title: A single-blind randomized controlled trial to evaluate the effect of extended counseling on uptake of pre-antiretroviral care in Eastern Uganda.
abstract: BACKGROUND
  Many newly screened people living with HIV (PLHIV) in Sub-Saharan Africa do not understand the importance of regular pre-antiretroviral (ARV) care because most of them have been counseled by staff who lack basic counseling skills. This results in low uptake of pre-ARV care and late treatment initiation in resource-poor settings. The effect of providing post-test counseling by staff equipped with basic counseling skills, combined with home visits by community support agents on uptake of pre-ARV care for newly diagnosed PLHIV was evaluated through a randomized intervention trial in Uganda.
  
  
  METHODS
  An intervention trial was performed consisting of post-test counseling by trained counselors, combined with monthly home visits by community support agents for continued counseling to newly screened PLHIV in Iganga district, Uganda between July 2009 and June 2010, Participants (N = 400) from three public recruitment centres were randomized to receive either the intervention, or the standard care (the existing post-test counseling by ARV clinic staff who lack basic training in counseling skills), the control arm. The outcome measure was the proportion of newly screened and counseled PLHIV in either arm who had been to their nearest health center for clinical check-up in the subsequent three months +2 months. Treatment was randomly assigned using computer-generated random numbers. The statistical significance of differences between the two study arms was assessed using chi-square and t-tests for categorical and quantitative data respectively. Risk ratios and 95% confidence intervals were used to assess the effect of the intervention.
  
  
  RESULTS
  Participants in the intervention arm were 80% more likely to accept (take up) pre-ARV care compared to those in the control arm (RR 1.8, 95% CI 1.4-2.1). No adverse events were reported.
  
  
  CONCLUSIONS
  Provision of post-test counseling by staff trained in basic counseling skills, combined with home visits by community support agents had a significant effect on uptake of pre-ARV care and appears to be a cost-effective way to increase the prerequisites for timely ARV initiation.
  
  
  BACKGROUND
  The trial was registered by Current Controlled Trials Ltd C/OBioMed Central Ltd as ISRCTN94133652 and received financial support from Sida and logistical support from the European Commission.
authors.affiliation: District Health Office, Iganga District Administration, PO Box 358, Iganga, Uganda. dlmuhamadi@yahoo.co.uk
authors.forename: Lubega
authors.initials: L
authors.lastname: Muhamadi
authors.forename: Nazarius M
authors.initials: NM
authors.lastname: Tumwesigye
authors.forename: Daniel
authors.initials: D
authors.lastname: Kadobera
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marrone
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: George
authors.initials: G
authors.lastname: Pariyo
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003153:Community Health Services; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006792:House Calls; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult