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Home-Based HIV Testing and Counseling in Kenya

Source:By Cassandra Blazer and Maria Claudia Escobar
Inside a modest two-room home in Kibera, the vast Nairobi slum, Bethryn(1) and her 12-year-old daughter Alice sit on a second-hand sofa neatly adorned with white doilies. Sitting opposite them is Felix, an HIV counselor, who was brought to the home by a community health worker. Felix has a particularly delicate mission today: to provide Alice with counseling and a rapid HIV test to see if her mother’s HIV infection was transmitted to her in the womb or during birth. Felix, well aware of how voices travel between dwellings in this cramped neighborhood, speaks very softly to Alice, asking her about school and what she knows about HIV. He explains why he has come and what the test will be like. Despite his gentle approach, the girl is clearly frightened, and her worried mother cannot keep her eyes from filling with tears. This is among the more difficult assignments Felix has encountered as an HIV counselor who tests people for HIV in their homes.

For Bethryn and Alice, thankfully, this HIV testing and counseling (HTC) session ends with a negative test result, and they are visibly relieved. Felix is equally happy to have been able to deliver the good news. He combs Kibera’s labyrinth of households 10 hours a day, six days a week, offering HIV testing. Despite the demands and the emotional challenges, he loves his job. “I feel good about people knowing their status in Kibera,” he says. “Many people would not know their status here if it was not for home-based HIV testing and counseling.”

Today in Kibera and elsewhere in Kenya, home-based HTC is an emerging approach for delivering HTC services and increases the number of people who know their HIV status. It allows individuals, couples, and families to learn their HIV status in their home environment. Home-based HTC clients appreciate the convenience and privacy of testing at home. In most cases, rapid HIV tests are used, so results are available for the client between 15 and 30 minutes, depending on whether confirmatory testing is required. Kenyan programs utilize HIV rapid tests to provide same-day, real time results. In all cases, post-test counseling is undertaken. When an HIV positive result is communicated, the HTC provider offers appropriate linkages for prevention, care, and treatment. For those found to be HIV-negative, efforts may be undertaken to help them remain uninfected.

Kenya has become a regional and global pioneer in home-based HTC. The country’s experience can provide a rich foundation for other countries starting to implement or seeking to use home-based HTC as one part of their national HIV response.

A counselor takes down the client’s information before conducting an HIV test in the client’s home

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