HIV This Week

Obare F, Fleming P, Anglewicz P, Thornton R, Martinson F, Kapatuka A, Poulin M, Watkins S, Kohler HP. Acceptance of repeat population-based voluntary counseling and testing for HIV in rural Malawi. Sex Transm Infect 2008 Oct 16. [Epub ahead of print]

Obare and colleagues set out to examine the acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi. Behavioural and biomarker data were collected in 2004 and 2006 from approximately 3,000 adult respondents. In 2004, oral swab specimens were collected and analyzed using enzyme-linked immunosorbent assay (ELISA) and confirmatory Western blot tests while finger-prick rapid testing was done in 2006. The authors use cross-tabulations with chi-square tests and significance tests of proportions to determine the statistical significance of differences in acceptance of voluntary counselling and testing by year, individual characteristics, and HIV risk. First, over 90% of respondents in each round accepted HIV test, despite variations in testing protocols. Second, the percentage of individuals who obtained their test results significantly increased from 67% in 2004 when the results were provided in randomly selected locations several weeks after the specimens were collected, to 98% in 2006 when they were made available immediately within the home. Third, whereas there were significant variations in the socio-demographic and behavioural profiles of those who were successfully contacted for a second HIV test, this was not the case for those who accepted repeat voluntary counselling and testing. This suggests that variations in the success of repeat testing might come from contacting the individuals rather than from accepting the test or knowing the results. Repeat HIV testing at home by trained health care workers from outside the local area, and with either saliva or blood, is almost universally acceptable in rural Malawi, and thus likely to be acceptable in similar contexts.

Editors’ note: Both the distance people must travel to receive their HIV results and the delay between the time of testing and availability of results can reduce the numbers of people who receive their test results. This study reveals persistently high HIV testing acceptance levels when people are offered at-home testing and immediate test results. Reasons for this may include both reduced transport costs and the perception that at-home testing is more confidential than clinic-based testing.