Acceptability and Uptake of Repeat Home-based HIV Counselling and Testing in Rural South Africa. Preliminary Data of the ANRS 12249 TasP Trial

Authors

Joseph Larmarange^1,2 Joanna Orne-Gliemann³ Collins Iwuji¹ John Imrie^1,4 France Lert⁵ François Dabis³ Marie-Louise Newell^1,6 for the ANRS 12249 TasP Study Group

1. Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa.
2. Centre Population et Développement (CEPED UMR 196 Université Paris Descartes Ined IRD), France.
3. INSERM / University of Bordeaux Segalen, ISPED, Centre Inserm U897- Épidemiologie-Biostatistique, France.
4. Centre for Sexual Health and HIV Research, University College of London, United Kingdom.
5. CESP (Inserm Unité 1018), Villejuif, France.
6. Faculty of Medicine, University of Southampton, United Kingdom.

Abstract

Background

The ANRS 12249 Treatment as Prevention (TasP) trial is assessing whether HIV testing of all members of a community, followed by immediate ART initiation of all HIV-infected individuals, regardless of immunological or clinical staging, will prevent onward sexual transmission and reduce HIV incidence in the same population. The implementation of universal and repeat home-based HIV testing is not documented yet in a high HIV incidence and prevalence context.

Methods

A cluster-randomised trial is implemented using a phased-approach in the Hlabisa sub-district (KwaZulu Natal, South Africa) where more than 20% of adults are living with HIV. The trial started in March 2012; ten clusters are implemented in the first phase to assess the feasibility and acceptability of the two consecutive interventions (test then treat). The HIV testing strategy consists in a large range of community and clinic HIV testing options including the implementation of 6-monthly rounds of home-based HIV counselling and testing by dedicated counsellors. At each home visit, trial participants are administered individual questionnaires and offered a rapid HIV test.

Results

As of April 30, 2013, 6 907 eligible subjects (16 years or above) were registered in six clusters and 5 122 (74%) were contacted. HIV status of 3 923 (76.5% of those contacted) was ascertained, 3 256 accepting the rapid HIV test at home and 667 being already aware of their HIV-positive status. We will present updated data from the first four trial clusters, where all eligible members of the community will have been offered three rounds of home-based HIV testing within 18 months. Uptake of HIV testing at each round will be reported. Uptake of repeat HIV testing will be measured among those testing HIV-negative at first round and who accept repeat HIV testing at rounds 2 and 3. We will also describe the reasons for HIV test refusal. Finally, we will present participants’ attitudes regarding repeat HIV testing, and changes between rounds 1 and 3.

Conclusions

Acceptance of regular and frequent HIV testing is key to the community-based efficacy of treatment as prevention initiatives in settings with very high incidence. Our data will provide first indications of whether repeat home-based HIV testing is acceptable and feasible in such a rural South African region.

Reference

Larmarange Joseph, Orne-Gliemann Joanna, Iwuji Collins, Imrie John, Lert France, Dabis François, Newell Marie-Louise and ANRS 12249 TasP Study Group (2013) “Acceptability and Uptake of Repeat Home-based HIV Counselling and Testing in Rural South Africa. Preliminary Data of the ANRS 12249 TasP Trial” (poster n°2406992), presented at the 17th International Conference on AIDS and STIs in Africa (ICASA), Cape Town.