Elsevier

Public Health

Volume 135, June 2016, Pages 3-13
Public Health

Review Paper
Strategies for delivery of HIV test results in population-based HIV seroprevalence surveys: a review of the evidence

https://doi.org/10.1016/j.puhe.2016.01.011Get rights and content

Highlights

  • More people tested and received results in HBHTC compared to facility-based testing.

  • Uptake of HIV test results was highest when testing and the provision of results were provided in the home.

  • The percentage of the population tested was highest when testing and results were provided at home.

  • Providing results the same day as testing in HBHTC produces higher uptake than delayed results.

Abstract

Objectives

Many population-based demographic surveys assess local and national HIV prevalence in developing countries through home-based HIV testing and counselling (HBHTC), but results are rarely returned to participants. This review gathered evidence on the feasibility and best practices of providing HIV test results during such surveys by reviewing population-based surveys that provided test results.

Study design

Literature review.

Methods

This review was conducted as part of a broader literature review related to HBHTC. We present results from population-based HIV seroprevalence surveys conducted between January 1984 and June 2013.

Results

We identified eighteen population-based surveys describing uptake of results when testing or results were offered in the home, four of which compare home uptake to facility-based testing. All were from Sub-Saharan Africa. More people tested and received results in HBHTC compared to facility-based testing. Uptake of test results (72%) and the percentage of the population tested (59%) was highest when testing and the provision of results were provided in the home compared to the provision of results elsewhere (41% uptake; 37% population coverage), as well as mobile/facility-based testing and the provision of results (15% uptake; 13% population coverage). Providing results the same day as testing in HBHTC produces higher uptake (97% uptake; 74% population coverage) than delayed results.

Conclusions

Inclusion of home testing and provision of HIV results to participants in national population-based surveys in Sub-Saharan Africa is possible and should be prioritized. The timing and location of testing and the provision of results during HBHTC as part of population-based surveys affects uptake of testing and population coverage.

Section snippets

Background

Population-based surveys such as the Demographic and Health Surveys (DHS) are used to assess local and nationally representative health data including determining HIV prevalence in many developing countries. Such studies, however, rarely return HIV results to participants1 despite the recognized importance of making people living with HIV/AIDS (PLHIV) aware of their status. HIV Counselling and Testing (HTC) is the first step in getting PLHIV linked to treatment2, 3 and has been shown to reduce

Methods

This review was conducted as part of a review of the literature related to HBHTC during population-based surveys and other studies that have provided testing and delivery of results in the home published January 1984 through June 2013. In this paper we present results for studies which conducted HIV testing as part of a survey and excluding studies where providing HIV testing and counselling was the primary objective. The review protocol including search terms and combinations are detailed in

Results

We identified 2466 articles from the initial search. Of these, 2146 were excluded after the authors screened the titles and abstracts. We excluded another 51 after in-depth review of the abstract. We identified an additional 69 articles from manual searches and reviewed 67 DHS/AIS reports. We therefore reviewed 336 full text articles, 18 of which met inclusion criteria for the review. Our search criteria had no geographical restrictions; however, all of the articles that met inclusion criteria

Discussion

Previous reviews have found HBHTC generally to be acceptable, with greater associated benefits than risks for participants.7, 17 This review, which identified evidence from Sub-Saharan Africa, supports these findings, and uniquely contributes to the literature by demonstrating that including HIV testing and delivery of results specifically within population-based surveys is acceptable and possible. In terms of increasing the number or proportion of individuals diagnosed and linked to care, the

Ethical approval

The manuscript reviewed published literature and publicly available reports and thus ethical approval for writing the manuscript was not required. The reviewed papers were from studies which each had ethics approval for their research.

Funding

This work was partially supported by USAID although the views expressed are exclusively those of the authors. Dr. Kiene was supported by a mentored research scientist career development award from the National Institutes of Mental Health (K01MH083536). K. Sileo

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    These authors contributed equally to this work.

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