Feasibility of Scaling Up Home-Based HIV Counselling and Testing among Women Delivering at Home: A Geita District Council Case, Tanzania

Author(s): Juma Adinan, Caroline Amour, Paulo L. Kidayi, Levina Msuya

Year: 2018

Abstract:

Background: Major progress has been made in implementing prevention of mother-to-child transmission of HIV (PMTCT) interventions in sub-Saharan Africa (SSA) over the past 10 years. However, new pediatric infections remain unacceptably high, contributing to over 90 percent of the estimated 390,000 infections globally in 2010 (United States Agency for International Development [USAID], 2010). About half (49%) of women in Tanzania do not deliver at health facilities, where those who are HIV-positive can be enrolled for PMTCT services (Tanzania Demographic Health Survey, 2012). Data on prevalence of HIV infection among women delivering at home (WDH) are scant. Studies have reported seroconversion among pregnant women who initially had negative HIV test results at an antenatal care (ANC) visit (Gay, et al., 2010; Oladeinde, et al., 2011; Mbena, et al., 2014; De Schacht, et al., 2014). A similar situation can happen to other women who deliver at home. Delivering at home is not only a missed opportunity for knowing one’s HIV status, but it also increases the chances of mother-to-child HIV transmission.

Objective: The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania.

Methods: A longitudinal household survey was conducted in Geita District Council in Geita Region, Tanzania. We used embedded mixed-methods to answer study objective. The study involved all mentally-able women who delivered within two years (WDTY) preceding the survey and their children under the age of two.

Results: Of the 993 women who participated in the study, a total of 879 (88.5%) had ever been tested for HIV and 791 (79.7%) tested during an ANC visit. Nearly all (981; 98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. Of the 565 WDH participants, 486 (86.0%) had ever tested for HIV. Among these, 433 (76.6%) tested during an ANC visit and 562 (99.4%) accepted HBHCT.

Of the 981 participants who accepted HBHCT, 52 (5.3%) [95%CI: 2.1–12.8%] tested HIV-positive. More than half (28; 53.8%) of the HIV-positive women were in the 25- to 35-years age category and half were newly identified during HBHCT. Among these women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV-positive participants who delivered at home, eight (25.8%) were enrolled in the PMTCT.

Also, HBHCT identified 19 new HIV infections among 393 community members who were not eligible to participate in the study but requested HIV testing.

Conclusion: HBHCT was acceptable and uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. HBHCT can be used as an intervention to improve PMTCT services among WDH, because it was acceptable for detecting new HIV infection among WDH as well as seroconversion among women with a negative HIV test in their previous PMTCT HIV testing.