Home-based HIV counselling and testing in western Kenya

East Afr Med J. 2010 Mar;87(3):100-8. doi: 10.4314/eamj.v87i3.62195.


Background: The World Health Organisation (WHO) estimates that only 12% of men and 10% of women in sub-Saharan Africa have been tested for HIV and know their test results. Home-based counselling and testing (HBCT) offers a novel approach to complement facility-based provider initiated testing and counselling (PITC) and voluntary counselling and testing (VCT) and could greatly increase HIV prevention opportunities. However, there is almost no evidence that large-scale, door-to-door testing is even feasible in settings with both limited resources and significant stigma around HIV and AIDS.

Objective: To describe our experience with the feasibility and acceptance of home-based HIV counselling and testing (HBCT) in two large, rural, administrative divisions of western Kenya.

Design: The USAID-AMPATH Partnership conducted population-based, house-to-house HIV counselling and testing in western Kenya between June 2007 and June 2009. All individuals aged > or = 13 years and all eligible children were offered HBCT. Children were eligible if they were above 13 years of age, and their mother was either HIV-positive or had unknown HIV serostatus, or if their mother was deceased or whose vital status was unknown.

Setting: Kosirai and Turbo Divisions, Rift Valley Province, Kenya.

Results: There were 47,066 households approached in 294 villages: 97% of households allowed entry. Of the 138,026 individuals captured, 101,167 individuals were eligible for testing: 89% of adults and 58% of children consented to HIV testing. The prevalence of HIVin these communities was 3.0%: 2.7% in adults and 3.7% among children. Prevalence was highest in the 36-45 year age group and was almost always higher among women and girls. All persons testing HIV-positive were referred to Academic Model Providing Access to Healthcare (AMPATH) for further assessment and care; all consenting persons were counselled on HIV risk-lowering behaviours.

Conclusion: Home-based HIV counselling and testing was feasible among this rural population in western Kenya, with a majority of the population accepting to get tested. These data suggest that scaling-up of HBCT is possible and may enable large numbers of individuals to know their HIV serostatus in sub-Saharan Africa. More research is needed to describe the cost-effectiveness and clinical impact of this approach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Serodiagnosis*
  • Adolescent
  • Adult
  • Child
  • Directive Counseling*
  • Feasibility Studies
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / epidemiology
  • HIV Infections / therapy*
  • Home Care Services / organization & administration*
  • Humans
  • Kenya
  • Male
  • Patient Acceptance of Health Care*
  • Rural Health Services / organization & administration
  • Young Adult