Africa who are at risk for HIV infection but have little access to clinics or desire to come forward for testing?
This question has bedeviled international aid workers for decades, but a new analysis published this week in PLoS Medicine shows that an overwhelming majority (83 percent) of patients in Kenya, Malawi, South Africa, Uganda, and Zambia who are offered home-based HIV testing and voluntary counseling accept.
Researchers, led by Kalpana Sabapathy of the London School of Hygiene and Tropical Medicine, Imperial College London, and Doctors Without Borders, reviewed 21 studies of home-based HIV testing in Africa, comprising more that 520,000 participants. Not only did most patients accept HIV testing, Sabapathy’s team found that men were as likely to do so as women, despite the fact that, in general, men are less likely to get tested for HIV than women.
Most importantly, Sabapathy’s analysis revealed that 40 to 70 percent of those who tested positive for HIV using at-home tests were previously undiagnosed. In the absence of home-based testing, these patients may have gone on to spread the disease to others, and may not have had access to HIV treatment until their condition worsened.
The Expert Take
Increasing rates of HIV testing is a top priority for the United Nations, especially in sub-Saharan Africa, where HIV prevalence remains highest. The beauty of home-based testing is that it does not require participants to seek testing and treatment, which could subject them to stigmatization in their communities.
Two of the studies researchers reviewed also demonstrated that the cost of home-based testing is less than $9 per person, making it a viable option for large-scale implementation around the world.
The researchers conclude that, “HBT [home-based testing] is able to reach wide sections of communities in a diverse range of contexts and settings. HBT provides the opportunity to acquire knowledge of HIV status at the doorstep for those who may not otherwise have sought testing… HBT is a gateway to accessing care early, and the benefits for individual and public health, both for treatment and prevention, make it an invaluable tool in the fight against HIV.”
Home-based HIV testing is a cost-effective, confidential way to reach the millions of at-risk individuals in Africa and elsewhere who would otherwise go untested. The more people who are aware of their HIV status, the greater the opportunity for patients to begin treatment early and to help stem the spread of the disease.
Source and Method
Researchers conducted a review of studies concerning home-based HIV testing in sub-Saharan Africa published between January 1, 2000 and September 24, 2012 to determine what percentage of individuals accepted the tests and what proportion of participants had been tested at least once in the past.
For full citations of the 21 studies included in this analysis, see the References list at the end of the published article, available here from PLoS Medicine.