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Community-based intervention improved HIV testing in developing countries
Sweat M. Lancet Infect Dis. 2011;doi:10.1016/S1473-3099(11)70060-3.
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Community-based voluntary counseling and testing significantly increased testing and detection of HIV infection in Tanzania, Zimbabwe and Thailand, according to new findings published in The Lancet Infectious Diseases.
“In many developing countries, a major contributor to the increase in HIV epidemics is that most people infected with HIV do not know they are infected,” Michael D. Sweat, PhD,professor at the Medical University of South Carolina, told Infectious Disease News. “It can be extremely difficult for people to get tested for HIV due to the challenges and costs of reaching HIV testing clinics. In addition, if people do not know that they are infected with HIV they will not seek care for AIDS-related illnesses.”
For the randomized study (Project Accept) the researchers set out to assess the effect of community mobilization, mobile community-based voluntary counseling and testing (CBVCT) and support after testing for HIV among participants aged between 16 and 32 years residing in 10 communities in Tanzania, eight in Zimbabwe and 14 in Thailand. HIV testing uptake, characteristics of those receiving their first HIV test and repeat testing between 2006 and 2009 were examined.
Communities were grouped in pairs based upon demographic and environmental characteristics. One community from each pair was randomly assigned to standard clinic-based voluntary counseling and testing (SVCT; consisted of counseling before and after HIV testing and rapid blood testing for infection) and the other community was assigned to CBVCT (community mobilization activities, easily accessible mobile voluntary counseling and testing for HIV and community-based support services after testing).
Compared with those assigned to SVCT, the number of participants who received their first HIV test was higher with CBVCT in Tanzania (9% vs. 37%), Zimbabwe (5% vs. 51%) and Thailand (23% vs. 69%). Further, CBVCT was associated with a fourfold increase in identifying HIV cases vs. SVCT across three study sites (952 vs. 264; P=.003). By study end, repeat testing increased to 28% for CBVCT communities across all study sites.
Overall, the proportion of couples testing together in Thailand was highest among all study sites, particularly with SVCT. “Many prevention experts believe that when a couple tests for HIV together, there is a greater chance of reducing transmission of HIV in the partnership,” Sweat said. “More studies are needed on how to increase couples testing together, and what impact this could have on reduction in HIV transmission.”
In an accompanying editorial, Joseph K. B. Matovu, of the College of Health Sciences in Uganda, wrote: “Alternative approaches are needed to increase uptake of voluntary counseling and testing (VCT) in couples, including provision of home-based VCT as part of mobile services, and use of influential networks in the community to stimulate demand and increase uptake in couples…Influential networks are composed of influential members of the community who are identified and trained to promote couples’ VCT through public endorsements and distribution of invitation letters to couples inviting them to come and receive VCT at existing facilities.” – by Ashley DeNyse
Disclosure: The researchers report no relevant financial disclosures.
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