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Home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. Sabapathy K 1 , Van den Bergh R 2 , Fidler S 3 , Hayes R 1 , Ford N 4

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Home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

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  1. Home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis Sabapathy K1, Van den Bergh R2, Fidler S3, Hayes R1, Ford N4 1. London School of Hygiene and Tropical Medicine, 2. Medecins Sans Frontieres (Brussels), 3. Imperial College London, 4. Medecins Sans Frontieres (Geneva) XIX INTERNATIONAL AIDS CONFERENCE July 2012, Washington D.C

  2. Background • Imperative to scale-up knowledge of HIV status • HBT removes physical barriers to access • Systematic review and meta-analysis • ‘Accepted testing’ (uptake) • ‘Received result overall’ (knowledge of status) • Sub-group analyses • Setting • Timing of study • Local HIV prevalence • Proportion previously tested • Incentives • Sensitisation campaign • Immediate result • Targettedtesting of household • member of HIV positive

  3. Results • 1200 articles  21 studies • Uganda, Malawi, Kenya, SA, Zambia • Local HIV prevalence estimates 4 – 22% • Proportion HIV +ve in studies 3 – 37% • Men comprised 48% offered HBT • Odds ratio of men testing: 0.84 (95% C.I. 0.56 - 1.27) • 5 – 66% previously tested

  4. Results Proportion who accepted HBT (N=474,516): 58.1% - 100%, Pooled proportion: 83.8% (95%CI: 80.9 - 86.6%) (20.13) Proportion who received result of HBT (N=432,835): 24.9% - 99.7%, Pooled proportion: 77.4% (95%CI: 74.0 – 80.7%) (20.12)

  5. Sub-group analyses No difference in uptake • Rural or urban • < 2005 or ≥ 2005 • Report of sensitisation campaign • Immediate result Increased uptake • <10% local HIV prevalence • <30% study population previously tested • Incentives • HBT for household member of HIV positive

  6. Conclusion • HBT achieves high uptake of testing & knowledge of HIV status • HBT reaches men and women • 40 -79% new diagnoses • No evidence of harm

  7. Recommendations Future research: • Role of HBT in repeated testing • Use of self-testing as part of HBT campaigns • Linkage to care & retention after HBT • Cost effectiveness in making new diagnoses Policy: • Voluntary HBT should be a key tool for increasing knowledge of HIV status, for treatment and prevention endeavours

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