Evaluation of a home-based voluntary counselling and testing intervention in rural Uganda
Evaluation of a home-based voluntary counselling and testing intervention in rural Uganda
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DOI：
10.1093/heapol/czi013
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发表时间：
2005-03-01
影响因子：
3.2
通讯作者：
Whitworth, J
中科院分区：
文献类型：
--
作者：
Wolff, B;Nyanzi, B;Whitworth, J
背景：自项目开始以来，乌干达西南部农村地区一项人群研究队列的年度血清调查的艾滋病毒检测结果的摄取率从未超过10%。2001年血清学调查后，在4个研究村进行了家庭咨询和HIV检测结果的干预，然后进行了定性评估，探讨了需求的性质和了解HIV状况的障碍。方法：对每年的血清学调查和咨询师记录进行分析，以评估干预对HIV检测结果接受的影响。文本数据分析来自21个焦点小组讨论的咨询师，以及那些已经收到艾滋病毒检测结果、要求但尚未收到和从未要求的男性和女性；34个深度访谈在那些从咨询办公室和家庭收到检测结果的人中平均分配。结果：在家中提供艾滋病毒结果显著增加了所有15岁成年人(P<；0.001)和25岁至54岁的46%的人对结果的接受程度，从10%到37%(p<；0.001)。以前男性在吸收测试结果方面的优势被有效地消除了。焦点小组讨论和深入访谈强调了在干预前从高能见度的公共设施获得艾滋病毒检测结果的大量非货币成本。家庭自愿咨询和检测(VCT)相对流行的最常见原因是不便、害怕被污名化以及从公共设施接收结果时的情绪脆弱性。这被认为不太适合年轻人和对检测持不同态度的夫妇。结论：送货上门的结果显示，与过去顽固的低吸毒率数据相比，人们对了解艾滋病毒状况的需求明显更高。将VCT整合到其他服务中，将测试中心设在较不显眼的环境中，或者直接面对测试周围的耻辱，可能是通过家庭VCT实现更高接受度的成本较低的方法。
Background: Uptake of HIV test results from an annual serosurvey of a population study cohort in rural southwestern Uganda had never exceeded 10% in any given year since inception in 1989. An intervention offering counselling and HIV results at home was conducted in four study villages following the 2001 serosurvey round, and followed by a qualitative evaluation exploring nature of demand and barriers to knowing HIV status.Methods: Data from annual serosurveys and counsellor records are analyzed to estimate the impact of the intervention on uptake of HIV test results. Textual data are analyzed from 21 focus group discussions among counsellors, and men and women who had received HIV test results, requested but not yet received, and never requested; and 34 in-depth interviews equally divided among those who had received test results either from counselling offices and homes.Results: Offering HIV results at home significantly increased uptake of results from 10 to 37% for all adults aged 15 (p < 0.001), and 46% of those age 25 to 54. Previous male advantage in uptake of test results was effectively eliminated. Focus group discussions and in-depth interviews highlight substantial non-monetary costs of getting HIV results from high-visibility public facilities prior to intervention. Inconvenience, fear of stigmatization, and emotional vulnerability of receiving results from public facilities were the most common explanations for the relative popularity of home-based voluntary counselling and testing (VCT). It is seen as less appropriate for youth and couples with conflicting attitudes toward testing.Conclusions: Home delivery of results revealed significantly higher demand to know HIV status than stubbornly low uptake figures from the past would suggest. Integrating VCT into other services, locating testing centres in less visible surroundings, or directly confronting stigma surrounding testing may be less expensive ways to reproduce increased uptake with home VCT.