Home-based HIV counseling and testing: client experiences and perceptions in Eastern Uganda.

Area of Science:

• Public Health
• Infectious Disease Research
• Health Services Research

Background:

• HIV testing uptake remains low in Sub-Saharan Africa, hindering prevention and treatment efforts.
• Home-Based HIV Counseling and Testing (HBHCT) is an initiative to improve access, but ethical concerns regarding consent, confidentiality, and post-test care persist.
• This study investigates client experiences with HBHCT concerning ethical considerations in Uganda.

Purpose of the Study:

• To explore client experiences with Home-Based HIV Counseling and Testing (HBHCT) in relation to ethical practices.
• To assess the uptake, satisfaction, and adherence to ethical standards of HBHCT services.
• To identify challenges and successes in accessing HIV care following HBHCT.

Main Methods:

• Conducted 395 individual interviews in Kumi district, Uganda, with clients who received HBHCT 6-12 months prior.
• Utilized semi-structured questionnaires to gather data on client experiences from community mobilization to post-test care access.
• Focused on ethical aspects including consent, confidentiality, counseling, and linkage to HIV services.

Main Results:

• Achieved a 95% HIV testing uptake among approached individuals, significantly higher than the Ugandan average (38%).
• 98% were informed of their right to decline testing; 94% were satisfied with counseling and provider interaction, with homes perceived as more private than facilities.
• Of 12 positive cases, 7 accessed follow-up care, and all married/cohabiting individuals disclosed their status to partners.

Conclusions:

• HBHCT demonstrates high effectiveness in increasing HIV testing uptake and satisfaction, and facilitates partner disclosure.
• The model shows promise in overcoming barriers to HIV testing and addressing disclosure challenges in Sub-Saharan Africa.
• Ensuring adequate access to post-test HIV services and care remains a critical area for improvement.