Share this article on:

Increasing Uptake of HIV Testing and Counseling Among the Poorest in Sub-Saharan Countries Through Home-Based Service Provision

Helleringer, Stéphane PhD; Kohler, Hans-Peter PhD; Frimpong, Jemima A MPH, PhD; Mkandawire, James RN

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 2009 - Volume 51 - Issue 2 - p 185-193
doi: 10.1097/QAI.0b013e31819c1726
Epidemiology and Social Science

Background: Uptake of HIV testing and counseling (HTC) is lower among members of the poorest households in sub-Saharan countries, thereby creating significant inequalities in access to HTC and possibly antiretroviral treatment.

Objectives: To measure uptake of home-based HTC and estimate HIV prevalence among members of the poorest households in a sub-Saharan population.

Methods: Residents of 6 villages of Likoma Island (Malawi) aged 18-35 and their spouses were offered home-based HTC services. Socioeconomic status, HIV testing history, and HIV risk factors were assessed. Differences in HTC uptake and HIV infection rates between members of households in the lowest income quartile and the rest of the population were estimated using logistic regression.

Results: Members of households in the lowest income quartile were significantly less likely to have ever used facility-based HTC 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 HTC services provided during the study (adjusted odds ratio = 1.70, 95% CI: 1.04 to 2.79). Socioeconomic differences in uptake of home-based HTC 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 HTC than among the rest of the population (adjusted odds ratio = 0.37, 95% CI: 0.14 to 0.96).

Conclusions: HTC uptake was high during a home-based HTC campaign on Likoma Island, particularly among the poorest. Home-based HTC has the potential to significantly reduce existing socioeconomic gradients in HTC uptake and help mitigate the impact of AIDS on the most vulnerable households.

From the *Population Studies Center, University of Pennsylvania, Philadelphia, PA; †Health Care Management, Wharton Business School, Philadelphia, PA; ‡Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY; and §Invest in Knowledge Initiative, University of Malawi College of Medicine, Blantyre, Malawi.

Received for publication August 12, 2008; accepted January 9, 2009.

Supported by National Institutes of Health grants RO1 HD044228 and RO1 HD/MH41713 and a PARC/Boettner/PSC Pilot Grant by the Population Studies Center, University of Pennsylvania, Philadelphia, PA.

Correspondence to: Stéphane Helleringer, Assistant Professor, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032 (e-mail: sh2813@columbia.edu).

Copyright © 2009 Wolters Kluwer Health, Inc. All rights reserved.