Medical Research Council, Parow, Cape Town, 7535, South Africa.
BMJ. 2013 Jun 13;346:f3481. doi: 10.1136/bmj.f3481.
To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa.
Cluster randomised controlled trial.
16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa.
4154 people aged 14 years or more who participated in a community survey.
Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics.
Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care.
Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73).
Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour.
Current Controlled Trials ISRCTN31271935.
评估基于家庭的艾滋病毒咨询和检测对南非一个农村分区的艾滋病毒检测流行率和报告行为变化的影响。
整群随机对照试验。
南非夸祖鲁-纳塔尔省乌姆齐姆库鲁分区的 16 个社区（群集）。
参加社区调查的 4154 名 14 岁及以上的人。
初级保健员进行挨家挨户的外展服务，并向所有同意的成年人和 14-17 岁的青少年提供基于家庭的艾滋病毒咨询和检测，并征得监护人同意。对照群集接受标准护理，包括在当地诊所提供艾滋病毒咨询和检测服务。
主要结果测量是艾滋病毒检测的流行率。其他结果包括艾滋病毒意识、耻辱感、性行为、易受暴力侵害的程度以及获得护理的机会。
总体而言，在研究期间，基于家庭的艾滋病毒咨询和检测组的参与者中有 69%接受了艾滋病毒检测，而对照组的参与者中有 47%接受了检测（流行率比 1.54，95%置信区间 1.32 至 1.81）。与对照组相比，干预组中更多的夫妇一起接受了咨询和检测（2.24，1.49 至 3.03）。该干预措施的效果超出了艾滋病毒检测范围，具有多重性伴侣减少 55%（0.45，0.33 至 0.62）的效果，并且在接受艾滋病毒检测的人群中效果更强（0.37，0.24 至 0.58），以及减少偶然性伴侣 45%（0.55，0.42 至 0.73）。
在一个具有高度耻辱感的农村环境中，基于家庭的艾滋病毒咨询和检测增加了艾滋病毒检测的流行率。益处还包括更多的夫妇接受咨询和检测，以及减少性风险行为。
当前对照试验 ISRCTN31271935。
