Promoting uptake of child HIV testing: an evaluation of the role of a home visiting program for orphans and vulnerable children in South Africa

ABSTRACT

HIV counseling and testing (HCT) is critical for children in generalized epidemic settings, but significant shortfalls in coverage persist, notably among orphans and others at disproportionate risk of infection. This study investigates the impact of a home visiting program in South Africa on orphaned and vulnerable children’s uptake of HCT. Using propensity score matching, survey data for children receiving home visits from trained community-based care workers were compared to data from children living in similar households that had not yet received home visits (n = 1324). Home visits by community-based care workers increased the odds of a child being tested by 97% (OR = 1.97, 95% CI = 1.34–2.92). The home visitation program had an especially pronounced effect on orphans, more than doubling their odds of being tested (OR = 2.12, 95% CI = 1.00–4.47) compared to orphans living in similar households that did not receive home visits. Orphan status alone had no effect on HCT independent of program exposure, suggesting that the program was uniquely able to increase testing in this subgroup. Results highlight the potential for increasing HCT access among children at high risk through targeted community-based initiatives.

KEYWORDS:

• HIV counseling and testing
• orphans and vulnerable children
• home visiting
• South Africa
• evaluation

Acknowledgements

The study team is particularly grateful for the support provided from personnel at USAID Southern Africa, particularly Anita Sampson. We further extend our appreciation to staff from Future Families in South Africa who supported the realization of this study. Importantly, we extend our gratitude to the participating caregivers who generously shared intimate details of their lives with the research team in order to increase our understanding of their circumstances and the impact programs can have on their lives; we sincerely hope that they and others in similar circumstances will be the ultimate beneficiaries of these research efforts.

Additional information

Funding

Funding for this project was provided by the United States Agency for International Development (USAID) Southern Africa under the President’s Emergency Plan for AIDS Relief (PEPFAR) through Cooperative Agreement [grant number AID-674-A-12-00002] awarded to Tulane University. The views expressed in this document do not necessarily reflect those of USAID or the United States Government.