Acceptance of repeat population-based voluntary counseling and testing for HIV in rural Malawi

Abstract

Objective: To examine the acceptance of repeat population-based voluntary counseling and testing (VCT) for HIV in rural Malawi.
Methods: Behavioral and biomarker data were collected in 2004 and 2006 from approximately 3,000 adult respondents. In 2004, oral swab specimens were collected and analyzed using enzyme-linked immunosorbent assay (ELISA) and confirmatory Western blot tests while finger-prick rapid testing was done in 2006. We use cross-tabulations with chi-square tests and significance tests of proportions to determine the statistical significance of differences in acceptance of VCT by year, individual characteristics and HIV risk.
Results: First, over 90% of respondents in each round accepted HIV test, despite variations in testing protocols. Second, the percentage of individuals who obtained their test results significantly increased from 67% in 2004 when the results were provided in randomly selected locations several weeks after the specimens were collected, to 98% in 2006 when they were made available immediately within the home. Third, whereas there were significant variations in the socio-demographic and behavioral profiles of those who were successfully contacted for a second HIV test, this was not the case for those who accepted repeat VCT. This suggests that variations in the success of repeat testing might come from contacting the individuals rather than from accepting the test or knowing the results.
Conclusions: Repeat HIV testing at home by trained health care workers from outside the local area, and with either saliva or blood, is almost universally acceptable in rural Malawi, and thus likely to be acceptable in similar contexts.