1. Home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis Sabapathy K 1, Van den Bergh R 2, Fidler S 3, Hayes R 1, Ford N 4 1. London School of Hygiene and Tropical Medicine, 2. Medecins Sans Frontieres (Brussels), 3. Imperial College London, 4. Medecins Sans Frontieres (Geneva) XIX INTERNATIONAL AIDS CONFERENCE July 2012, Washington D.C

2. Background Imperative to scale-up knowledge of HIV status HBT removes physical barriers to access  Systematic review and meta-analysis ‘Accepted testing’ (uptake) ‘Received result overall’ (knowledge of status) Sub-group analyses Setting Timing of study Local HIV prevalence Proportion previously tested Incentives Sensitisation campaign Immediate result Targetted testing of household member of HIV positive

3. Results 1200 articles  21 studies Uganda, Malawi, Kenya, SA, Zambia Local HIV prevalence estimates 4 – 22% Proportion HIV +ve in studies 3 – 37% Men comprised 48% offered HBT Odds ratio of men testing: 0.84 (95% C.I. 0.56 - 1.27) 5 – 66% previously tested

4. Results Proportion who received result of HBT (N=432,835): 24.9% - 99.7%, Pooled proportion: 77.4% (95%CI: 74.0 – 80.7%) (  2 0.12) Proportion who accepted HBT (N=474,516): 58.1% - 100%, Pooled proportion: 83.8% (95%CI: 80.9 - 86.6%) (  2 0.13)

5. Sub-group analyses No difference in uptake Rural or urban < 2005 or ≥ 2005 Report of sensitisation campaign Immediate result Increased uptake <10% local HIV prevalence <30% study population previously tested Incentives HBT for household member of HIV positive

6. Conclusion HBT achieves high uptake of testing & knowledge of HIV status HBT reaches men and women 40 -79% new diagnoses No evidence of harm

7. Recommendations Future research: Role of HBT in repeated testing Use of self-testing as part of HBT campaigns Linkage to care & retention after HBT Cost effectiveness in making new diagnoses Policy: Voluntary HBT should be a key tool for increasing knowledge of HIV status, for treatment and prevention endeavours