Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda
Abstract Background Refugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-07-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-018-3238-y |
| _version_ | 1819100098961866752 |
|---|---|
| author | Kelli N. O’Laughlin Wei He Kelsy E. Greenwald Julius Kasozi Yuchiao Chang Edgar Mulogo Zikama M. Faustin Patterson Njogu Rochelle P. Walensky Ingrid V. Bassett |
| author_facet | Kelli N. O’Laughlin Wei He Kelsy E. Greenwald Julius Kasozi Yuchiao Chang Edgar Mulogo Zikama M. Faustin Patterson Njogu Rochelle P. Walensky Ingrid V. Bassett |
| author_sort | Kelli N. O’Laughlin |
| collection | DOAJ |
| description | Abstract Background Refugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale. Methods From February–March 2014, we visited homes in 3 villages in Nakivale up to 3 times and offered HIV testing. We enrolled adults who spoke English, Kiswahili, Kinyarwanda, or Runyankore; some were refugees and some Ugandan nationals. We surveyed them about their socio-demographic characteristics. We evaluated the proportion of individuals encountered (feasibility) and assessed participation in HIV testing among those encountered (acceptability). We compared characteristics of home-based and clinic-based testers (from a prior study in Nakivale) using Wilcoxon rank sum and Pearson’s chi-square tests. We examined the relationship between a limited number of factors (time of visit, sex, and number of individuals at home) on willingness to test, using logistic regression models with the generalized estimating equations approach to account for clustering. Results Of 566 adults living in 319 homes, we encountered 507 (feasibility = 90%): 353 (62%) were present at visit one, 127 (22%) additional people at visit two, and 27 (5%) additional people at visit three. Home-based HIV testing participants totaled 378 (acceptability = 75%). Compared to clinic-based testers, home-based testers were older (median age 30 [IQR 24–40] vs 28 [IQR 22–37], p < 0.001), more likely refugee than Ugandan national (93% vs 79%, < 0.001), and more likely to live ≥1 h from clinic (74% vs 52%, < 0.001). The HIV prevalence was lower, but not significantly, in home-based compared to clinic-based testing participants (1.9 vs 3.4% respectively, p = 0.27). Testing was not associated with time of visit (p = 0.50) or sex (p = 0.66), but for each additional person at home, the odds of accepting HIV testing increased by over 50% (OR 1.52, 95%CI 1.12–2.06, p = 0.007). Conclusions Home-based HIV testing in Nakivale Refugee Settlement was feasible, with 90% of eligible individuals encountered within 3 visits, and acceptable with 75% willing to test for HIV, with a yield of nearly 2% individuals tested identified as HIV-positive. |
| first_indexed | 2024-12-22T00:57:23Z |
| format | Article |
| id | doaj.art-4c277ceef7f14e18be08c469cd5cdee4 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-22T00:57:23Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-4c277ceef7f14e18be08c469cd5cdee42022-12-21T18:44:16ZengBMCBMC Infectious Diseases1471-23342018-07-0118111010.1186/s12879-018-3238-yFeasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern UgandaKelli N. O’Laughlin0Wei He1Kelsy E. Greenwald2Julius Kasozi3Yuchiao Chang4Edgar Mulogo5Zikama M. Faustin6Patterson Njogu7Rochelle P. Walensky8Ingrid V. Bassett9Department of Emergency Medicine, Brigham & Women’s HospitalDivision of General Medicine, Massachusetts General HospitalHarvard Affiliated Emergency Medicine ResidencyUnited Nations High Commissioner for Refugees, Representation in UgandaHarvard Medical SchoolDepartment of Community Health, Mbarara University of Science and TechnologyBugema UniversityUnited Nations High Commissioner for Refugees, Representation in KenyaMedical Practice Evaluation Center, Department of Medicine, Massachusetts General HospitalMedical Practice Evaluation Center, Department of Medicine, Massachusetts General HospitalAbstract Background Refugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale. Methods From February–March 2014, we visited homes in 3 villages in Nakivale up to 3 times and offered HIV testing. We enrolled adults who spoke English, Kiswahili, Kinyarwanda, or Runyankore; some were refugees and some Ugandan nationals. We surveyed them about their socio-demographic characteristics. We evaluated the proportion of individuals encountered (feasibility) and assessed participation in HIV testing among those encountered (acceptability). We compared characteristics of home-based and clinic-based testers (from a prior study in Nakivale) using Wilcoxon rank sum and Pearson’s chi-square tests. We examined the relationship between a limited number of factors (time of visit, sex, and number of individuals at home) on willingness to test, using logistic regression models with the generalized estimating equations approach to account for clustering. Results Of 566 adults living in 319 homes, we encountered 507 (feasibility = 90%): 353 (62%) were present at visit one, 127 (22%) additional people at visit two, and 27 (5%) additional people at visit three. Home-based HIV testing participants totaled 378 (acceptability = 75%). Compared to clinic-based testers, home-based testers were older (median age 30 [IQR 24–40] vs 28 [IQR 22–37], p < 0.001), more likely refugee than Ugandan national (93% vs 79%, < 0.001), and more likely to live ≥1 h from clinic (74% vs 52%, < 0.001). The HIV prevalence was lower, but not significantly, in home-based compared to clinic-based testing participants (1.9 vs 3.4% respectively, p = 0.27). Testing was not associated with time of visit (p = 0.50) or sex (p = 0.66), but for each additional person at home, the odds of accepting HIV testing increased by over 50% (OR 1.52, 95%CI 1.12–2.06, p = 0.007). Conclusions Home-based HIV testing in Nakivale Refugee Settlement was feasible, with 90% of eligible individuals encountered within 3 visits, and acceptable with 75% willing to test for HIV, with a yield of nearly 2% individuals tested identified as HIV-positive.http://link.springer.com/article/10.1186/s12879-018-3238-yHIV testingHome-based HIV testingRefugeesUgandaDisplaced populationHumanitarian |
| spellingShingle | Kelli N. O’Laughlin Wei He Kelsy E. Greenwald Julius Kasozi Yuchiao Chang Edgar Mulogo Zikama M. Faustin Patterson Njogu Rochelle P. Walensky Ingrid V. Bassett Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda BMC Infectious Diseases HIV testing Home-based HIV testing Refugees Uganda Displaced population Humanitarian |
| title | Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda |
| title_full | Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda |
| title_fullStr | Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda |
| title_full_unstemmed | Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda |
| title_short | Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda |
| title_sort | feasibility and acceptability of home based hiv testing among refugees a pilot study in nakivale refugee settlement in southwestern uganda |
| topic | HIV testing Home-based HIV testing Refugees Uganda Displaced population Humanitarian |
| url | http://link.springer.com/article/10.1186/s12879-018-3238-y |
| work_keys_str_mv | AT kellinolaughlin feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT weihe feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT kelsyegreenwald feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT juliuskasozi feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT yuchiaochang feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT edgarmulogo feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT zikamamfaustin feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT pattersonnjogu feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT rochellepwalensky feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda AT ingridvbassett feasibilityandacceptabilityofhomebasedhivtestingamongrefugeesapilotstudyinnakivalerefugeesettlementinsouthwesternuganda |