The addition of community mobilization activities and support services to a mobile HIV counseling and testing program can greatly improve the rates of initial and repeat testing in remote rural communities, according to new research supported by the HIV Prevention Trials Network (HPTN) and the National Institute of Mental Health (NIMH).
Results from the “Project Accept” study (HPTN 043), conducted in rural communities in Tanzania, Zimbabwe, and Thailand, were published today online in The Lancet Infectious Diseases http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70060-3/abstract . 
“Knowledge of HIV status is an important gateway to prevention and treatment services. This study answers the question of how best to scale up testing in resource-limited settings,” says Quarraisha Abdool Karim, HPTN co-principal investigator and associate scientific director of CAPRISA. “It shows HIV testing becomes more accessible through a community-based approach. In developing countries, most people infected with HIV do not know their infection status.”
"An essential component of any prevention effort is to combine interventions both for HIV-infected and uninfected persons,” adds Sten Vermund, HPTN co-principal investigator and Amos Christie Chair of Global Health at the Vanderbilt University School of Medicine. “The NIMH Project Accept/HPTN 043 team has demonstrated that a radical increase in testing acceptance is feasible in highly diverse rural and urban settings in both Africa and Asia. This vital clinical trial discovery gives us hope that prevention and treatment programs can reach people who know their HIV status."
HPTN 043 is the first international randomized controlled Phase III trial to determine the efficacy of a community-level intervention with an HIV incidence endpoint. Communities in each setting were paired according to demographic characteristics, and one of each pair was then randomized to receive either clinic-based voluntary counseling and testing alone or a combination of clinic-based testing and community-based testing. The community-based testing included mobile HIV testing along with community mobilization and post-test psychosocial support services. The results of the impact of this intervention on new HIV infections will be available in 2012.
The researchers found that the proportion of persons who received their first HIV test during the study was higher in areas that received the “combination” testing than in those areas that received “stand-alone” clinic-based testing in Tanzania (37 percent vs. 9 percent), Zimbabwe (51 percent vs. 5 percent), and Thailand (69 percent vs. 23 percent).
Although the HIV prevalence rate was higher in the stand-alone testing areas than in the areas that received combination testing, the programs in the combination-testing areas detected almost four times more HIV cases (952 vs. 264) because they were able to test a greater number of people. Repeat HIV testing in areas that received the combination testing increased at all sites, reaching 28 percent of all those who were tested by the end of the intervention period.
Previous studies have shown that men are often difficult to reach with HIV prevention services. In this study a larger proportion of male clients received HIV tests in the combination-testing areas compared to the stand-alone testing areas. Few clients tested for HIV infection as couples in Tanzania and Zimbabwe but the proportion of clients who tested as part of a couple in Thailand was much higher than it was at other sites.
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