Feasibility, acceptability and cost of home-based HIV testing in rural Kenya.
OBJECTIVE
To demonstrate the feasibility, acceptability and cost of home-based HIV testing and to examine the applicability of the model to high HIV prevalence settings.


METHODS
Quantitative, qualitative and cost data were collected during a home-based HIV testing program in a high-prevalence rural area of Kenya; data on age, gender and marital status along with HIV test results were collected. This was complemented with qualitative research including key informant interviews with counselors and program managers to highlight experiences and challenges. Direct costs of the interventions were estimated through the review of budgets and monthly expenditure sheets.


RESULTS
Of 3180 15-49-year olds exposed to a community awareness campaign, 2033 (63.9%) agreed to be visited by counselors, of whom 1984 (97.6%) agreed to be tested and receive the results. Adult HIV prevalence was 8.2% and married women were 4.8 times more likely to be HIV-positive than those never married. Counselors reported feeling welcomed and noted the enthusiasm of the community towards testing. The total cost of the exercise was $17,569. The program cost was $2.60 for each of the 6750 community members, $5.88 for each person tested, and $84 per positive case detected.


CONCLUSIONS
This study suggests that home-based HIV testing is feasible with high uptake, and has the potential to substantially expand access to HIV testing services. There is a strong economic case for the extension of such a screening program to other communities.
Negin
Joel
J
School of Public Health, University of Sydney, Sydney, Australia. jnegin@health.usyd.edu.au
Wariero
James
J
Mutuo
Patrick
P
Jan
Stephen
S
Pronyk
Paul
P
D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D015497:HIV-1; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D006699:Home Care Services / Q000191:economics / Q000592:standards*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D012423:Rural Health; D055815:Young Adult