Barnabas, R.V., van Rooyen, H., Timwesigye, E., et al. The Lancet HIV (May 2016), doi: 10.1016/S2352-3018(16)00020-5.
This study investigated whether community-based HIV testing with counselor support and point-of-care CD4 cell count testing would increase uptake of antiretroviral therapy (ART) and male circumcision (MC). Between June 2013 and March 2015, 15,332 participants were tested in South Africa and Uganda. Those found positive (n = 1,325) were randomly assigned in a factorial design to receive (1:1:1) lay counselor clinic facilitation, lay counselor follow-up visits, or standard clinic referral; and subsequently (1:1) either point-of-care CD4 testing or referral for CD4 testing. HIV-negative uncircumcised men (n = 750) were randomly assigned to receive mobile phone text message reminders, home visits, or standard referral for MC. Lay counselor facilitation of clinic visit increased clinic linkage; and lay counselor follow-up increased ART uptake. Text message reminders and lay counselor visits increased uptake of MC; with text messages, MC uptake nearly doubled relative to standard referral. Half of HIV-positive individuals in both groups (community-based and standard clinical care) achieved viral suppression at nine months. The authors concluded that community-based approaches and use of trained lay people are key components of combination HIV prevention strategies.