Wolff Brent, Nyanzi Barbara, Katongole George, Ssesanga Deo, Ruberantwari Anthony, Whitworth Jimmy
Medical Research Council, P.O. 49, Entebbe, Uganda.
Health Policy Plan. 2005 Mar;20(2):109-16. doi: 10.1093/heapol/czi013.
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.
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.
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.
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.
自1989年开展以来，乌干达西南部农村地区一项人群研究队列的年度血清学调查中，每年的艾滋病毒检测结果知晓率从未超过10%。在2001年血清学调查轮次之后，在四个研究村庄开展了一项在家中提供咨询和艾滋病毒检测结果的干预措施，并随后进行了一项定性评估，以探究需求的性质以及了解艾滋病毒感染状况的障碍。
分析年度血清学调查和咨询记录的数据，以评估干预措施对艾滋病毒检测结果知晓率的影响。对来自咨询师、已收到艾滋病毒检测结果者、已申请但尚未收到检测结果者以及从未申请者的21次焦点小组讨论的文本数据进行分析；对同样来自已从咨询办公室和家中收到检测结果者的34次深入访谈的数据进行分析。
在家中提供艾滋病毒检测结果显著提高了所有15岁及以上成年人的结果知晓率，从10%提高到37%（p < 0.001），25至54岁人群中的知晓率为46%。以往男性在检测结果知晓率方面的优势被有效消除。焦点小组讨论和深入访谈凸显了在干预措施实施之前，从高知名度公共机构获取艾滋病毒检测结果存在大量非货币成本。不便、担心被污名化以及在公共机构接收检测结果时的情感脆弱性是基于家庭的自愿咨询和检测（VCT）相对更受欢迎的最常见原因。对于青少年以及对检测持矛盾态度的夫妇而言，这种方式被认为不太合适。
上门送达检测结果显示，了解艾滋病毒感染状况的需求显著高于过去一直很低的知晓率数据所表明的情况。将VCT整合到其他服务中、将检测中心设置在不太显眼的地方，或者直接应对检测相关的污名化问题，可能是以较低成本重现家庭VCT带来的知晓率提高的方式。
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