title: Client characteristics and acceptability of a home-based HIV counselling and testing intervention in rural South Africa.
abstract: BACKGROUND
  HIV counselling and testing (HCT) is a critical gateway for addressing HIV prevention and linking people to treatment, care, and support. Since national testing rates are often less than optimal, there is growing interest in expanding testing coverage through the implementation of innovative models such as home-based HIV counselling and testing (HBHCT). With the aim of informing scale up, this paper discusses client characteristics and acceptability of an HBHCT intervention implemented in rural South Africa.
  
  
  METHODS
  Trained lay counsellors offered door-to-door rapid HIV testing in a rural sub-district of KwaZulu-Natal, South Africa. Household and client data were captured on cellular phones and transmitted to a web-based data management system. Descriptive analysis was undertaken to examine client characteristics, testing history, HBHCT uptake, and reasons for refusal. Chi-square tests were performed to assess the association between client characteristics and uptake.
  
  
  RESULTS
  Lay counsellors visited 3,328 households and tested 75% (5,086) of the 6,757 people met. The majority of testers (73.7%) were female, and 57% had never previously tested. With regard to marital status, 1,916 (37.7%), 2,123 (41.7%), and 818 (16.1%) were single, married, and widowed, respectively. Testers ranged in age from 14 to 98 years, with a median of 37 years. Two hundred and twenty-nine couples received couples counselling and testing; 87.8%, 4.8%, and 7.4% were concordant negative, concordant positive, and discordant, respectively. There were significant differences in characteristics between testers and non-testers as well as between male and female testers. The most common reasons for not testing were: not being ready/feeling scared/needing to think about it (34.1%); knowing his/her status (22.6%), being HIV-positive (18.5%), and not feeling at risk of having or acquiring HIV (10.1%). The distribution of reasons for refusal differed significantly by gender and age.
  
  
  CONCLUSIONS
  These findings indicate that HBHCT is acceptable in rural South Africa. However, future HBHCT programmes should carefully consider community context, develop strategies to reach a broad range of clients, and tailor intervention messages and services to meet the unique needs of different sub-groups. It will also be important to understand and address factors related to refusal of testing.
authors.affiliation: South African Medical Research Council, Francie van Zijl Drive, Parrowvallei, Tygerberg, South Africa. reshnaik@gmail.com
authors.forename: Reshma
authors.initials: R
authors.lastname: Naik
authors.forename: Hanani
authors.initials: H
authors.lastname: Tabana
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.forename: Wanga
authors.initials: W
authors.lastname: Zembe
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003376:Counseling / Q000379:methods* / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult