Even though the prevalence of HIV/ AIDS in Kenya has stabilized at 7.1 % , there are still an estimated 166,000 incident instances of HIV per twelvemonth. In attempts to forestall new infections, cut down mortality and extenuate the socio-economic impacts of HIV, the Kenyan authorities set a end in 2009 to accomplish cosmopolitan coverage of services, and make 80 % of all HIV infected individuals by 2013 ( KNASP, 2009 ) . As HIV testing is cardinal to any effectual HIV preventative plan ( Summers 2000 ) it is important that HIV proving in the state is scaled up to recognize these ends. Kenya relies chiefly on installation based HCT ( HIV guidance and proving ) , initiated by the client or supplier ( Negin et al, 2009 ) . That 63.5 % of Kenyans have ne’er been tested for HIV ( PlusNews, 2009 ) is grounds for the low end product rates of installation based theoretical accounts. Even though well successful in observing HIV septic individuals, installation based approaches merely manage to make the subdivision of the population with entree to wellness attention. They are likely to lose the HIV infected individuals ‘ sexual spouses and household members, people in lower socio-economic place and people in rural scenes ( Ganguli et al, 2009 ) . A survey conducted in Zambia by Fylkenses & A ; Siziya ( 2004 ) reported that given the option, 84 % of respondents preferable proving from place compared to any other location. Complementary theoretical accounts that overcome the barriers presented by installation based theoretical accounts, and take HCT to peoples places necessitate to be implemented as the agencies to accomplish cosmopolitan coverage of HCT ( Ganguli et al,2009 ) This paper discusses the facets of Home Based HIV Counselling and Testing ( HBHCT ) that make it the suited theoretical account to scale up HCT in Kenya, and how it can be optimized to accomplish higher end product rates. It besides discusses the challenges in implementing this theoretical account in Kenya ‘s limited resource scene.
HBHCT is earning popularity in rural parts of Sub Saharan Africa. Following community sensitisation, professional or laic counselors move from door to door and offer guidance and proving services to all individuals that give consent. A survey on the acceptableness of HBHCT conducted by Negin et Al ( 2009 ) in Sauri small town, western Kenya reported that 63.9 % of the entire small town population agreed to be visited by counselors, and out of these 97.6 % agreed to be tested. It went on to describe that counselors were heartily received by the community, with word of mouth enlisting from those tested traveling on through out the survey. Other surveies besides report similar consequences in the high acceptableness of HBHCT in African scenes ( Wolf et al, 2005 ; Ganguli et Al, 2009 ; Angoti et Al, 2009 ) . The Ugandan survey by Wolf et Al ( 2005 ) reported that the fright of the walk place after proving was the prevailing account for the popularity of HBHCT. One husbandman in Western Kenya after taking the trial was quoted as stating:
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“ Home testing is really helpful. It is private, so your consequences and even the fact that you are tested are hidden. In the normal VCT Centres you can run into people who know you and will speak about you. ” ( PlusNews, 2009 ) .
As HBHCT reduces the barrier of stigma environing proving in extremely seeable wellness installation contexts, it carries great possible to spread out proving in high prevalence scenes. ( Negin et al, 2009 ) .
Distance is another good documented barrier to HCT particularly in rural scenes. The convenience of taking the trial from place eliminates the fiscal costs of traveling, and the chance cost of clip spent going and waiting to see the wellness supplier ( Angoti et al, 2009 ) .
“ Geting consequences at place saves me from have oning my good frock and holding to walk all the manner to the counselors office in order to acquire my consequences. In fact the counselor can give me my consequences as I work in the banana plantations so I do non hold to go forth my work half done ” .
( FGD. A adult female in south western rural Uganda waiting for her consequences. Angoti et Al, 2009 )
Consequences from Demographic studies done in parts of Sub-Saharan Africa have shown a strong correlativity between Socio-economic place and consumption of HCT. Poor entree, incommodiousness, fiscal and timeserving costs involved limit the consumption of HCT amongst the most vulnerable families, with a bigger impact falling on adult females. The underprivileged have therefore been excluded from the possible benefits of cognizing their Hiv position, including following schemes to forestall transmittal of infection to spouses and kids, increased endurance and improved quality of life from the usage of ART ( ( Anti Retro viral Treatment ) . Failure to turn to this tendency may turn HIV/AIDS into a disease of the hapless. A survey conducted in Malawi reported high consumption of HBHCT among the poorest socio-economic strata and concluded that HBHCT has great capacity in fulfilling the strong unmet demands of HCT among the poorest families of Sub-Saharan Africa. In so making, HBHCT can cut down the socio-economic gradients of HCT consumption, and extenuate the impact of HIV on the most vulnerable families ( Helleringer et al, 2009 ) .
Harmonizing to the Kenya National AIDS Strategic Plan study ( 2009 ) , Married twosomes are at higher hazard of HIV infection than their individual opposite numbers ; 44 % of all new infections are reported as happening among married or live togethering twosomes through heterosexual sex. Yet more than 75 % of Kenyan twosomes do non cognize their spouses HIV position ( PlusNews, 2009 ) . Couples stand to profit from a HBHCT plan as this has been identified as been more efficient than other theoretical accounts in aiming twosomes and households. It is particularly successful in proving household members of known HIV infected individuals. This has enhanced credence and household support, while advancing hazard decrease ( Ganguli et al,2009 ) . In one Kenyan survey, some sero-reactive respondents consented to reiterate proving through HBHCT as it gave them the chance to unwrap their HIV position to their spouses. Further research is surely required in orienting this theoretical account to adequately run into the testing and reding demands of twosomes. ( Negin et al, 2009 ) .
Mobile outreaches through new waves and bikes are already in usage to make distant geographical parts. Like HBHCT, they besides increase entree and convenience and can be integrated with services such a immunisation. However they are expensive to run and necessitate a batch of work force. Follow up after station trial guidance is hard, and a batch of community mobilisation is needed to guarantee uptake on the scheduled twenty-four hours ( Bateganya et al, 2009 ) . These restraints make HBHCT the more cost effectual pick over nomadic outreaches. In their survey, Negin et Al ( 2009 ) examined the cost of HBHCT in rural Kenya, and reported that it cost $ 5.88 per individual screened, and $ 84 per positive instance detected. These costs were much lower than costs in traditional installation based theoretical accounts. They concluded that their survey provided a strong economic instance to scale up HBHCT to other rural parts of Kenya.
Home bringing of trial consequences has been associated with a 3 to 4 times addition in the consumption of HIV consequences compared to installation based system as it eliminates the clip, cost and anxiousness associated with roll uping consequences at a ulterior day of the month ( Wolff et al, 2005 ) . Optimizing HBHTC entails the application of rapid trials to guarantee that carry oning the trial and giving back consequences are undertaken in one sitting. These trials must be sensitive and specific plenty to observe the prevalent HIV subtypes while forestalling false negative consequences. They should besides hold a long shelf life and be heat stable to maximise their usage in rural scenes. The combination of two rapid trials, such as Gold and Determine, is already in successful usage in most resource limited scenes. These have been found to hold the same dependability as the Elisa confirmed with western smudge, but at a much cheaper cost. Even though they can non observe acute HIV infection, rapid trials have great possible in optimising door to door guidance and testing. ( Ganguli et al, 2009 ) .
Harmonizing to Baiden et Al ( 2007 ) the deficit of professional counselors, in portion due to encephalon drain, in resource limited scenes puts VCT theoretical accounts that entirely depend on professional counselors at hazard of inefficiency and unsustainability. This has led some HBHTC plans to enroll laic counselors. In his survey in rural Ghana, he reported 98.7 % blessing for the usage of ballad counselors by his respondents. The chief grounds given in favor of these counselors were there handiness and socio-cultural acquaintance. One female respondent in the survey was quoted as stating:
“ I want the individual to come from the community because he will cognize the people really good, and cognize how to associate to them. If the individual is non from the community the people will be loath to speak to him. ” ( Baiden et al, 2007 ) .
Lay counselors, even though executable and acceptable, present the challenge of keeping confidentiality. A Malawian survey reported concerns that counselors may non maintain their trial consequences secret, and preferable counselors from outside their community. A 48 twelvemonth old respondent was quoted as stating:
“ … the counselor buzzword reveal the secret because he does n’t cognize anyone in the small towns and he will non hold clip to uncover because we expect him after proving to travel someplace else where there is no 1 who is familiar with me ” ( Angoti et al, 2009 ) .
Such apprehensivenesss can non be ignored, and lay counselors must be made good cognizant of the impact transgressing confidentially can hold on the unity of door to door proving ( Baiden et al, 2007 ) . One Kenyan survey took ballad counselors through a 3 month HIV guidance and proving class. The counselors were so registered with the National AIDS Control Council, and were required to carry on proving as per the national policy ( Negin J. et Al, 2009 ) .
Even though HBHCT has many advantages, there are several barriers to implementing HBHCT in resource hapless scenes.According to Ganguli et Al ( 2009 ) challenges environing proving include: deficiency of uninterrupted supply of good quality trial kits, deficiency of confirmatory trials in instance of discordant rapid trial consequences and deficiency of cold ironss needed to continue test kit viability. Free-of-charge ego administered place based trial kits have been proposed for usage in scenes with a deficit of human resources. However they are shaped with troubles in the correct usage and reading of consequences, and can take to mistreat of human rights by forceful testing of vulnerable people such as adult females, kids and handicapped individuals. Ganguli et Al ( 2009 ) goes on to discourse the issue environing the referral of individuals proving positive to HIV plans supplying intervention, psychosocial support and attention. Scaling up HIV proving through any attack is non good unless such referral systems exist. As HBHCT reaches people with hapless entree to wellness attention, national coverage of HIV plans is critical to do this theoretical account successful on a big graduated table. This will necessitate strong political will and committedness. Harmonizing to Negin et Al ( 2009 ) , challenges confronting counselors include: fire out from walking long distances and proving big households, compassion weariness and troubles reding in complex polygamous households. He went on to foreground the importance of continuously oversing and back uping the counselors.
Expanding the coverage of HIV guidance and proving to all families in Kenya is critical in commanding the epidemic in the state. By get the better ofing barriers presented by installation based attacks, place based guidance and testing is a extremely acceptable theoretical account that carries great potency in spread outing HIV guidance and testing, and cut downing the figure of lost chances for proving. The chance it provides for proving twosomes is peculiarly utile in the Kenyan scene where 44 % of new infections are happening amongst married or live togethering twosomes. Scaling up HBHCT to national degree may non be executable due to
hapless substructure, limited supplies and equipment, deficit of human resource and limited coverage of HIV plans. However, HBHCT is a practical and promising theoretical account that should be used to complement but non utility traditional theoretical accounts. Use of two rapid trial devices and ballad counselors are some of the schemes that can be employed to optimise door to door proving in resource limmited scenes. Strong political will and committedness is overriding to guaranting its continued success and sustainability.