BMC Infectious Diseases
Volume 18, Issue 1, 2018

Feasibility and acceptability of home-based HIV testing among refugees: A pilot study in Nakivale refugee settlement in southwestern Uganda (Article) (Open Access)

O'Laughlin K.N.* , He W. , Greenwald K.E. , Kasozi J. , Chang Y. , Mulogo E. , Faustin Z.M. , Njogu P. , Walensky R.P. , Bassett I.V.
  • a Brigham and Women's Hospital, Department of Emergency Medicine, 75 Francis Street, Boston, MA 02115, United States, Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States, Harvard Medical School, Boston, MA 02114-2698, United States, Harvard Humanitarian Initiative, Cambridge, MA, United States
  • b Massachusetts General Hospital, Division of General Medicine, 50 Staniford St, Suite 560, Boston, MA 02114-2698, United States
  • c Harvard Affiliated Emergency Medicine Residency, 75 Francis Street, Boston, MA 02115, United States
  • d United Nations High Commissioner for Refugees, Representation in Uganda, P.O. Box 3813, Kampala, Uganda
  • e Harvard Medical School, Boston, MA 02114-2698, United States, Massachusetts General Hospital, Division of General Medicine, 50 Staniford St, Suite 560, Boston, MA 02114-2698, United States
  • f Mbarara University of Science and Technology, Department of Community Health, P.O Box 1410, Mbarara, Uganda
  • g Bugema University, Kasese Campus, P.O. Box 6529, Kampala, Uganda
  • h United Nations High Commissioner for Refugees, Representation in Kenya, P.O. Box 43801-00100, Nairobi, Kenya
  • i Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States, Harvard Medical School, Boston, MA 02114-2698, United States, Massachusetts General Hospital, Division of Infectious Disease, 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States, Brigham and Women's Hospital, Division of Infectious Disease, 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States, Harvard University Center for AIDS Research (CFAR), 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States
  • j Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States, Harvard Medical School, Boston, MA 02114-2698, United States, Massachusetts General Hospital, Division of Infectious Disease, 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States, Harvard University Center for AIDS Research (CFAR), 50 Staniford St, 9th Floor, Boston, MA 02114-2698, United States

Abstract

Background: Refugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale. Methods: From February-March 2014, we visited homes in 3 villages in Nakivale up to 3 times and offered HIV testing. We enrolled adults who spoke English, Kiswahili, Kinyarwanda, or Runyankore; some were refugees and some Ugandan nationals. We surveyed them about their socio-demographic characteristics. We evaluated the proportion of individuals encountered (feasibility) and assessed participation in HIV testing among those encountered (acceptability). We compared characteristics of home-based and clinic-based testers (from a prior study in Nakivale) using Wilcoxon rank sum and Pearson's chi-square tests. We examined the relationship between a limited number of factors (time of visit, sex, and number of individuals at home) on willingness to test, using logistic regression models with the generalized estimating equations approach to account for clustering. Results: Of 566 adults living in 319 homes, we encountered 507 (feasibility = 90%): 353 (62%) were present at visit one, 127 (22%) additional people at visit two, and 27 (5%) additional people at visit three. Home-based HIV testing participants totaled 378 (acceptability = 75%). Compared to clinic-based testers, home-based testers were older (median age 30 [IQR 24-40] vs 28 [IQR 22-37], p < 0.001), more likely refugee than Ugandan national (93% vs 79%, < 0.001), and more likely to live ≥1 h from clinic (74% vs 52%, < 0.001). The HIV prevalence was lower, but not significantly, in home-based compared to clinic-based testing participants (1.9 vs 3.4% respectively, p = 0.27). Testing was not associated with time of visit (p = 0.50) or sex (p = 0.66), but for each additional person at home, the odds of accepting HIV testing increased by over 50% (OR 1.52, 95%CI 1.12-2.06, p = 0.007). Conclusions: Home-based HIV testing in Nakivale Refugee Settlement was feasible, with 90% of eligible individuals encountered within 3 visits, and acceptable with 75% willing to test for HIV, with a yield of nearly 2% individuals tested identified as HIV-positive. © 2018 The Author(s).

Author Keywords

HIV testing Uganda Displaced population Home-based HIV testing Refugees HIV Humanitarian

Index Keywords

household HIV Infections diagnostic kit refugee Human immunodeficiency virus infection home care human Refugees middle aged controlled study Logistic Models screening test Feasibility Studies intermethod comparison Human immunodeficiency virus prevalence Uganda Surveys and Questionnaires Humans chi square distribution male Chi-Square Distribution female pilot study evaluation study questionnaire refugee camp prevalence Article feasibility study major clinical study adult Ugandan Direct-To-Consumer Screening and Testing statistical model Reagent Kits, Diagnostic sex Pilot Projects
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85050086955&doi=10.1186%2fs12879-018-3238-y&partnerID=40&md5=1b3fbbfbf534bcd2f136fc2831b51c20
DOI: 10.1186/s12879-018-3238-y
ISSN: 14712334
Original Language: English