Home Based HIV Counseling and testing to optimize HIV identification, Kampala, Uganda Cecilia Nawavvu Co-authors Rhoda Wanyenze, Janeva Busingye, Joseph Ouma, Allan Wanzusi and Alice Namale XVII International AIDS Conference, 6 th August 2008, Mexico City.

Outline MJAP HIV services Home based HIV Counseling and testing (HBHCT) services Results Challenges Conclusions & recommendations

MJAP HIV services HBHCT implemented under Mulago-Mbarara Teaching Hospitals’ Joint AIDS Program (MJAP) MJAP is a partnership Mulago and Mbarara Teaching Hospitals MJAP also provides –Routine HIV counseling and testing (RCT) - Also called Provider initiated testing and counseling (PITC) –HIV care including antiretroviral therapy (ART) –Integrated TB/HIV services –Capacity building for HIV care and treatment

Background to HCT services Free patient HIV testing was limited prior to MJAP initiatives –Nov started free Hospital based PITC High HIV prevalence among patients’ family members (≈ 24%) –Oct 2005 piloted HBHCT for index HIV positive individuals

HBHCT procedures Household members of index HIV infected clients attending 3 urban clinics in Kampala Visited household if index client: –Consented to be visited –Had disclosed sero-status to household member –Requested counselor assisted disclosure –Had ART adherence concerns

HBHCT services HIV/AIDS education to household members Individual pre-and post-test counseling Test adults >18 yrs if: –Unknown HIV status –Tested negative 6 weeks earlier, with risky exposure - unprotected sex with partner of unknown HIV status Children < 12 yrs tested if biological mother is HIV positive or dead

HIV/AIDS health education

Consent procedures Adults provide written consent Children aged <12 years -Parents or guardians consent Children aged years -Consent by parents/guardians -Assent by children

HIV testing Serial rapid testing –Determine, Statpak and Unigold Results given before leaving household Children <18 months: DNA PCR HIV positives receive Co-trimoxazole and referrals for HIV care Quality control – Dry blood spot (DBS) –All positives and every 20 th negative result

HIV testing at home

Results Visited 1,452 households between 10/2005 to 10/2007 Majority (75%) of index clients females – 4,661 eligible household members counseled –4,174 (≈90%) consented to test 1,597 adults (≥18yrs) 2,577 Children (<18 yrs)

HIV Prevalence excludes index patient; much higher than population prevalence (Uganda HIV sero-behavioural survey-UHSBS, 2004/5)

HIV prevalence among children Age group (yrs) Number testedPositivePrevalence ≤ Totals2, HIV Prevalence twice the population prevalence of 2.2% - UHSBS, 2004/5.

Challenges Privacy High demand - neighbors interested in testing High cost of providing test at home Stigma Still very few test as couples Misses –School going children –Index patients who have not disclosed or requested counselor- assisted disclosure Needs of orphans and vulnerable children not fully addressed Males hard to reach

Conclusions & recommendations Testing in homes highly acceptable in a crowded urban setting More HIV infections identified within the households of index HIV clients –Adults and children under five Need to integrate testing of family members in HIV care programs Test neighbours who demand the services

Acknowledgements PEPFAR/CDC Uganda Ministry of Health Mulago Hospital and Complex MJAP Staff/ HBHCT staff Community members