New findings by DGHI researchers suggest that mobile voluntary counseling and testing (MVCT) for HIV is effective in reaching and recruiting individuals at high risk of HIV who have not previously been tested and can facilitate their access to HIV care and treatment earlier. The research is also one of the first studies to shed light on the characteristics that prevent others from being tested.
Led by DGHI faculty Jan Ostermann and Nathan Thielman, the study tested 900 clients in four MVCT campaigns offered in dispensaries, ward offices, and schools in rural villages in the Kilimanjaro Region of Tanzania. MVCT clients reported greater numbers of recent and lifetime partners and higher rates of known or suspected HIV-infected partners. The new study in PLoS ONE also showed half of the participants ages 18-50 had never been tested for HIV.
Researchers also found the most common reasons individuals did not participate in the free MVCT campaign were associated with local accessibility. In follow-up assessments among more than 300 individuals not tested, 33 percent cited distance from available testing sites, 22 percent could not leave work, and 13 percent were unaware of available testing locations. Other reasons for never being tested included HIV-related stigma and testing-related fears.
“Whether expanded HIV testing strategies reduce such barriers and successfully attract new and high-risk testers or attract primarily lower risk repeat testers has substantial implications for their cost effectiveness and for the possible success of universal testing and treatment policies,” said Ostermann, the lead author. “We find no evidence of adverse risk selection, but stigma and fears of testing or test disclosure remain significant barriers, and we are currently exploring ways to evaluate how testing options could be adapted to reduce these barriers.”
Researchers are exploring whether educational campaigns to reduce stigma and fears of testing may improve the effectiveness of MVCT in attracting new and high-risk populations.
Researchers used aerial photography to identify and survey a random community sample. This novel sampling approach allowed researchers to better assess how those who tested differed from those who did not present for testing.
Other researchers on the study include Elizabeth Reddy, Meghan M. Shorter, Charles Muiruri, Antipas Mtalo, Dafrosa Itemba, Bernard Njau, John Bartlett and John Crump. The study is funded by the Duke University Center for AIDS Research (CFAR), supported by the National Institutes of Health. MVCT staff were employed by KIWAKKUKI, a women-led HIV/AIDS service organization in nearby Moshi, Tanzania.
Read the study.