IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v97y2013icp210-219.html
   My bibliography  Save this article

The seven Cs of the high acceptability of home-based VCT: Results from a mixed methods approach in Zambia

Author

Listed:
  • Jürgensen, Marte
  • Sandøy, Ingvild F.
  • Michelo, Charles
  • Fylkesnes, Knut
  • Mwangala, Sheila
  • Blystad, Astrid

Abstract

HIV testing and counselling is a critical gateway to prevention and treatment. Yet, coverage remains insufficient, few couples are tested together and gender differences in access exist. We used an embedded mixed methods approach to investigate possible explanations for the high acceptance of home-based voluntary HIV counselling and testing (HB-VCT) in a pair-matched cluster-randomized trial in Zambia. A baseline survey included 1694 individuals in 36 clusters. Adults in 18 intervention clusters were offered HB-VCT by lay counsellors. Standard testing services were available in both trial arms. After the completion of the intervention, a follow-up survey was conducted in all trial clusters. In addition, 21 in-depth interviews and one focus group discussion were conducted with home-based VCT clients in the intervention arm. Informants favoured the convenience, confidentiality and credibility of HB-VCT. Counsellors were perceived as trustworthy owing to their closeness and conduct, and the consent process was experienced as convincing. Couple testing was selected by 70% of cohabiting couples and was experienced as beneficial by both genders. Levels of first-time testing (68% vs. 29%, p < 0.0001) and re-testing (94% vs. 74%, p < 0.0001) were higher in the intervention than in the control arm. Acceptance of HIV testing and counselling is dependent on stigma, trust and gender. The confidentiality of home-based VCT was essential for overcoming stigma-related barriers, and the selection of local counsellors was important to ensure trust in the services. The high level of couple counselling within HB-VCT may contribute to closing the gender gap in HIV testing, and has benefits for both genders and potentially for prevention of HIV transmission. The study demonstrates the feasibility of achieving high test coverage with an opt-in consent approach. The embedded qualitative component confirmed the high satisfaction with HB-VCT reported in the quantitative survey and was crucial to fully understand the intervention and its consequences.

Suggested Citation

  • Jürgensen, Marte & Sandøy, Ingvild F. & Michelo, Charles & Fylkesnes, Knut & Mwangala, Sheila & Blystad, Astrid, 2013. "The seven Cs of the high acceptability of home-based VCT: Results from a mixed methods approach in Zambia," Social Science & Medicine, Elsevier, vol. 97(C), pages 210-219.
  • Handle: RePEc:eee:socmed:v:97:y:2013:i:c:p:210-219
    DOI: 10.1016/j.socscimed.2013.07.033
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953613004425
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2013.07.033?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Courtenay, Will H., 2000. "Constructions of masculinity and their influence on men's well-being: a theory of gender and health," Social Science & Medicine, Elsevier, vol. 50(10), pages 1385-1401, May.
    2. Fylkesnes, Knut & Sandøy, Ingvild Fossgard & Jürgensen, Marte & Chipimo, Peter J. & Mwangala, Sheila & Michelo, Charles, 2013. "Strong effects of home-based voluntary HIV counselling and testing on acceptance and equity: A cluster randomised trial in Zambia," Social Science & Medicine, Elsevier, vol. 86(C), pages 9-16.
    3. Kalpana Sabapathy & Rafael Van den Bergh & Sarah Fidler & Richard Hayes & Nathan Ford, 2012. "Uptake of Home-Based Voluntary HIV Testing in Sub-Saharan Africa: A Systematic Review and Meta-Analysis," PLOS Medicine, Public Library of Science, vol. 9(12), pages 1-14, December.
    4. Angotti, Nicole & Bula, Agatha & Gaydosh, Lauren & Kimchi, Eitan Zeev & Thornton, Rebecca L. & Yeatman, Sara E., 2009. "Increasing the acceptability of HIV counseling and testing with three C's: Convenience, confidentiality and credibility," Social Science & Medicine, Elsevier, vol. 68(12), pages 2263-2270, June.
    5. Gilson, Lucy, 2003. "Trust and the development of health care as a social institution," Social Science & Medicine, Elsevier, vol. 56(7), pages 1453-1468, April.
    6. Jan Ostermann & Elizabeth A Reddy & Meghan M Shorter & Charles Muiruri & Antipas Mtalo & Dafrosa K Itemba & Bernard Njau & John A Bartlett & John A Crump & Nathan M Thielman, 2011. "Who Tests, Who Doesn't, and Why? Uptake of Mobile HIV Counseling and Testing in the Kilimanjaro Region of Tanzania," PLOS ONE, Public Library of Science, vol. 6(1), pages 1-8, January.
    7. Genberg, Becky L. & Hlavka, Zdenek & Konda, Kelika A. & Maman, Suzanne & Chariyalertsak, Suwat & Chingono, Alfred & Mbwambo, Jessie & Modiba, Precious & Van Rooyen, Heidi & Celentano, David D., 2009. "A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS," Social Science & Medicine, Elsevier, vol. 68(12), pages 2279-2287, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dominic Bukenya & Janet Seeley & Grace Tumwekwase & Elizabeth Kabunga & Eugene Ruzagira, 2020. "How Follow-Up Counselling Increases Linkage to Care Among HIV-Positive Persons Identified Through Home-Based HIV Counselling and Testing: A Qualitative Study in Uganda," SAGE Open, , vol. 10(1), pages 21582440199, January.
    2. Sánchez-Sandoval, Yolanda & Aragón, Claudia & Verdugo, Laura, 2022. "Future expectations of adolescents in Residential Care: The role of self-perceptions," Children and Youth Services Review, Elsevier, vol. 143(C).
    3. Pollitt, Amanda M. & Donnelly, Rachel & Mernitz, Sara E. & Umberson, Debra, 2020. "Differences in how spouses influence each other's alcohol use in same- and different-sex marriages: A daily diary study," Social Science & Medicine, Elsevier, vol. 264(C).
    4. World Bank, 2015. "Zambias HIV Response," World Bank Publications - Reports 22080, The World Bank Group.
    5. Melander, Stina, 2023. "Different logics of pain: the gendered dimension of chronic pain in a relational setting," Social Science & Medicine, Elsevier, vol. 335(C).
    6. Kévin Jean & Xavier Anglaret & Raoul Moh & France Lert & Rosemary Dray-Spira, 2012. "Barriers to HIV Testing in Côte d'Ivoire: The Role of Individual Characteristics and Testing Modalities," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-9, July.
    7. Wiklund, Maria & Bengs, Carita & Malmgren-Olsson, Eva-Britt & Öhman, Ann, 2010. "Young women facing multiple and intersecting stressors of modernity, gender orders and youth," Social Science & Medicine, Elsevier, vol. 71(9), pages 1567-1575, November.
    8. Parker, Rhiannon & Larkin, Theresa & Cockburn, Jon, 2017. "A visual analysis of gender bias in contemporary anatomy textbooks," Social Science & Medicine, Elsevier, vol. 180(C), pages 106-113.
    9. Ingrid V Bassett & Darshini Govindasamy & Alison S Erlwanger & Emily P Hyle & Katharina Kranzer & Nienke van Schaik & Farzad Noubary & A David Paltiel & Robin Wood & Rochelle P Walensky & Elena Losina, 2014. "Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-11, January.
    10. Michelle Calvarese, 2015. "The Effect of Gender on Stress Factors: An Exploratory Study among University Students," Social Sciences, MDPI, vol. 4(4), pages 1-8, November.
    11. Oliffe, John, 2005. "Constructions of masculinity following prostatectomy-induced impotence," Social Science & Medicine, Elsevier, vol. 60(10), pages 2249-2259, May.
    12. Schneider, Pia, 2005. "Trust in micro-health insurance: an exploratory study in Rwanda," Social Science & Medicine, Elsevier, vol. 61(7), pages 1430-1438, October.
    13. Madsen, Julian & Jobson, Laura & Slewa-Younan, Shameran & Li, Haoxiang & King, Kylie, 2024. "Mental health literacy among Arab men living in high-income Western countries: A systematic review and narrative synthesis," Social Science & Medicine, Elsevier, vol. 346(C).
    14. Hatcher, Abigail M. & Gibbs, Andrew & McBride, Ruari-Santiago & Rebombo, Dumisani & Khumalo, Mzwakhe & Christofides, Nicola J., 2022. "Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa," Social Science & Medicine, Elsevier, vol. 295(C).
    15. Månsdotter, Anna & Lundin, Andreas, 2010. "How do masculinity, paternity leave, and mortality associate? -A study of fathers in the Swedish parental & child cohort of 1988/89," Social Science & Medicine, Elsevier, vol. 71(3), pages 576-583, August.
    16. Brownlie, Julie & Howson, Alexandra, 2006. "'Between the demands of truth and government': Health practitioners, trust and immunisation work," Social Science & Medicine, Elsevier, vol. 62(2), pages 433-443, January.
    17. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    18. Dahlin, Johanna & Härkönen, Juho, 2013. "Cross-national differences in the gender gap in subjective health in Europe: Does country-level gender equality matter?," Social Science & Medicine, Elsevier, vol. 98(C), pages 24-28.
    19. Leslie D. Williams & Alastair van Heerden & Xolani Ntinga & Georgios K. Nikolopoulos & Dimitrios Paraskevis & Samuel R. Friedman, 2023. "Pilot Testing Two Versions of a Social Network Intervention to Increase HIV Testing and Case-finding among Men in South Africa’s Generalized HIV Epidemic," IJERPH, MDPI, vol. 21(1), pages 1-10, December.
    20. Smirnova, Michelle & Owens, Jennifer Gatewood, 2017. "Medicalized addiction, self-medication, or nonmedical prescription drug use? How trust figures into incarcerated women's conceptualization of illicit prescription drug use," Social Science & Medicine, Elsevier, vol. 183(C), pages 106-115.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:97:y:2013:i:c:p:210-219. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.