Brief Counselling After Home-Based HIV Counselling and Testing Strongly Increases Linkage to Care: A Cluster-Randomized Trial in Uganda
Ruzagira, E., Grosskurth, H., Kamali, A., Baisley, K. Journal of the International AIDS Society (October 2017), 20:e25014, doi: 10.1002/jia2.25014.
This open-label, cluster-randomized trial compared the effectiveness of a counseling intervention on linkage to care versus a referral-only intervention for clients who tested positive during home-based HIV testing in 28 rural communities in Uganda. Two counseling sessions, provided at one and two months after diagnosis, covered acceptance of diagnosis, care-seeking plans, stigma, disclosure, psychosocial support for linkage to care, information on care services, antiretroviral treatment (ART), and reasons for early linkage to care. Of 302 individuals enrolled in the study, 134 were reported linked to care. However, facility records (and confirmation with 7 patients) showed that only 127 individuals had actually linked to care. Those in the intervention arm were significantly more likely to link to care than those in the control arm (51% versus 33%). This effect increased after the second month of follow-up when counseling had been provided. Clients in the intervention arm were also more likely to obtain CD4 cell count results, initiate ART, and report higher adherence to cotrimoxazole. The authors concluded that counseling has significant impacts on both linkage to care and other service access, including ART, among clients who test positive during home-based counseling and testing.