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Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe.

Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, Chandiwana S, Munyati S, Mason PR, Butterworth AE, Godfrey-Faussett P, Hayes RJ - PLoS Med. (2006)

Bottom Line: The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders.Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8).Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. elc1@mweb.co.zw

ABSTRACT

Background: HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT).

Methods and findings: The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8).

Conclusions: High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.

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Timing of Uptake among Employees Who Accepted VCT or VouchersBroken line denotes on-site VCT uptake; solid line denotes off-site voucher uptake.
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pmed-0030238-g003: Timing of Uptake among Employees Who Accepted VCT or VouchersBroken line denotes on-site VCT uptake; solid line denotes off-site voucher uptake.

Mentions: VCT was available for 2-y at each site, but direct offer was made to each employee only once, unless HIV testing was indicated because of an HIV-related illness. The timing of first uptake among participants who accepted at least one on-site VCT or voucher is shown inFigure 3. Among employees who were present at the start of intervention, 1,239 (75.5%) of 1,640 who accepted VCT with rapid HIV testing did so within the first 2 mo of the intervention, with the corresponding proportion for voucher uptake being 274 (62.7%) of 437 participants. The high early uptake in part reflects the impact of direct offer, but there was obvious collective enthusiasm for on-site HIV testing, with demand outstripping counselling capacity in the first few weeks. Another possible manifestation of group dynamics, whereby employees encouraged one another to be tested, were the less prominent peaks in voucher uptake corresponding to periodic multiple requests for vouchers from a single site (Figure 3).


Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe.

Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, Chandiwana S, Munyati S, Mason PR, Butterworth AE, Godfrey-Faussett P, Hayes RJ - PLoS Med. (2006)

Timing of Uptake among Employees Who Accepted VCT or VouchersBroken line denotes on-site VCT uptake; solid line denotes off-site voucher uptake.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1483908&req=5

pmed-0030238-g003: Timing of Uptake among Employees Who Accepted VCT or VouchersBroken line denotes on-site VCT uptake; solid line denotes off-site voucher uptake.
Mentions: VCT was available for 2-y at each site, but direct offer was made to each employee only once, unless HIV testing was indicated because of an HIV-related illness. The timing of first uptake among participants who accepted at least one on-site VCT or voucher is shown inFigure 3. Among employees who were present at the start of intervention, 1,239 (75.5%) of 1,640 who accepted VCT with rapid HIV testing did so within the first 2 mo of the intervention, with the corresponding proportion for voucher uptake being 274 (62.7%) of 437 participants. The high early uptake in part reflects the impact of direct offer, but there was obvious collective enthusiasm for on-site HIV testing, with demand outstripping counselling capacity in the first few weeks. Another possible manifestation of group dynamics, whereby employees encouraged one another to be tested, were the less prominent peaks in voucher uptake corresponding to periodic multiple requests for vouchers from a single site (Figure 3).

Bottom Line: The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders.Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8).Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. elc1@mweb.co.zw

ABSTRACT

Background: HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT).

Methods and findings: The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8).

Conclusions: High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.

Show MeSH