More privacy for in-home HIV testing might encourage more people to know their status in Uganda

About 7 out of 10 people living in the same household will decline home-based HIV testing if the first person who was offered such a test declines. Healthcare workers should consider offering home HIV tests in a way that keeps a person’s decision whether or not to take it private, said researchers.

Home-based HIV testing can help more people to know their HIV status and get the treatments that they need. Previous research showed that the behaviour of other people can affect whether an individual tests for HIV. This study looked at such social factors when it comes to home-based HIV testing.

The researchers specifically wanted to know how many people would agree to a home HIV test if another member of their household refused. They also wanted to find out if age and gender are important in this decision. 

From July 2016 to July 2017, healthcare workers in Kampala, Uganda, were sent to the homes of tuberculosis (TB) patients to offer the people who live with them free TB and HIV testing. 

They then used a computer model to see the trend of the responses across the group. 

They collected data from 228 people in 123 households. They found that men who were the first in the household to be offered an HIV test declined it more often than women. About 71% of the rest of the people in the home decided not to take the test if the first person that was offered a test declined. 

With their model, they showed that when one person in a household declines HIV testing, there is a high risk that other people in the home will also decline the test. They also noticed that there was no trend in the age of the people who first declined the tests. 

Researchers say community health workers could use this information to help more people know their HIV status. For example, they might first offer HIV testing to people who would be more likely to say yes, or they could find ways to offer the test to people without other people in the home knowing whether they agreed to test or not.

The researchers caution that they used a small number of participants in this study, so their model may not represent the larger population. They also couldn't test if differences in household income influenced HIV testing decisions.

They suggest that future research should look at how income or the level of education affects a person’s decision about home HIV testing.

The authors of this paper were from Uganda.

Abstract

Background Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda. Methods We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used to generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members. Results Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender. Conclusions The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.

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