title: Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial.
abstract: OBJECTIVE
  To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa.
  
  
  METHODS
  Cluster randomised controlled trial.
  
  
  METHODS
  16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa.
  
  
  METHODS
  4154 people aged 14 years or more who participated in a community survey.
  
  
  METHODS
  Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics.
  
  
  METHODS
  Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care.
  
  
  RESULTS
  Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73).
  
  
  CONCLUSIONS
  Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN31271935.
authors.affiliation: Medical Research Council, Parow, Cape Town, 7535, South Africa. tanya.doherty@mrc.ac.za
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.forename: Hanani
authors.initials: H
authors.lastname: Tabana
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.forename: Reshma
authors.initials: R
authors.lastname: Naik
authors.forename: Wanga
authors.initials: W
authors.lastname: Zembe
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.forename: Sonja
authors.initials: S
authors.lastname: Swanevelder
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
authors.forename: Anna
authors.initials: A
authors.lastname: Thorson
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekström
authors.forename: Mickey
authors.initials: M
authors.lastname: Chopra
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006699:Home Care Services; D006801:Humans; D008297:Male; D013019:South Africa