title: Home-based counseling and testing for HIV and syphilis - an evaluation of acceptability and quality control, in remote Amazonas State, Brazil.
abstract: OBJECTIVE
  Home-based, voluntary counselling and testing (HBCT) can help scale up early diagnosis. We aimed to evaluate the acceptance of HBCT for HIV and syphilis, estimate the prevalence among home-tested individuals and assess the performance of point-of-care testing by health staff using dried tube specimens (DTS) in a remote municipality of the Amazon region.
  
  
  METHODS
  Community health teams conducted door-to-door outreach in the urban area of São Gabriel da Cachoeira, Amazonas. HBCT for HIV and syphilis was offered to all residents aged ≥15 years. To provide an external quality assurance (EQA) of the healthcare workers' (HCW') ability to perform testing, DTS panels of reference samples were reconstituted and tested by the workers.
  
  
  RESULTS
  HBCT was offered to 1752 individuals and accepted by 1501 (85.6%). Those tested had a median age 32.0 years, 64.4% were women and 85.1% were indigenous; none were previously tested using a rapid test. The prevalence of HIV was 0.37% in men and 0.0% in women; the prevalence of syphilis was 1.12% in men and 2.69% in women. Eleven HCW tested 44 DTS samples for HIV and 44 for syphilis. EQA testing revealed that workers interpreted 55.8% and 90.7% of HIV and syphilis reference samples correctly.
  
  
  CONCLUSIONS
  HBCT was acceptable and successful in reaching untested individuals. However, there were concerns with the quality of test performance, highlighting the need for continual evaluation and retraining of community HCW. As Brazil scales up HIV and syphilis testing, our findings highlight how HBCT can maximise coverage in similar remote areas and improve knowledge about prevalence of these infections.
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil.
authors.forename: Luciana Viana da Costa
authors.initials: LV
authors.lastname: Ribeiro
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil TransLab. Departament of Medical Sciences, Universitat de Girona, Girona, Catalunya, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Sabidó
authors.affiliation: STI/AIDS Department, Fundação Alfredo da Matta, Manaus, Amazonas State, Brazil Facultad de Medicina Calixto García, La Habana, Cuba.
authors.forename: Enrique
authors.initials: E
authors.lastname: Galbán
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil.
authors.forename: Jorge Augusto de Oliveira
authors.initials: JA
authors.lastname: Guerra
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Rosanna W
authors.initials: RW
authors.lastname: Peeling
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil STI/AIDS Department, Fundação Alfredo da Matta, Manaus, Amazonas State, Brazil.
authors.forename: Adele Schwartz
authors.initials: AS
authors.lastname: Benzaken
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001938:Brazil; D003376:Counseling / Q000379:methods* / Q000592:standards; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006792:House Calls; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011786:Quality Control; D013587:Syphilis / Q000175:diagnosis*; D055815:Young Adult
keywords: COMMUNITY SERVICES; HIV; SCREENING; SYPHILIS