Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis.
Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.We conducted a systematic review and random-effects meta-analysis of studies...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS Medicine |
| Online Access: | http://europepmc.org/articles/PMC3514284?pdf=render |
| _version_ | 1819262972622536704 |
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| author | Kalpana Sabapathy Rafael Van den Bergh Sarah Fidler Richard Hayes Nathan Ford |
| author_facet | Kalpana Sabapathy Rafael Van den Bergh Sarah Fidler Richard Hayes Nathan Ford |
| author_sort | Kalpana Sabapathy |
| collection | DOAJ |
| description | Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.We conducted a systematic review and random-effects meta-analysis of studies published between 1 January 2000 and 24 September 2012 that reported on uptake of HBT in sub-Saharan Africa, to assess the proportion of individuals accepting HBT and receiving their test result. Our initial search yielded 1,199 articles; 114 were reviewed as full-text articles, and 19 publications involving 21 studies (n = 524,867 individuals offered HBT) were included for final review and meta-analysis. The studies came from five countries: Uganda, Malawi, Kenya, South Africa, and Zambia. The proportion of people who accepted HBT (n = 474,377) ranged from 58.1% to 99.8%, with a pooled proportion of 83.3% (95% CI: 80.4%-86.1%). Heterogeneity was high (τ(2) = 0.11). Sixteen studies reported on the number of people who received the result of HBT (n = 432,835). The proportion of individuals receiving their results out of all those offered testing ranged from 24.9% to 99.7%, with a pooled proportion of 76.7% (95% CI: 73.4%-80.0%) (τ(2) = 0.12). HIV prevalence ranged from 2.9% to 36.5%. New diagnosis of HIV following HBT ranged from 40% to 79% of those testing positive. Forty-eight percent of the individuals offered testing were men, and they were just as likely to accept HBT as women (pooled odds ratio = 0.84; 95% CI: 0.56-1.26) (τ(2) = 0.33). The proportion of individuals previously tested for HIV among those offered a test ranged from 5% to 66%. Studies in which <30% of individuals had been previously tested, local HIV prevalence was <10%, incentives were provided, or HBT was offered to household members of HIV-positive individuals showed higher uptake of testing. No evidence was reported of negative consequences of HBT.HBT could substantially increase awareness of HIV status in previously undiagnosed individuals in sub-Saharan Africa, with over three-quarters of the studies in this review reporting >70% uptake. It could be a valuable tool for treatment and prevention efforts. |
| first_indexed | 2024-12-23T20:06:11Z |
| format | Article |
| id | doaj.art-632c20a73f6f4daf94b7a873edad1b4d |
| institution | Directory Open Access Journal |
| issn | 1549-1277 1549-1676 |
| language | English |
| last_indexed | 2024-12-23T20:06:11Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Medicine |
| spelling | doaj.art-632c20a73f6f4daf94b7a873edad1b4d2022-12-21T17:32:55ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762012-01-01912e100135110.1371/journal.pmed.1001351Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis.Kalpana SabapathyRafael Van den BerghSarah FidlerRichard HayesNathan FordImproving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.We conducted a systematic review and random-effects meta-analysis of studies published between 1 January 2000 and 24 September 2012 that reported on uptake of HBT in sub-Saharan Africa, to assess the proportion of individuals accepting HBT and receiving their test result. Our initial search yielded 1,199 articles; 114 were reviewed as full-text articles, and 19 publications involving 21 studies (n = 524,867 individuals offered HBT) were included for final review and meta-analysis. The studies came from five countries: Uganda, Malawi, Kenya, South Africa, and Zambia. The proportion of people who accepted HBT (n = 474,377) ranged from 58.1% to 99.8%, with a pooled proportion of 83.3% (95% CI: 80.4%-86.1%). Heterogeneity was high (τ(2) = 0.11). Sixteen studies reported on the number of people who received the result of HBT (n = 432,835). The proportion of individuals receiving their results out of all those offered testing ranged from 24.9% to 99.7%, with a pooled proportion of 76.7% (95% CI: 73.4%-80.0%) (τ(2) = 0.12). HIV prevalence ranged from 2.9% to 36.5%. New diagnosis of HIV following HBT ranged from 40% to 79% of those testing positive. Forty-eight percent of the individuals offered testing were men, and they were just as likely to accept HBT as women (pooled odds ratio = 0.84; 95% CI: 0.56-1.26) (τ(2) = 0.33). The proportion of individuals previously tested for HIV among those offered a test ranged from 5% to 66%. Studies in which <30% of individuals had been previously tested, local HIV prevalence was <10%, incentives were provided, or HBT was offered to household members of HIV-positive individuals showed higher uptake of testing. No evidence was reported of negative consequences of HBT.HBT could substantially increase awareness of HIV status in previously undiagnosed individuals in sub-Saharan Africa, with over three-quarters of the studies in this review reporting >70% uptake. It could be a valuable tool for treatment and prevention efforts.http://europepmc.org/articles/PMC3514284?pdf=render |
| spellingShingle | Kalpana Sabapathy Rafael Van den Bergh Sarah Fidler Richard Hayes Nathan Ford Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Medicine |
| title | Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. |
| title_full | Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. |
| title_fullStr | Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. |
| title_full_unstemmed | Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. |
| title_short | Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. |
| title_sort | uptake of home based voluntary hiv testing in sub saharan africa a systematic review and meta analysis |
| url | http://europepmc.org/articles/PMC3514284?pdf=render |
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