title: Taking HIV Testing to Families: Designing a Family-Based Intervention to Facilitate HIV Testing, Disclosure, and Intergenerational Communication.
abstract: BACKGROUND
  Facility-based HIV testing does not capture many adults and children who are at risk of HIV in South Africa. This underscores the need to provide targeted, age-appropriate HIV testing for children, adolescents, and adults who are not accessing health facilities. While home-based counseling and testing has been successfully delivered in multiple settings, it also often fails to engage adolescents. To date, the full potential for testing entire families and linking them to treatment has not been evaluated.
  
  
  METHODS
  The steps to expand a successful home-based counseling and testing model to a family-based counseling and testing approach in a high HIV prevalence context in rural South Africa are described. The primary aim of this family-based model is to increase uptake of HIV testing and linkage to care for all family members, through promoting family cohesion and intergenerational communication, increasing HIV disclosure in the family, and improving antiretroviral treatment uptake, adherence, and retention. We discuss the three-phased research approach that led to the development of the family-based counseling and testing intervention.
  
  
  RESULTS
  The family-based intervention is designed with a maximum of five sessions, depending on the configuration of the family (young, mixed, and older families). There is an optional additional session for high-risk or vulnerable family situations. These sessions encourage HIV testing of adults, children, and adolescents and disclosure of HIV status. Families with adolescents receive an intensive training session on intergenerational communication, identified as the key causal pathway to improve testing, linkage to care, disclosure, and reduced stigma for this group. The rationale for the focus on intergenerational communication is described in relation to our formative work as well as previous literature, and potential challenges with pilot testing the intervention are explored.
  
  
  CONCLUSIONS
  This paper maps the process for adapting a novel and largely successful home-based counseling and testing intervention for use with families. Expanding the successful home-based counseling and testing model to capture children, adolescents, and men could have significant impact, if the pilot is successful and scaled-up.
authors.affiliation: Human and Social Development Program, Human Sciences Research Council , Pietermaritzburg , South Africa.
authors.forename: Heidi
authors.initials: H
authors.lastname: van Rooyen
authors.affiliation: Human and Social Development Program, Human Sciences Research Council, Pietermaritzburg, South Africa; School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
authors.forename: Zaynab
authors.initials: Z
authors.lastname: Essack
authors.affiliation: Human and Social Development Program, Human Sciences Research Council, Pietermaritzburg, South Africa; Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa; Section of Child of Adolescent Psychiatry, Department of Psychiatry, Oxford University, Oxford, UK.
authors.forename: Tamsen
authors.initials: T
authors.lastname: Rochat
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow , Glasgow , UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wight
authors.affiliation: School of Public Health, University of the Western Cape , Cape Town , South Africa.
authors.forename: Lucia
authors.initials: L
authors.lastname: Knight
authors.affiliation: Royal Hospital for Children, Glasgow, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Ruth
authors.initials: R
authors.lastname: Bland
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
keywords: HIV testing; adolescents; disclosure; family-based counseling and testing; family-based intervention; home-based counseling and testing; intergenerational communication