title: Household-based HIV counseling and testing as a platform for referral to HIV care and medical male circumcision in Uganda: a pilot evaluation.
abstract: BACKGROUND
  Combination HIV prevention initiatives incorporate evidence-based, biomedical and behavioral interventions appropriate and acceptable to specific populations, aiming to significantly reduce population-level HIV incidence. Knowledge of HIV serostatus is key to linkages to HIV care and prevention. Household-based HIV counseling and testing (HBCT) can achieve high HIV testing rates. We evaluated HBCT as a platform for delivery of combination HIV prevention services in sub-Saharan Africa.
  
  
  METHODS
  We conducted HBCT in a semi-urban area in southwestern Uganda. All adults received standard HIV prevention messaging. Real-time electronic data collection included a brief risk assessment and prevention triage algorithm for referrals of HIV seropositive persons to HIV care and uncircumcised HIV seronegative men with multiple sex partners to male circumcision. Monthly follow-up visits for 3 months were conducted to promote uptake of HIV care and male circumcision.
  
  
  RESULTS
  855 households received HBCT; 1587 of 1941 (81.8%) adults were present at the HBCT visit, 1557 (98.1% of those present) were tested and received HIV results, of whom, 46.5% were men. A total of 152 (9.8%) were HIV seropositive, for whom the median CD4 count was 456 cells/µL, and 50.7% were newly-identified as HIV seropositive. Three months after HBCT, 88.5% of HIV seropositive persons had attended an HIV care clinic; among those with CD4 counts <250 cells/µL, 71.4% initiated antiretroviral therapy. Among 123 HIV seronegative men with an HIV+ partner or multiple partners, 62.0% were circumcised by month 3.
  
  
  CONCLUSIONS
  HBCT achieves high levels of knowledge of HIV serostatus and is an effective platform for identifying at-risk persons and achieving higher uptake of HIV prevention and care services through referrals and targeted follow-up than has been accomplished through other single focus strategies.
authors.affiliation: Integrated Community Based Initiatives, Kabwohe, Uganda.
authors.forename: Henry
authors.initials: H
authors.lastname: Tumwebaze
authors.forename: Elioda
authors.initials: E
authors.lastname: Tumwesigye
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.forename: Jennifer
authors.initials: J
authors.lastname: Revall
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Murnane
authors.forename: Larry W
authors.initials: LW
authors.lastname: Chang
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
mesh_terms: D000328:Adult; D000465:Algorithms; D002944:Circumcision, Male / Q000379:methods*; D003150:Community Health Workers; D003376:Counseling / Q000379:methods*; D019317:Evidence-Based Medicine; D005191:Family Characteristics; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011336:Probability; D012017:Referral and Consultation; D012306:Risk; D012747:Sexual Partners; D013997:Time Factors; D014454:Uganda