Increasing uptake of HIV testing and counseling among the poorest in sub-Saharan countries: the role of home-based testing and counseling

Stephane Helleringer, Columbia University
James Mkandawire, Montfort Hospital, Malawi

Low uptake of HIV testing and counseling (HTC) at health facilities among the poorest in sub-Saharan countries may generate significant inequalities in access to ARV treatment. Existing facility-based strategies to increase HTC uptake such as routine testing may not reach the poorest. We offered home-based HTC services to 852 inhabitants of Likoma Island. Members of the poorest households were significantly less likely to have ever been tested at a health facility than the rest of the population, but were significantly more likely to accept home-based HTC services [OR=1.70]. Socioeconomic differences in uptake of home-based HTC were not due to underlying differences in sexual behaviors. While existing strategies to expand HIV testing (e.g., routine testing during health care) are unlikely to reach the poorest, home-based HTC may increase access to HIV prevention and ARV treatment among the poorest. It may help mitigate the impact of AIDS on the most vulnerable households.