Widespread HIV counseling and testing strategies are needed to link HIV-positive persons to care and HIV-negative individuals to prevention. We evaluated home-based counseling and testing (HBCT) as a platform to achieve high HIV testing coverage, high linkages to care, and antiretroviral therapy (ART) uptake in Mbarara, Uganda, and KwaZulu-Natal, South Africa. HBCT was conducted starting in September 2011. HIV-positive persons received point-of-care CD4 tests, stage-specific HIV-care counseling, facilitated referral to local clinics, and follow-up visits at one, two, three, six, nine, and 12 months, which included evaluation of ART uptake. HIV testing of 3,552 adults identified 636 HIV-positive persons – 404 in KwaZulu-Natal (32% prevalence) and 232 in Mbarara (11% prevalence). Of the 382 HIV+ persons not on ART, 78 (32%) in KwaZulu-Natal and 48 (35%) in Mbarara were ART eligible (CD4 of less than 350 cells/µL). At six months, more than 97% of participants had visited an HIV clinic and, of those with CD4 of less than 350 cells/µL who had not yet initiated ART, 51% and 73% in KwaZulu-Natal and Mbarara, respectively, initiated ART. Community viral load decreased significantly by 1.74 log10 copies/mL (p<0.0001) among HIV-positive persons eligible for ART. This study of HBCT in rural South Africa and Uganda demonstrates high uptake of HIV testing and successful linkages to HIV care in high HIV-prevalence, resource-constrained settings.  


Dr. Ruanne Barnabas is an Infectious Disease Physician-Scientist at the University of Washington and affiliate at the Fred Hutchinson Cancer Research Center. She completed her medical training at the University of Cape Town, her doctorate in Mathematical Modeling at the University of Oxford and her Infectious Diseases training at the University of Washington. Her research focuses on HIV treatment and prevention, specifically on interventions that reduce HIV viral load and, consequently, disease progression and transmission. Her projects use both empiric data and mathematical models to better understand HIV clinical progression and transmission, and estimate the potential impact of HIV interventions at the population level. The ultimate aim of her work is to estimate the effectiveness and cost effectiveness of HIV treatment and prevention interventions to inform clinical trial design.