{"id":768,"date":"2013-01-03T16:15:48","date_gmt":"2013-01-03T16:15:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=768"},"modified":"2013-01-03T16:19:38","modified_gmt":"2013-01-03T16:19:38","slug":"home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2013\/01\/03\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\/","title":{"rendered":"Home-based HIV testing: an acceptable intervention for sub-Saharan Africans?"},"content":{"rendered":"

HIV testing is the gateway to accessing care \u2013 but can involve issues of stigma.\u00a0 So improving accessibility to testing \u2013 by, amongst other things, overcoming the associated stigma \u2013 is a major concern for developed and underdeveloped countries alike, and has led to initiatives for testing in \u201cnon-traditional settings\u201d (e.g. the UK based HINTS study: http:\/\/sti.bmj.com\/content\/88\/8\/601.abstract?sid=30e86f02-5f14-47ea-a52f-890e265e9295<\/a>).\u00a0 In many low-income countries, where need is particularly great, and medical infra-structure poor (e.g. many nations of sub-Saharan African), these \u201cnon-traditional settings\u201d have included non-medical ones, including the home (see Obare & Kohler (2009): http:\/\/sti.bmj.com\/content\/85\/2\/139.abstract?sid=ec2937f2-fabf-4e25-bcf2-3d8d1c6fc021<\/a>).<\/p>\n

Yet, serious concerns have recently been raised about the implications of implementing such an approach in low-resource settings.\u00a0 It is argued that the consequences of stigma may be very serious for those affected (Turan & Cohen: http:\/\/link.springer.com\/article\/10.1007\/s10461-010-9798-5\/fulltext.html<\/a>) , and that, where there is a drive to implement testing by untrained and ill-qualified staff, considerations of acceptability can easily be over-ridden (e.g.\u00a0 Human Rights Watch<\/i>: http:\/\/www.hrw.org\/sites\/default\/files\/reports\/lesotho1108.pdf<\/a>).<\/p>\n

So a recent meta-analysis of Sabathy & Ford in PLoS-Medicine seeking to cast a light on the acceptability of home-testing\u00a0 in sub-Saharan Africa is very welcome (http:\/\/www.plosmedicine.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pmed.1001351<\/a>).<\/p>\n

21 studies reported in 19 papers are selected as meeting the criteria, and derive from six sub-Saharan African countries.\u00a0 The overall results are a strong endorsement of the acceptability of home-based testing (HBT).\u00a0 Of those offered the test 77% accepted and received a result; furthermore, among those testing positive between 40% and 79% turned out not to have tested previously.\u00a0 There were two particularly encouraging findings.\u00a0 First, in the eight studies that separated data on the basis of gender, 47% of those offered the test were men.\u00a0 This is important, given the often very low rates of male attendance (as low as 9%) for facility-based testing.\u00a0 Second, in the two studies that report CD4 counts, \u00a0only 68% and 69% respectively of those testing positive had a CD4 count >200.\u00a0 The authors conclude that HBT may be a useful approach for earlier detection.<\/p>\n

The study identifies as its key finding the potential of HBT to reach wide sections of the community who would not otherwise have sought testing.\u00a0 It also indicates a number of directions for further research.\u00a0 These include, most obviously, the feasibility and acceptability of repeat HBT for ongoing knowledge of HIV status.\u00a0 On this the study of Obare & Kohler 2009 has produced some encouraging results (http:\/\/sti.bmj.com\/content\/85\/2\/139.abstract?sid=ec2937f2-fabf-4e25-bcf2-3d8d1c6fc021<\/a>).\u00a0 The option of self-testing with support from HBT staff is also something to be explored.\u00a0 Finally, the whole issue of the cost-effectiveness of HBT relative to other interventions requires further research in order to guide policy-makers operating in resource-poor settings.<\/p>\n","protected":false},"excerpt":{"rendered":"

HIV testing is the gateway to accessing care \u2013 but can involve issues of stigma.\u00a0 So improving accessibility to testing \u2013 by, amongst other things, overcoming the associated stigma \u2013 is a major concern for developed and underdeveloped countries alike, and has led to initiatives for testing in \u201cnon-traditional settings\u201d (e.g. the UK based HINTS […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1642],"tags":[],"class_list":["post-768","post","type-post","status-publish","format-standard","hentry","category-hiv-testing"],"yoast_head":"\nHome-based HIV testing: an acceptable intervention for sub-Saharan Africans? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/01\/03\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Home-based HIV testing: an acceptable intervention for sub-Saharan Africans? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"HIV testing is the gateway to accessing care \u2013 but can involve issues of stigma.\u00a0 So improving accessibility to testing \u2013 by, amongst other things, overcoming the associated stigma \u2013 is a major concern for developed and underdeveloped countries alike, and has led to initiatives for testing in \u201cnon-traditional settings\u201d (e.g. the UK based HINTS [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2013\/01\/03\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2013-01-03T16:15:48+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2013-01-03T16:19:38+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/01\\\/03\\\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/01\\\/03\\\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Home-based HIV testing: an acceptable intervention for sub-Saharan Africans?\",\"datePublished\":\"2013-01-03T16:15:48+00:00\",\"dateModified\":\"2013-01-03T16:19:38+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/01\\\/03\\\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\\\/\"},\"wordCount\":505,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"HIV testing\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/01\\\/03\\\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/01\\\/03\\\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/01\\\/03\\\/home-based-hiv-testing-an-acceptable-intervention-for-sub-saharan-africans\\\/\",\"name\":\"Home-based HIV testing: an acceptable intervention for sub-Saharan Africans? 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