Household-Based HIV Counseling and Testing as a Platform for Referral to HIV Care and Medical Male Circumcision in Uganda: A Pilot Evaluation
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
PloS one
Abstract
Combination HIV prevention initiatives incorporate evidence-based, biomedical and behavioral interventions
appropriate and acceptable to specific populations, aiming to significantly reduce population-level HIV incidence.
Knowledge of HIV serostatus is key to linkages to HIV care and prevention. Household-based HIV counseling and testing
(HBCT) can achieve high HIV testing rates. We evaluated HBCT as a platform for delivery of combination HIV prevention
services in sub-Saharan Africa.
Methods: We conducted HBCT in a semi-urban area in southwestern Uganda. All adults received standard HIV prevention
messaging. Real-time electronic data collection included a brief risk assessment and prevention triage algorithm for referrals
of HIV seropositive persons to HIV care and uncircumcised HIV seronegative men with multiple sex partners to male
circumcision. Monthly follow-up visits for 3 months were conducted to promote uptake of HIV care and male circumcision.
Results: 855 households received HBCT; 1587 of 1941 (81.8%) adults were present at the HBCT visit, 1557 (98.1% of those
present) were tested and received HIV results, of whom, 46.5% were men. A total of 152 (9.8%) were HIV seropositive, for
whom the median CD4 count was 456 cells/mL, and 50.7% were newly-identified as HIV seropositive. Three months after
HBCT, 88.5% of HIV seropositive persons had attended an HIV care clinic; among those with CD4 counts ,250 cells/mL,
71.4% initiated antiretroviral therapy. Among 123 HIV seronegative men with an HIV+ partner or multiple partners, 62.0%
were circumcised by month 3.
Conclusions: HBCT achieves high levels of knowledge of HIV serostatus and is an effective platform for identifying at-risk
persons and achieving higher uptake of HIV prevention and care services through referrals and targeted follow-up than has
been accomplished through other single focus strategies.
Description
Keywords
HIV Counseling, Testing, Circumcision, Referral to HIV
Citation
Tumwebaze H, Tumwesigye E, Baeten JM, Kurth AE, Revall J, et al. (2012) Household-Based HIV Counseling and Testing as a Platform for Referral to HIV Care and Medical Male Circumcision in Uganda: A Pilot Evaluation. PLoS ONE 7(12): e51620. doi:10.1371/journal.pone.0051620