Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial
Identifieur interne : 002C92 ( Main/Exploration ); précédent : 002C91; suivant : 002C93Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial
Auteurs : Tanya Doherty [Afrique du Sud] ; Hanani Tabana [Afrique du Sud, Suède] ; Debra Jackson [Afrique du Sud] ; Reshma Naik [États-Unis] ; Wanga Zembe [Afrique du Sud] ; Carl Lombard [Afrique du Sud] ; Sonja Swanevelder [Afrique du Sud] ; Matthew P. Fox [États-Unis] ; Anna Thorson [Suède] ; Anna Mia Ekström [Suède] ; Mickey Chopra [États-Unis]Source :
- BMJ : British Medical Journal [ 0959-8138 ] ; 2013-06-13.
Descripteurs français
- Wicri :
- topic : Collecte de données, Téléphone mobile, Santé publique, Essai, Zone urbaine.
English descriptors
- KwdEn :
- Baseline, Baseline differences, Baseline survey, Behaviour, Casual partner, Clinic, Cluster randomised, Communication survey, Community health workers, Community leaders, Composite indices, Confidence interval, Control areas, Control arms, Control clusters, Counselling, Counsellor, Couple counselling, Data collection, Data collectors, Design effect, Discordant couples, Drinking water source, Global aids epidemic, Guardian consent, Health facility, High levels, Higher uptake, Household members, Human sciences research council, Immediate antiretroviral therapy, Intervention, Intervention clusters, Intervention effect, Intimate partner violence, Intracluster correlation coefficient, June, Lancet, Local clinics, Local women, Main outcome, Mobile phone, More couples, Multiple partners, National antenatal sentinel, National community health workers, Participant, Past year, Prevalence, Prevalence ratio, Prevalence ratios, Primary outcome, Protective effect, Public health, Randomised, Randomised clusters, Reprint, Research council, Research table, Rural subdistrict, Secondary outcomes, Sexual behaviour, Sexual partner, Sexual risk behaviour, Sisonke district, Sisonke district department, Standard care, Stigma, Stigmatising behaviours, Study arms, Study period, Subdistrict, Syphilis prevalence survey, Test results, Testing, Testing campaign, Testing intervention, Testing services, Umzimkhulu subdistrict, Unaids, Unaids report, Urban area, World health, World health organization.
- Teeft :
- Baseline, Baseline differences, Baseline survey, Behaviour, Casual partner, Clinic, Cluster randomised, Communication survey, Community health workers, Community leaders, Composite indices, Confidence interval, Control areas, Control arms, Control clusters, Counselling, Counsellor, Couple counselling, Data collection, Data collectors, Design effect, Discordant couples, Drinking water source, Global aids epidemic, Guardian consent, Health facility, High levels, Higher uptake, Household members, Human sciences research council, Immediate antiretroviral therapy, Intervention, Intervention clusters, Intervention effect, Intimate partner violence, Intracluster correlation coefficient, June, Lancet, Local clinics, Local women, Main outcome, Mobile phone, More couples, Multiple partners, National antenatal sentinel, National community health workers, Participant, Past year, Prevalence, Prevalence ratio, Prevalence ratios, Primary outcome, Protective effect, Public health, Randomised, Randomised clusters, Reprint, Research council, Research table, Rural subdistrict, Secondary outcomes, Sexual behaviour, Sexual partner, Sexual risk behaviour, Sisonke district, Sisonke district department, Standard care, Stigma, Stigmatising behaviours, Study arms, Study period, Subdistrict, Syphilis prevalence survey, Test results, Testing, Testing campaign, Testing intervention, Testing services, Umzimkhulu subdistrict, Unaids, Unaids report, Urban area, World health, World health organization.
Abstract
Objective To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa. Design Cluster randomised controlled trial. Setting 16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa. Participants 4154 people aged 14 years or more who participated in a community survey. Intervention Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics. Main outcome measures Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care. Results Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73). Conclusions Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour. Trial registration Current Controlled Trials ISRCTN31271935.
Url:
DOI: 10.1136/bmj.f3481
Affiliations:
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Karolinska Institutet, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="Chopra, Mickey" sort="Chopra, Mickey" uniqKey="Chopra M" first="Mickey" last="Chopra">Mickey Chopra</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>UNICEF, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2013-06-13">2013-06-13</date><biblScope unit="volume">346</biblScope></imprint><idno type="ISSN">0959-8138</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Baseline</term><term>Baseline differences</term><term>Baseline survey</term><term>Behaviour</term><term>Casual partner</term><term>Clinic</term><term>Cluster randomised</term><term>Communication survey</term><term>Community health workers</term><term>Community leaders</term><term>Composite indices</term><term>Confidence interval</term><term>Control areas</term><term>Control arms</term><term>Control clusters</term><term>Counselling</term><term>Counsellor</term><term>Couple counselling</term><term>Data collection</term><term>Data collectors</term><term>Design effect</term><term>Discordant couples</term><term>Drinking water source</term><term>Global aids epidemic</term><term>Guardian consent</term><term>Health facility</term><term>High levels</term><term>Higher uptake</term><term>Household members</term><term>Human sciences research council</term><term>Immediate antiretroviral therapy</term><term>Intervention</term><term>Intervention clusters</term><term>Intervention effect</term><term>Intimate partner violence</term><term>Intracluster correlation coefficient</term><term>June</term><term>Lancet</term><term>Local clinics</term><term>Local women</term><term>Main outcome</term><term>Mobile phone</term><term>More couples</term><term>Multiple partners</term><term>National antenatal sentinel</term><term>National community health workers</term><term>Participant</term><term>Past year</term><term>Prevalence</term><term>Prevalence ratio</term><term>Prevalence ratios</term><term>Primary outcome</term><term>Protective effect</term><term>Public health</term><term>Randomised</term><term>Randomised clusters</term><term>Reprint</term><term>Research council</term><term>Research table</term><term>Rural subdistrict</term><term>Secondary outcomes</term><term>Sexual behaviour</term><term>Sexual partner</term><term>Sexual risk behaviour</term><term>Sisonke district</term><term>Sisonke district department</term><term>Standard care</term><term>Stigma</term><term>Stigmatising behaviours</term><term>Study arms</term><term>Study period</term><term>Subdistrict</term><term>Syphilis prevalence survey</term><term>Test results</term><term>Testing</term><term>Testing campaign</term><term>Testing intervention</term><term>Testing services</term><term>Umzimkhulu subdistrict</term><term>Unaids</term><term>Unaids report</term><term>Urban area</term><term>World health</term><term>World health organization</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Baseline</term><term>Baseline differences</term><term>Baseline survey</term><term>Behaviour</term><term>Casual partner</term><term>Clinic</term><term>Cluster randomised</term><term>Communication survey</term><term>Community health workers</term><term>Community leaders</term><term>Composite indices</term><term>Confidence interval</term><term>Control areas</term><term>Control arms</term><term>Control clusters</term><term>Counselling</term><term>Counsellor</term><term>Couple counselling</term><term>Data collection</term><term>Data collectors</term><term>Design effect</term><term>Discordant couples</term><term>Drinking water source</term><term>Global aids epidemic</term><term>Guardian consent</term><term>Health facility</term><term>High levels</term><term>Higher uptake</term><term>Household members</term><term>Human sciences research council</term><term>Immediate antiretroviral therapy</term><term>Intervention</term><term>Intervention clusters</term><term>Intervention effect</term><term>Intimate partner violence</term><term>Intracluster correlation coefficient</term><term>June</term><term>Lancet</term><term>Local clinics</term><term>Local women</term><term>Main outcome</term><term>Mobile phone</term><term>More couples</term><term>Multiple partners</term><term>National antenatal sentinel</term><term>National community health workers</term><term>Participant</term><term>Past year</term><term>Prevalence</term><term>Prevalence ratio</term><term>Prevalence ratios</term><term>Primary outcome</term><term>Protective effect</term><term>Public health</term><term>Randomised</term><term>Randomised clusters</term><term>Reprint</term><term>Research council</term><term>Research table</term><term>Rural subdistrict</term><term>Secondary outcomes</term><term>Sexual behaviour</term><term>Sexual partner</term><term>Sexual risk behaviour</term><term>Sisonke district</term><term>Sisonke district department</term><term>Standard care</term><term>Stigma</term><term>Stigmatising behaviours</term><term>Study arms</term><term>Study period</term><term>Subdistrict</term><term>Syphilis prevalence survey</term><term>Test results</term><term>Testing</term><term>Testing campaign</term><term>Testing intervention</term><term>Testing services</term><term>Umzimkhulu subdistrict</term><term>Unaids</term><term>Unaids report</term><term>Urban area</term><term>World health</term><term>World health organization</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Collecte de données</term><term>Téléphone mobile</term><term>Santé publique</term><term>Essai</term><term>Zone urbaine</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa. Design Cluster randomised controlled trial. Setting 16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa. Participants 4154 people aged 14 years or more who participated in a community survey. Intervention Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics. Main outcome measures Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care. Results Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73). Conclusions Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour. Trial registration Current Controlled Trials ISRCTN31271935.</div></front></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Suède</li><li>États-Unis</li></country><region><li>Massachusetts</li><li>Svealand</li><li>État de New York</li></region><settlement><li>Stockholm</li></settlement></list><tree><country name="Afrique du Sud"><noRegion><name sortKey="Doherty, Tanya" sort="Doherty, Tanya" uniqKey="Doherty T" first="Tanya" last="Doherty">Tanya Doherty</name></noRegion><name sortKey="Doherty, Tanya" sort="Doherty, Tanya" uniqKey="Doherty T" first="Tanya" last="Doherty">Tanya Doherty</name><name sortKey="Doherty, Tanya" sort="Doherty, Tanya" uniqKey="Doherty T" first="Tanya" last="Doherty">Tanya Doherty</name><name sortKey="Jackson, Debra" sort="Jackson, Debra" uniqKey="Jackson D" first="Debra" last="Jackson">Debra Jackson</name><name sortKey="Lombard, Carl" sort="Lombard, Carl" uniqKey="Lombard C" first="Carl" last="Lombard">Carl Lombard</name><name sortKey="Swanevelder, Sonja" sort="Swanevelder, Sonja" uniqKey="Swanevelder S" first="Sonja" last="Swanevelder">Sonja Swanevelder</name><name sortKey="Tabana, Hanani" sort="Tabana, Hanani" uniqKey="Tabana H" first="Hanani" last="Tabana">Hanani Tabana</name><name sortKey="Zembe, Wanga" sort="Zembe, Wanga" uniqKey="Zembe W" first="Wanga" last="Zembe">Wanga Zembe</name></country><country name="Suède"><region name="Svealand"><name sortKey="Tabana, Hanani" sort="Tabana, Hanani" uniqKey="Tabana H" first="Hanani" last="Tabana">Hanani Tabana</name></region><name sortKey="Ekstrom, Anna Mia" sort="Ekstrom, Anna Mia" uniqKey="Ekstrom A" first="Anna Mia" last="Ekström">Anna Mia Ekström</name><name sortKey="Thorson, Anna" sort="Thorson, Anna" uniqKey="Thorson A" first="Anna" last="Thorson">Anna Thorson</name></country><country name="États-Unis"><region name="Massachusetts"><name sortKey="Naik, Reshma" sort="Naik, Reshma" uniqKey="Naik R" first="Reshma" last="Naik">Reshma Naik</name></region><name sortKey="Chopra, Mickey" sort="Chopra, Mickey" uniqKey="Chopra M" first="Mickey" last="Chopra">Mickey Chopra</name><name sortKey="Fox, Matthew P" sort="Fox, Matthew P" uniqKey="Fox M" first="Matthew P" last="Fox">Matthew P. 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