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ART uptake higher when offered treatment initiation at home
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When offered the option of initiating HIV care at home, a significantly higher proportion of adults self-testing for HIV began ART compared with adults offered only facility-based services, according to researchers from the Liverpool School of Tropical Medicine in the United Kingdom.
“At a time when universal test and treat approaches to controlling the HIV epidemic are being considered, home initiation of HIV care shows high promise as a simple strategy to improve uptake of ART when HIV self-testing is carried out at home,” the researchers wrote in JAMA.
The researchers conducted a cluster randomized trial in Blantyre, Malawi, from Jan. 30 to Nov. 5, 2012. Participants who had received access to HIV self-testing in a parent study were randomly assigned to HIV self-testing followed by optional home initiation of care or self-testing with standard facility-based HIV care.
This study included 16,660 adults: 8,194 in the home care group and 8,466 in the facility care group. During the study period, 244 adults initiated ART within 6 months of HIV self-testing available. The incidence of ART initiation was significantly higher in the home care group: 2.2% vs. 0.7% in the facility care group (RR=2.94; 95% CI, 2.1-4.12).
There was no significant difference between the two groups in uptake of HIV self-testing, but the participants in the home care group were significantly more likely to report a positive result: 6% vs. 3.3% in the facility care group (RR=1.86; 95% CI, 1.16-2.97). Among the patients who initiated ART, 28.7% of those in the home care group and 23.8% of those in the facility group were lost from ART.
“The trend toward poorer outcomes among the ART initiators in the home group means careful monitoring and treatment support should be provided for home ART initiators in future studies to avoid losing the initial population benefits of home ART initiation,” the researchers wrote.
Disclosure: See study for a full list of researchers’ financial disclosures.
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