title: Promoting uptake of child HIV testing: an evaluation of the role of a home visiting program for orphans and vulnerable children in South Africa.
abstract: HIV counseling and testing (HCT) is critical for children in generalized epidemic settings, but significant shortfalls in coverage persist, notably among orphans and others at disproportionate risk of infection. This study investigates the impact of a home visiting program in South Africa on orphaned and vulnerable children's uptake of HCT. Using propensity score matching, survey data for children receiving home visits from trained community-based care workers were compared to data from children living in similar households that had not yet received home visits (n = 1324). Home visits by community-based care workers increased the odds of a child being tested by 97% (OR = 1.97, 95% CI = 1.34-2.92). The home visitation program had an especially pronounced effect on orphans, more than doubling their odds of being tested (OR = 2.12, 95% CI = 1.00-4.47) compared to orphans living in similar households that did not receive home visits. Orphan status alone had no effect on HCT independent of program exposure, suggesting that the program was uniquely able to increase testing in this subgroup. Results highlight the potential for increasing HCT access among children at high risk through targeted community-based initiatives.
authors.affiliation: a Highly Vulnerable Children Research Center, School of Social Work , Tulane University , New Orleans , LA , USA.
authors.forename: Tonya R
authors.initials: TR
authors.lastname: Thurman
authors.affiliation: a Highly Vulnerable Children Research Center, School of Social Work , Tulane University , New Orleans , LA , USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Luckett
authors.affiliation: a Highly Vulnerable Children Research Center, School of Social Work , Tulane University , New Orleans , LA , USA.|b Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine , Tulane University , New Orleans , LA , USA.
authors.forename: Tory
authors.initials: T
authors.lastname: Taylor
authors.affiliation: a Highly Vulnerable Children Research Center, School of Social Work , Tulane University , New Orleans , LA , USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Carnay
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D054540:Child, Orphaned / Q000706:statistics & numerical data; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration; D003256:Community Participation; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology; D006293:Health Promotion / Q000379:methods*; D006699:Home Care Services / Q000458:organization & administration*; D006792:House Calls; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D015397:Program Evaluation; D012111:Residence Characteristics; D013019:South Africa
keywords: HIV counseling and testing; South Africa; evaluation; home visiting; orphans and vulnerable children