Home‐based HIV voluntary counseling and testing in developing countries

Moses Bateganya; Omar A Abdulwadud; Susan M Kiene

doi:10.1002/14651858.CD006493.pub2

Pruebas y asesoramiento domiciliario voluntario para el VIH en países en vías de desarrollo

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Referencias

Referencias de los estudios incluidos en esta revisión

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Fykesnes K, Siziya S. A randomised trial on acceptability of voluntary HIV counseling and testing. Tropical Medicine and International Health 2004;9:566‐72.

Wolff B, Nyanzi B, Katongole, Ssesanga D, Ruberantwari A, Whitworth J. Evaluation of a home‐based voluntary counseling and testing intervention in rural Uganda. 2005: 20 (2)‐109‐116. Health Policy and Planning 2005;20(2):109‐16.

Referencias de los estudios excluidos de esta revisión

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Bunnell R, Ekwaru JP, Solberg P, Wamai N, Kajura‐Bikako W, Were W, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS 2006;20:85‐92.

Corbett EL, Makamure B, Cheung YB, Dauya E, Matambo R, Bandason T, et al. HIV incidence during a cluster‐randomized trial of two strategies providing voluntary counseling and testing at the workplace, Zimbabwe. AIDS 2007;21:483‐89.

Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, et al. Uptake of workplace HIV counseling and testing: a cluster‐Randomised trial in Zimbabwe. PLoS Med 2006;3(7):1005‐12.

Fylkesnes K, Haworth A, Rosensvard C, Kwapa PM. HIV counseling and testing: overemphasizing high acceptance rates a threat to confidentiality and the right to know. AIDS 1999;13:2469‐74.

Hutchison AB, Branson BM, Kim A, Farnham PG. A meta‐analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status. AIDS 2006;20:1597‐1604.

Kassler WJ, Alwano‐Edyegu MG, Marum E, Biryahwaho B, Kataaha P, Dillon B. Rapid HIV testing with same‐day results: a field trial in Uganda. IInternational Journal of STD & AIDS 1998;9:134‐8.

Matovu JKB, Kigozi G, Nalugoda F, Wabwire‐Mangeni F, Gray RH. The Rakai Project counseling programme experience. Tropical Medicine and International Health 2002;7(12):1064‐67.

Spielberg F, Critchlow C, Vittinghoff E, Coletti AS, Sheppard H, Mayer KH, et al. Home collection for frequent HIV testing: acceptability of oral fluids, dried blood spots and telephone results. AIDS 2000;14:1819‐28.

Suggaravetsiri P, Yanai H, Chongsuvivatwong V, Naimpasan O, Akarasewi. Integrated counseling and screening for tuberculosis and HIV among household contacts of tuberculosis patients in an endemic area of HIV infection: Chiang Rai, Thailand. International Journal Tuberculosis and Lung Disease 2003;7(12):S424‐31.

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Were W, Mermin J, Bunnel R, Ekwaru JP, Kaharuza F. Home‐based model for HIV voluntary counseling and testing. Lancet 2003;361(9368):1569.

Yoder PS, Katahoire AR, Kyaddondo D, Akol Z, Bunnell R, Kaharuza F. Home‐Based HIV Testing and Counseling In a Survey Context in Uganda. United States Agency for Intenational Development2006.

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Referencias de los estudios en curso

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Charlebois E. Family‐based HIV voluntary counseling and testing in patients at risk for tuberculosis.

Jaffar S. Comparison of Facility and Home‐Based ART Delivery Systems in Uganda.

Referencias adicionales

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Alcorn K, Smart T. Routine opt‐out counseling and testing: findings from the 2006 PEPFAR meeting. Third Annual PEPFAR Meeting, Durban South Africa. http://hivinsite.ucsf.edu/InSite. (accessed 18‐09‐06).

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Gallo RC, Montagnier L. The discovery of HIV as the cause of AIDS. New England Journal of Medicine 2003;349(24):2283‐5.

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Liechty CA. The evolving role of HIV counseling and testing in resource‐limited settings: HIV prevention and linkage to expanding HIV care access. Curr HIV/AIDS Rep 2004;1(4):181‐185.

Matovu JK, Kigozi G, Nalugoda F, Wabwire‐Mangeni F, Gray RH, 2002. The Rakai project counseling program experience. Tropical Medicine and International Health 2002;7:1064‐7.

Mermin J. A Family‐Based Approach to Preventive Care and Antiretroviral Therapy in Africa. 12th Conference on Retroviruses and Opportunistic Infections, Boston http://www.retroconference.org/Search_Abstract_2005/Default.aspx (accessed 19‐09‐06). 2005.

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Wolff B, Nyanzi B, Katongole, Ssesanga D, Ruberantwari A, Whitworth J. Evaluation of a home‐based voluntary counseling and testing intervention in rural Uganda. 2005: 20 (2)‐109‐116. Health Policy and Planning 2005;20(2):109‐16.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Fylkesnes 2004

Methods	Design: Randomised Randomisation unit: Stratified random cluster using the number of household in each area.Clusters were selected with probability proportional size Allocation concealment: Not clearly described Blinding: not described Intention to treat: The analysis was done using the number of subjects initially willing as denominator and not on the total number randomized to each group
Participants	Participants 15 years and older living in household in Chelston, a residential area in Lusaka, Zambia. N =2445 (total number interviewed) n1102 (VCT at local clinic), n=1343 (optional location) Age: not described Gender: not described
Interventions	VCT at an optional location. Subjects were visited by a counselor at home, and offered a choice of counseling at home, clinic or other place. The majority of the subjects (84%) preferred home‐based counseling. For this group the following procedure was implemented: The day after the survey interview, subjects were visited at home by counsellor, gave consent, and were offered pre‐test counseling and gave blood. The next day the counselor returned for home visit for post‐test counseling
Outcomes	Primary outcomes: Acceptability of pre‐test counseling only; acceptability of pre‐test counseling and test; acceptability of post‐test counseling and receive test result. Secondary outcome: Not stated
Notes	Authors state that all testing of blood from the home‐based group were carried out at the local clinic and not at home. Control group received VCT at local clinic with the same‐day results. Counsellors from a different geographical area were recruited and counseled both groups. The study was stated as randomised but method of allocation of the two groups was not described The study was conduced in 1999.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Wolff 2005

Methods	Design: Non randomized/Pre/post intervention evaluation (cohort) Randomisation unit: NA Sampling design: Not specified. Study is part of a survey in a cohort Allocation concealment: NA Blinding: NA Loss to follow up: The numbers included in the analysis for the two time periods however may indicate attrition bias. The authors also state that home delivery rates excluded any test results obtained outside the serosurvey and the observation period was shorter. It is possible that the proportions excluded from analysis were different between the home and facility groups
Participants	Participants, 15 years and above were part of a natural history cohort in 15 villages in rural south western Uganda. The undergo yearly sero surveys at which blood for testing is taken for HIV testing with the option of collecting results from the clinic. VCT uptake was then calculated from the number who received their results.N=464 (sero‐surveyed in 2001) Inclusion criteria: all participants 15 years and above, living in the study area who participated in the sero surveys for study period
Interventions	During the intervention year (2000‐2001), patients were given the option of receiving HIV test results at their homes compared to earlier years when results were picked from the study clinics.
Outcomes	Primary outcome: Acceptability of VCT (accepting to get results at home) Secondary outcome: Barriers to knowing sero‐status
Notes	Location: Authors state that all testing of blood was part of annual sero surveys, however receipt of results was optional. In previous years, HIV test results would be picked from the clinic. In the intervention year counselor gave the option of delivering. VCT uptake during two time periods were Date 2000‐2001
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D ‐ Not used

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Bunnell 2006	This prospective study offered home‐based HIV testing to all participants and their house hold members but did not offer a comparison (facility based testing)
Corbett 2007	This cluster‐randomised trial (retrospective secondary analysis) investigated the effects of delivery of counseling and testing on HIV incidence to employees at their work places. It did offer any comparison that was a subject of this review.
Corbett 2006	This cluster randomised study compared work place on‐site VCT uptake with offsite uptake. Home based VCT was not offered to any of the participants.
Fylkesnes 1999	This study was part of a population based survey. Neither counseling, testing or receipt of HIV results occured in the home setting. Although it evaluated VCT uptake it did not address the review question.
Hutchison 2006	This is a review and as such doesnot report original data.
Kassler 1998	Two HIV testing protocol were evaluated. Rapid testing and same day results versus standard protocol with results after 2 weeks.
Matovu 2002	Presented experiences on provision of VCT in a research setting.
Spielberg 2000	Study was conducted in the United states, a developed country setting. It Dry Blood Spots to Oaral Fluid Collection for HIV testing and also compared receipt of results by phone or by a visit to the clinic. Therefore it did not compare home based HIV testing to another model of testing.
Suggaravetsiri 2003	Household members were offered HIV testing at the home and not compared with any other group.
Were 2003 1	Results of this study were published as a letter leaving out critical study details. Attempts to contact the authors were futile.
Yoder 2006	The home VCT based survey only assessed acceptance or refusal of results at home. Participants were not given an option of receipt of results at an alternative site.

Characteristics of ongoing studies [ordered by study ID]

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Chalebois 2007

Trial name or title	Family‐Based HIV Voluntary counseling and testing in Patients at Risk for Tuberculosis
Methods
Participants	Household members of patients being evaluated for TB
Interventions	Home‐Based Voluntary counseling and testong
Outcomes	Uptake of VCT
Starting date	2007
Contact information	Dr Edwin Charlebois, University of California and San Francisco
Notes	This study has started recriting patients at the clinic in Mulago Kampala

Jaffar 2005

Trial name or title	Comparison of Facility and Home‐Based ART Delivery Systems in Uganda
Methods
Participants	House hold members aged 18 and above, of index patients recruited into the home and facility based arms of the study
Interventions	Home based VCT
Outcomes	Family member HIV testing
Starting date	2005
Contact information	Shabbar Jaffer PhD, London School of Tropical Medicine and Hygiene
Notes	Recritment of patients in the main study ended but follow up continues.

Data and analyses

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Comparison 1. Home and Facility Based Counseling and testing (Fylekesnes 2004)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post test counseled and given the test result (Fylkesnes 2004) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.1 Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 1 Post test counseled and given the test result (Fylkesnes 2004).
2 Pretest counseled (Fylkesnes 2004) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 2 Pretest counseled (Fylkesnes 2004).
3 Pretest counseled and tested (Fylkesnes 2004) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.3 Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 3 Pretest counseled and tested (Fylkesnes 2004).
4 Willingness to test (Willing to test out of those who were surveyed Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.4 Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 4 Willingness to test (Willing to test out of those who were surveyed.
5 Post test counseled and given results (Intention to treat) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.5 Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 5 Post test counseled and given results (Intention to treat).
6 Post test counseled and given results (OT) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.6 Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 6 Post test counseled and given results (OT).

Open in table viewer

Comparison 2. Acceptability of HIV test results (Wolff 2005)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Accepted to recieve HIV test results Show forest plot	1	1868	Odds Ratio (M‐H, Fixed, 95% CI)	5.23 [4.02, 6.80]
Open in figure viewer Analysis 2.1 Comparison 2 Acceptability of HIV test results (Wolff 2005), Outcome 1 Accepted to recieve HIV test results.
2 Receipt of HIV test results Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.2 Comparison 2 Acceptability of HIV test results (Wolff 2005), Outcome 2 Receipt of HIV test results.
3 Adjusted Receipt of results (Wolff) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.3 Comparison 2 Acceptability of HIV test results (Wolff 2005), Outcome 3 Adjusted Receipt of results (Wolff).

Figure 1

Traveling HIV Tester and Counselor (De Cock 2006)

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Figure 2

A housewife undergoing HIV testing in the comfort of her home

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Figure 3

TASO Jinja counselor and tester performing HIV rapid test in the home and taking a dry blood spot for quality control

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Figure 4

Studies flow diagram

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Analysis 1.1

Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 1 Post test counseled and given the test result (Fylkesnes 2004).

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Analysis 1.2

Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 2 Pretest counseled (Fylkesnes 2004).

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Analysis 1.3

Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 3 Pretest counseled and tested (Fylkesnes 2004).

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Analysis 1.4

Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 4 Willingness to test (Willing to test out of those who were surveyed.

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Analysis 1.5

Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 5 Post test counseled and given results (Intention to treat).

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Analysis 1.6

Comparison 1 Home and Facility Based Counseling and testing (Fylekesnes 2004), Outcome 6 Post test counseled and given results (OT).

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Analysis 2.1

Comparison 2 Acceptability of HIV test results (Wolff 2005), Outcome 1 Accepted to recieve HIV test results.

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Analysis 2.2

Comparison 2 Acceptability of HIV test results (Wolff 2005), Outcome 2 Receipt of HIV test results.

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Analysis 2.3

Comparison 2 Acceptability of HIV test results (Wolff 2005), Outcome 3 Adjusted Receipt of results (Wolff).

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Table 1. Methodological Quality Assessment of Observational studies

Quality measure	Cross‐sectional	Cohort
External Validity	Extent to which results of the study provide a correct basis for applicabiliy
	Representativeness of the sample	Representativeness of the sample
	What percentage of selected individuals agreed to participate	What percentage of selected individuals agreed to participate
Internal validity	Extent to which systematic error, bias is minimised in the study
	How was HIV status determined	How was HIV status determined
Detection bias
	How was HIV status assessed	How was HIV status assessed
	How acceptance of the test assesed	How acceptance of the test assesed
Attrition bias
	Were selected patients included in the final analysis	Was follow up adequate
	Were there refusals	What proportions were lost to follow up
Selection bias
	Confirmation that positive patients were not included	Confirmation that positive patients were not included
	Was confounding handled	Was confounding handled

Table 1. Methodological Quality Assessment of Observational studies

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Comparison 1. Home and Facility Based Counseling and testing (Fylekesnes 2004)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post test counseled and given the test result (Fylkesnes 2004) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 Pretest counseled (Fylkesnes 2004) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Pretest counseled and tested (Fylkesnes 2004) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4 Willingness to test (Willing to test out of those who were surveyed Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

5 Post test counseled and given results (Intention to treat) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

6 Post test counseled and given results (OT) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 1. Home and Facility Based Counseling and testing (Fylekesnes 2004)

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Comparison 2. Acceptability of HIV test results (Wolff 2005)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Accepted to recieve HIV test results Show forest plot	1	1868	Odds Ratio (M‐H, Fixed, 95% CI)	5.23 [4.02, 6.80]

2 Receipt of HIV test results Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Adjusted Receipt of results (Wolff) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 2. Acceptability of HIV test results (Wolff 2005)

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Referencias

Referencias de los estudios incluidos en esta revisión

Fylkesnes 2004 {published data only}

Wolff 2005 {published data only}

Referencias de los estudios excluidos de esta revisión

Bunnell 2006 {published data only}

Corbett 2007 {published data only}

Corbett 2006 {published data only}

Fylkesnes 1999 {published data only}

Hutchison 2006 {published data only}

Kassler 1998 {published data only}

Matovu 2002 {published data only}

Spielberg 2000 {published data only}

Suggaravetsiri 2003 {published data only}

Were 2003 1 {published data only}

Yoder 2006 {published data only}

Referencias de los estudios en curso

Chalebois 2007 {unpublished data only}

Jaffar 2005 {unpublished data only}

Referencias adicionales

Alcorn 2006

Anderson 2005

Botswana 2003

Botswana 2004

CDC 2006

Cochrane 2006

Coovadia 2000

De Cock 2006

De Zoysa 1995

Fylkesnes 1999

Gallo 2003

Global Report 2007

Guyana 2005

Higgins 2005

Kaiser 2005

Kamya 2007

Liechty 2004

Matovu 2002

Mermin 2005

MOH‐Uganda 2005

Morin 2006

Murana 2005

Nakchbandi 1998

Prabhat 2002

RevMan 2003 [Computer program]

Seeley 1991

Summers 2000

Sweat 1998

TASO 2005

UBOS 2001

UNAIDS 2004

UNAIDS 2006

UNDP 2006

VCT Efficacy 2000

Wanyenze 2004

Were 2003

Were 2006

WHO 2005

WHO 2007

Wolff 2005

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Characteristics of ongoing studies [ordered by study ID]

Data and analyses

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