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BMC Public Health. 2012; 12: 824.
Published online Sep 25, 2012. doi:  10.1186/1471-2458-12-824
PMCID: PMC3487909
Client characteristics and acceptability of a home-based HIV counselling and testing intervention in rural South Africa
Reshma Naik,corresponding author1,2 Hanani Tabana,1,3 Tanya Doherty,1,4 Wanga Zembe,1 and Debra Jackson4
1South African Medical Research Council, Francie van Zijl Drive, Parrowvallei, Tygerberg, 7505, South Africa
2Boston University, School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
3Karolinska Institutet, Division of Global Health (IHCAR), Department of Public Health Sciences, Nobels vag 9 5-171 77, Stockholm, Sweden
4University of the Western Cape, School of Public Health, Modderdam Road, Bellville, 7535, South Africa
corresponding authorCorresponding author.
Reshma Naik: reshnaik/at/gmail.com; Hanani Tabana: Hanani.Tabana/at/mrc.ac.za; Tanya Doherty: Tanya.Doherty/at/mrc.ac.za; Wanga Zembe: Wanga.Zembe/at/mrc.ac.za; Debra Jackson: debrajackson/at/mweb.co.za
Received May 4, 2012; Accepted September 3, 2012.
Abstract
Background
HIV counselling and testing (HCT) is a critical gateway for addressing HIV prevention and linking people to treatment, care, and support. Since national testing rates are often less than optimal, there is growing interest in expanding testing coverage through the implementation of innovative models such as home-based HIV counselling and testing (HBHCT). With the aim of informing scale up, this paper discusses client characteristics and acceptability of an HBHCT intervention implemented in rural South Africa.
Methods
Trained lay counsellors offered door-to-door rapid HIV testing in a rural sub-district of KwaZulu-Natal, South Africa. Household and client data were captured on cellular phones and transmitted to a web-based data management system. Descriptive analysis was undertaken to examine client characteristics, testing history, HBHCT uptake, and reasons for refusal. Chi-square tests were performed to assess the association between client characteristics and uptake.
Results
Lay counsellors visited 3,328 households and tested 75% (5,086) of the 6,757 people met. The majority of testers (73.7%) were female, and 57% had never previously tested. With regard to marital status, 1,916 (37.7%), 2,123 (41.7%), and 818 (16.1%) were single, married, and widowed, respectively. Testers ranged in age from 14 to 98 years, with a median of 37 years. Two hundred and twenty-nine couples received couples counselling and testing; 87.8%, 4.8%, and 7.4% were concordant negative, concordant positive, and discordant, respectively. There were significant differences in characteristics between testers and non-testers as well as between male and female testers. The most common reasons for not testing were: not being ready/feeling scared/needing to think about it (34.1%); knowing his/her status (22.6%), being HIV-positive (18.5%), and not feeling at risk of having or acquiring HIV (10.1%). The distribution of reasons for refusal differed significantly by gender and age.
Conclusions
These findings indicate that HBHCT is acceptable in rural South Africa. However, future HBHCT programmes should carefully consider community context, develop strategies to reach a broad range of clients, and tailor intervention messages and services to meet the unique needs of different sub-groups. It will also be important to understand and address factors related to refusal of testing.
Keywords: Home-based HIV counselling and testing, Community-based, Acceptability, South Africa, Lay counsellors
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