Home-based HIV Testing and Counseling

Bringing HIV Testing into a Client's Home

Home-based HIV testing and counseling (HBHTC) is a new, innovative HIV testing model that expands HTC into communities and households by offering HTC services in a client’s home. Here, AIDSTAR-One provides HBHTC resources including a selection of literature, HBHTC tools, case studies, and reports for program implementers.

About this resource

A New HIV Testing and Counseling Strategy

Countries with high HIV prevalence, whether generalized or mixed epidemics, are tasked with increasing coverage and uptake of HIV testing and counseling (HTC), which has the potential to increase enrollment into care and treatment for those who test positive for HIV. Additionally, HTC provides the opportunity for HIV prevention counseling, which can help promote behavior change and provide access to prevention services (e.g., couples testing and prevention of mother-to-child transmission). Despite global advances in expansion of HTC, testing rates remain low. Various HTC models have been utilized for expanding access to testing and access to related services. Home-based HIV testing and counseling (HBHTC), a relatively new model, is a strategy by which HTC services are provided to clients in their homes; this strategy removes barriers (e.g., logistical and stigma) that may be associated with facility-based HTC. HBHTC has been found to be highly acceptable and reach individuals who do not access health facilities.

Home-Based HIV Testing and Counseling Overview

HBHTC has been demonstrated to be an effective component of a national HIV strategy. However, consideration of where and how to implement HBHTC, as well as the target audience, should occur prior to implementation. In many countries, HBHTC programs in both rural and urban contexts have utilized three basic approaches:

  1. Door-to-door: Counselors visit households in a select geographical area offering HTC to household members
  2. Index client: Counselors visit households with a known HIV-positive member, targeting other household members
  3. Integrated: Counselors or community health workers (CHWs) provide HTC, in addition to other health-related services (e.g., tuberculosis screening and family planning).

 

Potential strengths of the HBHTC model include the following:

  • Ensures clients receive HIV test results
  • May reach more "first time" testers compared to those using facility-based models
  • Can utilize lay counselors or CHWs, reducing the burden on human resources
  • Offers HTC to entire families and/or households, and may reach couples and partners
  • Limits client transport costs to facilities and lessens stigma associated with visiting HTC facilities
  • Reaches populations who may not access HTC in health facilities (e.g., children, rural populations, poorer households).

 

Areas for HBHTC programmatic inquiry include:

  • Identifying populations that would benefit most from HBHTC
  • Identifying factors affecting consent (e.g., child testing, in home-based settings)
  • Identifying programmatic needs for HBHTC (e.g., counselor training, supply chains, and quality assurance systems)
  • Assessing costs of implementation, especially of materials, time, transportation for counselors, and human resources
  • Determining HBHTC program goals, effectiveness, and feasibility, and monitoring quality of services.

 

The potential added value of including an HBHTC strategy appears strong for generalized and perhaps mixed epidemics. If an index approach is used, there is also possible added value for concentrated epidemics. AIDSTAR-One presents a selection of published HBHTC articles, in addition to International AIDS Society (IAS) and Conference on Retroviruses and Opportunistic Infections (CROI) abstracts related to HBHTC. This selection demonstrates acceptability and effectiveness of HBHTC, compares HBHTC with facility-based testing models, and reviews cost-effectiveness studies. The HBHTC literature selection may be used to inform program planners and policymakers in decision making on implementation of HBHTC programs.