South African Medical Research Council, Francie van Zijl Drive, Parrowvallei, Tygerberg, South Africa.
BMC Public Health. 2012 Sep 25;12:824. doi: 10.1186/1471-2458-12-824.
BACKGROUND: HIV counselling and testing (HCT) is a critical gateway for addressing HIV prevention and linking people to treatment, care, and support. Since national testing rates are often less than optimal, there is growing interest in expanding testing coverage through the implementation of innovative models such as home-based HIV counselling and testing (HBHCT). With the aim of informing scale up, this paper discusses client characteristics and acceptability of an HBHCT intervention implemented in rural South Africa. METHODS: Trained lay counsellors offered door-to-door rapid HIV testing in a rural sub-district of KwaZulu-Natal, South Africa. Household and client data were captured on cellular phones and transmitted to a web-based data management system. Descriptive analysis was undertaken to examine client characteristics, testing history, HBHCT uptake, and reasons for refusal. Chi-square tests were performed to assess the association between client characteristics and uptake. RESULTS: Lay counsellors visited 3,328 households and tested 75% (5,086) of the 6,757 people met. The majority of testers (73.7%) were female, and 57% had never previously tested. With regard to marital status, 1,916 (37.7%), 2,123 (41.7%), and 818 (16.1%) were single, married, and widowed, respectively. Testers ranged in age from 14 to 98 years, with a median of 37 years. Two hundred and twenty-nine couples received couples counselling and testing; 87.8%, 4.8%, and 7.4% were concordant negative, concordant positive, and discordant, respectively. There were significant differences in characteristics between testers and non-testers as well as between male and female testers. The most common reasons for not testing were: not being ready/feeling scared/needing to think about it (34.1%); knowing his/her status (22.6%), being HIV-positive (18.5%), and not feeling at risk of having or acquiring HIV (10.1%). The distribution of reasons for refusal differed significantly by gender and age. CONCLUSIONS: These findings indicate that HBHCT is acceptable in rural South Africa. However, future HBHCT programmes should carefully consider community context, develop strategies to reach a broad range of clients, and tailor intervention messages and services to meet the unique needs of different sub-groups. It will also be important to understand and address factors related to refusal of testing.
背景：艾滋病咨询和检测（HCT）是解决艾滋病预防问题并将人们与治疗、护理和支持联系起来的关键途径。由于全国检测率往往不够理想，因此越来越有兴趣通过实施创新模式（如家庭艾滋病咨询和检测（HBHCT））来扩大检测范围。本文旨在为扩大规模提供信息，讨论了在南非农村实施的 HBHCT 干预措施的客户特征和可接受性。
方法：经过培训的非专业咨询师在南非夸祖鲁-纳塔尔省的一个农村分区进行挨家挨户的快速 HIV 检测。家庭和客户数据通过手机捕获并传输到基于网络的数据管理系统。采用描述性分析方法检查客户特征、检测史、HBHCT 参与情况和拒绝原因。使用卡方检验评估客户特征与参与度之间的关联。
结果：非专业咨询师共访问了 3328 户家庭，对 6757 名符合条件的人中的 75%（5086 人）进行了检测。大多数测试者（73.7%）为女性，57%的人以前从未接受过检测。就婚姻状况而言，分别有 1916 人（37.7%）、2123 人（41.7%）和 818 人（16.1%）为单身、已婚和丧偶。测试者年龄在 14 至 98 岁之间，中位数为 37 岁。229 对夫妇接受了夫妇咨询和检测；87.8%、4.8%和 7.4%的检测结果分别为阴性一致、阳性一致和不一致。测试者和非测试者之间以及男女测试者之间的特征存在显著差异。未接受检测的最常见原因是：未准备好/感到害怕/需要考虑（34.1%）；知道自己的状况（22.6%）、HIV 阳性（18.5%）和不认为自己有或可能感染 HIV 的风险（10.1%）。拒绝检测的原因分布因性别和年龄而异。
结论：这些发现表明 HBHCT 在南非农村地区是可以接受的。然而，未来的 HBHCT 计划应仔细考虑社区背景，制定策略以覆盖广泛的客户群体，并根据不同亚组的独特需求调整干预信息和服务。了解和解决与拒绝检测相关的因素也很重要。
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