Different populations reached with different community HIV testing and counselling approaches

New research from Lesotho provides more insight into what types of community-based HIV testing and counselling (HTC) are most effective in reaching people with HIV services in resource-limited settings.  The cluster randomised control trial, published in PLOS One, looked at whether home-based HTC (HB-HTC) resulted in a higher uptake of HTC than delivery through community gathering and mobile clinics (MC-HTC).

Many people refuse HIV testing and counselling (HTC) services provided at health care facilities because of fear of stigma and discrimination. This is worrisome, as the success of HIV programmes partly relies on the uptake and accessibility of HTC. Community-based approaches will increase HTC service uptake, although less is known about the most effective method of service delivery – either in the home, or via mobile testing.  This makes developing and implementing programmes such as these a challenge.

The study concluded that the overall HTC uptake was highest in the HB-HTC approach. In both groups the uptake of services among adolescence and adults was the same, the uptake of service for children under the age of 12 was significantly higher in the HB-HTC approach. HB-HTC also reached more first time testers and men. MC-HTC, on the other hand, had a slightly higher HIV detection rate. There was no difference in HIV service uptake one month after testing for both groups.

This study shows that both HB and MC-HTC approaches can achieve increased uptake of HTC services, although the preferred strategy should be guided by the objective of the HTC intervention.  Where HTC uptake among groups is generally poor – men, first-time testers and children – HB-HTC is the preferred option. The MC-HTC approach is more appropriate when the detection of new HIV infections is the major goal. Finally, the findings of this trial highlight the need for further research into strategies of improving the link between HIV testing and HIV services uptake.