A voluntary counseling and testing (VCT) program using a mobile van to travel to marketplaces in townships and villages overcomes the structural barriers to HIV testing in Sub-Saharan Africa, according to UCSF researchers.
“Mobile VCT eliminates the cost and inconvenience of having to travel to urban centers for HIV testing, while the presence of the mobile van with outreach workers in busy marketplaces creates familiarity with the testing process and reduces the stigma associated with this process, a significant psychological barrier to testing,” said study lead author, Gertrude Khumalo-Sakutukwa, MSW, M Med Sc, an academic specialist at the UCSF AIDS Policy Research Center.
Khumalo-Sakutukwa presented the findings at the XV International AIDS Conference in Bangkok, Thailand on July 14.
A mobile testing van traveled to six marketplaces in villages and townships in Epworth and Seke, Zimbabwe on a rotating basis offering free VCT using rapid HIV tests and same-day results. Researchers had identified the cost of paying for an HIV test and the cost and inconvenience of traveling to the city as the significant structural barriers to testing.
The major psychological barriers identified by the researchers included social stigma associated with being seen going into an HIV testing site, assumption that testers have HIV or AIDS, and fear of learning that one did indeed have HIV. Researchers addressed these concerns by creating a community advisory board (CAB) before testing started and having CAB members engage the community, creating awareness and generating discussions about HIV and testing. The rotating presence of the mobile VCT van in crowded marketplaces became the talk of the community, leading to increased familiarity and diminished stigma.
“Two elements of mobile VCT should be noted. One is the acceptance of rapid tests, and participants liked getting their results the same day and had no doubts that the results were theirs because the blood samples were not sent away for a week. Second, it is important to provide post-test support services including post-test clubs that include both negative and positive test-takers and linkages to medical, psychosocial, and spiritual services for those who test positive,” said study co-author, Stephen F. Morin, PhD, director, UCSF AIDS Policy Research Center.
Co-authors on the study are Janell Routh, MD, resident in the UCSF Department of Pediatrics; Agnès Fiamma, MPH, project director, Tim Lane, PhD, MPH, fellow, both at the UCSF AIDS Policy Research Center; and Katherine Fritz, MPH, PhD, assistant professor of medicine at the UCSF Center for AIDS Prevention Studies.
This study was funded by the UCSF AIDS Research Institute and the Office of AIDS Research and the National Institute of Mental Health at the National Institutes of Health. The project was developed in collaboration with the HIV Prevention Trials Network.
The AIDS Policy Research Center is a component of the UCSF AIDS Research Institute (ARI). UCSF ARI houses hundreds of scientists and dozens of programs throughout UCSF and affiliated labs and institutions, making ARI one of the largest AIDS research entities in the world.