title: Uptake of voluntary counselling and testing among young people participating in an HIV prevention trial: comparison of opt-out and opt-in strategies.
abstract: BACKGROUND
  HIV voluntary counselling and testing (VCT) is an integral component of HIV prevention and treatment programmes. However, testing coverage in sub-Saharan Africa is still low, particularly among young people. As treatment becomes more widely available, strategies to expand VCT coverage are critically important. We compare VCT uptake using two delivery strategies (opt-in and opt-out) within the MEMA kwa Vijana trial in 20 communities in northwest Tanzania.
  
  
  METHODS
  We analysed data from 12,590 young persons (median (IQR) age 22 years (20-23)) to assess the effect of delivery strategy on VCT uptake. Ten communities used an opt-in approach and 10 used opt-out, balanced across intervention and control. Conditional logistic regression was used to examine factors associated with uptake within each strategy.
  
  
  RESULTS
  VCT uptake was significantly higher with the opt-out approach (90.9% vs 60.5%, prevalence ratio = 1.51, CI = 1.41-1.62). Among females, uptake in the opt-out approach was associated with decreased knowledge of HIV acquisition, sex with a casual partner, and being HSV-2 seronegative; among males, uptake was associated with lower education and increasing lifetime partners. In contrast, uptake using the opt-in approach varied by ethnic group, religion and marital status, and increased with increasing knowledge of STI acquisition (males) or pregnancy prevention (females).
  
  
  CONCLUSIONS
  VCT uptake among young people was extremely high when offered an opt-out strategy. Sociodemographic and knowledge factors affected uptake in different ways depending on delivery strategy. Increased knowledge may increase young persons' self-efficacy, which may have a different impact on testing uptake, depending on the approach used.
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Kathy
authors: K
authors: Baisley
authors: Aoife M
authors: AM
authors: Doyle
authors: John
authors: J
authors: Changalucha
authors: Kaballa
authors: K
authors: Maganja
authors: Deborah
authors: D
authors: Watson-Jones
authors: Richard
authors: R
authors: Hayes
authors: David
authors: D
authors: Ross
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000379:methods* / Q000706:statistics & numerical data*; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D055815:Young Adult