267321 Quality of in home rapid HIV testing by community lay counsellors in rural South Africa

Monday, October 29, 2012 : 8:30 AM - 8:45 AM

Debra Jackson, RN MPH DSc , School of Public Health, University of the Western Cape, Cape Town, South Africa
Reshma Naik, MPH , School of Public Health, Boston University, Boston
Hanani Tabana, MPH , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Tanya Doherty, PhD , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Lorna Madurai , Global Clinical and Viral Laboratories, Amanzimtoti, South Africa
Low rates of HIV testing in health facilities suggests that expansion of HIV counselling and testing (HCT) to non-clinical settings is critical to the achievement of national goals for prevention, care and treatment. As such, due consideration must be given to the ability of lay counsellors to perform HCT in community settings.

As part of a community randomized controlled trial, we implemented a home-based HCT intervention. Using the same rapid HIV test kits used by district health facilities, trained lay counsellors conducted door-to-door HIV testing in the Sisonke District of South Africa. To monitor test quality and counsellor skill, additional dry blood spots were sent for laboratory-based ELISA testing. Cross tabulations were done to assess result correspondence. Sensitivity and specificity were also calculated using the laboratory test as the gold standard and 95% confidence intervals were calculated using the Wilson method.

From a total of 3,861 samples, the counselor and lab results matched in all but eleven cases. We found a sensitivity of 98.3% (95% CI: 96.5 - 99.2%) and a specificity of 99.9% (95% CI: 99.7 - 99.9%) for the lay counselor field-based rapid tests. Both measures are high and the lower confidence bound for specificity meets the international standard for assessing HIV rapid tests.

These findings indicate that adequately trained lay counsellors are capable of conducting high quality rapid HIV tests and accurately interpreting the results. This will have important implications for the expansion of HCT services in community-based settings.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Compare rapid HIV tests results conducted in the community by lay health workers to those obtained in the laboratory. Describe the quality of rapid home-based HIV testing done by lay health workers.

Keywords: HIV Interventions, Community-Based Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Co-Principal Investigator involved in all aspects of the study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.