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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Human Immunodeficiency Virus | Research article

Effect and cost of two successive home visits to increase HIV testing coverage: a prospective study in Lesotho, Southern Africa

Authors: Niklaus Daniel Labhardt, Isaac Ringera, Thabo Ishmael Lejone, Alain Amstutz, Thomas Klimkait, Josephine Muhairwe, Tracy Renee Glass

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Home-based HIV testing and counselling (HB-HTC) is frequently used to increase awareness of HIV status in sub-Saharan Africa. Whereas acceptance of HB-HTC is usually high, testing coverage may remain low due to household members being absent during the home visits. This study assessed whether two consecutive visits, one during the week, one on the weekend, increase coverage.

Methods

The study was a predefined nested-study of the CASCADE-trial protocol and conducted in 62 randomly selected villages and 17 urban areas in Butha-Buthe district, Lesotho. HB-HTC teams visited each village/urban area twice: first during a weekday, followed by a weekend visit to catch-up for household members absent during the week. Primary outcome was HTC coverage after first and second visit. Coverage was defined as all individuals who knew their HIV status out of all household members (present and absent).

Results

HB-HTC teams visited 6665 households with 18,286 household members. At first visit, 69.2 and 75.4% of household members were encountered in rural and urban households respectively (p < 0.001) and acceptance for testing was 88.5% in rural and 79.5% in urban areas (p < 0.001), resulting in a coverage of 61.8 and 61.5%, respectively. After catch-up visit, the HTC coverage increased to 71.9% in rural and 69.4% in urban areas. The number of first time testers was higher at the second visit (47% versus 35%, p < 0.001). Direct cost per person tested and per person tested HIV positive were lower during weekdays (10.50 and 335 USD) than during weekends (20 and 1056 USD).

Conclusions

A catch-up visit on weekends increased the proportion of persons knowing their HIV status from 62 to 71% and reached more first-time testers. However, cost per person tested during catch-up visits was nearly twice the cost during first visit.

Trial registration

NCT02692027 (prospectively registered on February 21, 2016).
Appendix
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Metadata
Title
Effect and cost of two successive home visits to increase HIV testing coverage: a prospective study in Lesotho, Southern Africa
Authors
Niklaus Daniel Labhardt
Isaac Ringera
Thabo Ishmael Lejone
Alain Amstutz
Thomas Klimkait
Josephine Muhairwe
Tracy Renee Glass
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7784-z

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