title: Feasibility and effectiveness of two community-based HIV testing models in rural Swaziland.
abstract: OBJECTIVE
  To evaluate the feasibility (population reached, costs) and effectiveness (positivity rates, linkage to care) of two strategies of community-based HIV testing and counselling (HTC) in rural Swaziland.
  
  
  METHODS
  Strategies used were mobile HTC (MHTC) and home-based HTC (HBHTC). Information on age, sex, previous testing and HIV results was obtained from routine HTC records. A consecutive series of individuals testing HIV-positive were followed up for 6 months from the test date to assess linkage to care.
  
  
  RESULTS
  A total of 9 060 people were tested: 2 034 through MHTC and 7 026 through HBHTC. A higher proportion of children and adolescents (<20 years) were tested through HBHTC than MHTC (57% vs. 17%; P < 0.001). MHTC reached a higher proportion of adult men than HBHTC (42% vs. 39%; P = 0.015). Of 398 HIV-positive individuals, only 135 (34%) were enrolled in HIV care within 6 months. Of 42 individuals eligible for antiretroviral therapy, 22 (52%) started treatment within 6 months. Linkage to care was lowest among people who had tested previously and those aged 20-40 years. HBHTC was 50% cheaper (US$11 per person tested; $797 per individual enrolled in HIV care) than MHTC ($24 and $1698, respectively).
  
  
  CONCLUSIONS
  In this high HIV prevalence setting, a community-based testing programme achieved high uptake of testing and appears to be an effective and affordable way to encourage large numbers of people to learn their HIV status (particularly underserved populations such as men and young people). However, for community HTC to impact mortality and incidence, strategies need to be implemented to ensure people testing HIV-positive in the community are linked to HIV care.
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Lucy Anne
authors.initials: LA
authors.lastname: Parker
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Kiran
authors.initials: K
authors.lastname: Jobanputra
authors.affiliation: Médecins Fans Frontières, Nhlangano, Swaziland.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Rusike
authors.affiliation: Swaziland National AIDS Programme, Mbabane, Swaziland.
authors.forename: Sikhathele
authors.initials: S
authors.lastname: Mazibuko
authors.affiliation: Swaziland National AIDS Programme, Mbabane, Swaziland.
authors.forename: Velephi
authors.initials: V
authors.lastname: Okello
authors.affiliation: Médecins Fans Frontières, Nhlangano, Swaziland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kerschberger
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jouquet
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Joanne
authors.initials: J
authors.lastname: Cyr
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Teck
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003376:Counseling; D013541:Eswatini; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D006699:Home Care Services / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D008952:Mobile Health Units / Q000191:economics; D015995:Prevalence; D015397:Program Evaluation / Q000191:economics; D012111:Residence Characteristics; D012424:Rural Population; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; HIV diagnosis and management; HIV prevention; HIV testing and counselling; SIDA; asesoramiento y prueba del VIH; community-based interventions; conseils et dépistage du VIH; diagnostic et prise en charge du VIH.; diagnóstico y manejo del VIH; intervenciones basadas en la comunidad; interventions communautaires; prevención del VIH; prévention du VIH