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Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention

LANCET 2014年第9939期384卷 272-279页

作者： Jones, Alexandra Cremin, Ide Abdullah, Fareed Idoko, John Cherutich, Peter Kilonzo, Nduku Rees, Helen Hallett, Timothy O'Reilly, Kevin Koechlin, Florence Schwartlander, Bernhard de Zalduondo, Barbara Kim, Susan Jay, Jonathan Huh, Jacqueline Piot, Peter Dybul, Mark Georgetown Univ Ctr Law ONeill Inst Natl & Global Hlth Law Washington DC USA Univ London Imperial Coll Sci Technol & Med Sch Publ Hlth London England SANAC Pretoria South Africa Natl Agcy Control AIDS Abuja Nigeria Natl AIDS STD Control Programme NASCOP Nairobi Kenya Liverpool Voluntary Counselling & Testing Care & Nairobi Kenya Univ Witwatersrand Wits Reprod Hlth & HIV Inst ZA-2050 Johannesburg South Africa WHO Dept HIV AIDS CH-1211 Geneva Switzerland UNAIDS Dept Evidence Strategy & Results Geneva Switzerland UNAIDS Off Deputy Execut Director Programme Geneva Switzerland London Sch Hyg & Trop Med Directors Off London WC1 England Global Fund Fight AIDS TB & Malaria Geneva Switzerland

Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.

关键词： Epidemic infection risk aids prevention Population at Risk HIV Persons Pre-Exposure Prophylaxis Pandemics Public Health Circumcision, Male

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Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

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LANCET GLOBAL HEALTH 2022年第12期10卷 E1715-E1743页

作者： Lozano, Rafael Haakenstad, Annie Yearwood, Jamal Akeem Fullman, Nancy Bintz, Corinne Bienhoff, Kelly Weaver, Marcia R. Nandakumar, Vishnu Joffe, Jonah N. LeGrand, Kate E. Knight, Megan Abbafati, Cristiana Abbasi-Kangevari, Mohsen Abdoli, Amir Abeldano Zuniga, Roberto Ariel Adedeji, Isaac Akinkunmi Adekanmbi, Victor Adetokunboh, Olatunji O. Afzal, Muhammad Sohail Afzal, Saira Agudelo-Botero, Marcela Ahinkorah, Bright Opoku Ahmad, Sajjad Ahmadi, Ali Ahmadi, Sepideh Ahmed, Ali Rashid, Tarik Ahmed Aji, Budi Akande-Sholabi, Wuraola Alam, Khurshid Al Hamad, Hanadi Alhassan, Robert Kaba Ali, Liaqat Alipour, Vahid Aljunid, Syed Mohamed Ameyaw, Edward Kwabena Amin, Tarek Tawfik Amu, Hubert Amugsi, Dickson A. Ancuceanu, Robert Andrade, Pedro Prata Anjum, Afifa Arabloo, Jalal Arab-Zozani, Morteza Ariffin, Hany Arulappan, Judie Aryan, Zahra Ashraf, Tahira Atnafu, Desta Debalkie Atreya, Alok Ausloos, Marcel Avila-Burgos, Leticia Ayano, Getinet Ayanore, Martin Amogre Azari, Samad Badiye, Ashish D. Baig, Atif Amin Bairwa, Mohan Bakkannavar, Shankar M. Baliga, Shrikala Banik, Palash Chandra Baernighausen, Till Winfried Barra, Fabio Barrow, Amadou Basu, Sanjay Bayati, Mohsen Belete, Rebuma Bell, Arielle Wilder Bhagat, Devidas S. Bhagavathula, Akshaya Srikanth Bhardwaj, Pankaj Bhardwaj, Nikha Bhaskar, Sonu Bhattacharyya, Krittika Bhutta, Zulfiqar A. Bibi, Sadia Bijani, Ali Bikbov, Boris Biondi, Antonio Bolarinwa, Obasanjo Afolabi Bonny, Aime Brenner, Hermann Buonsenso, Danilo Burkart, Katrin Busse, Reinhard Butt, Zahid A. Butt, Nadeem Shafique Caetano dos Santos, Florentino Luciano Cahuana-Hurtado, Lucero Alberto Camera, Luis Cardenas, Rosario Carneiro, Vera L. A. Catala-Lopez, Ferran Chandan, Joht Singh Charan, Jaykaran Chavan, Prachi P. Chen, Simiao Chen, Shu Choudhari, Sonali Gajanan Chowdhury, Enayet Karim Chowdhury, Mohiuddin Ahsanul Kabir Cirillo, Massimo Corso, Barbara Dadras, Omid Dahlawi, Saad M. A. Dai, Xiaochen Dandona, Lalit Dandona, Rakhi Dangel, William James Alberto Davila-Cervantes, Claudio Davletov, Kairat Deuba, Univ Washington Inst Hlth Metr & Evaluat Seattle WA 98195 USA Univ Washington Sch Med Dept Hlth Metr Sci Seattle WA USA Univ Washington Div Allergy & Infect Dis Seattle WA 98195 USA Univ Washington Dept Anesthesiol & Pain Med Seattle WA 98195 USA Harvard Univ Dept Global Hlth & Populat Boston MA 02115 USA Harvard Univ Brigham & Womens Hosp Boston MA 02115 USA Harvard Univ TH Chan Sch Publ Hlth Boston MA 02115 USA Harvard Univ Ctr Primary Care Boston MA 02115 USA Harvard Univ Dept Global Hlth & Social Med Boston MA 02115 USA Harvard Univ Div Cardiol Boston MA 02115 USA Harvard Univ Div Gen Internal Med Boston MA 02115 USA Gates Ventures Dept Nutr Seattle WA USA Univ Roma La Sapienza Dept Jurid & Econ Studies Rome Italy Univ Tehran Med Sci Noncommunicable Dis Res Ctr Tehran Iran Univ Tehran Med Sci Natl Inst Hlth Res Tehran Iran Univ Tehran Med Sci Multiple Sclerosis Res Ctr Tehran Iran Univ Tehran Med Sci Students Sci Res Ctr SSRC Tehran Iran Univ Tehran Med Sci Digest Dis Res Inst Tehran Iran Univ Tehran Med Sci Dept Epidemiol & Biostat Tehran Iran Univ Tehran Med Sci Sina Trauma & Surg Res Ctr Tehran Iran Jahrom Univ Med Sci Zoonoses Res Ctr Jahrom Iran Univ Sierra Sur Postgrad Dept Miahuatlan De Porfirio D Mexico Natl Res Council Mexico Mexico City DF Mexico Olabisi Onabanjo Univ Dept Sociol Ago Iwoye Nigeria Univ Texas Galveston Dept Obstet & Gynecol Galveston TX USA Univ Texas Galveston Off Hlth Policy & Legislat Affairs Galveston TX USA Stellenbosch Univ DSI NRF Ctr Excellence Epidemiol Modelling & Anal Stellenbosch South Africa Stellenbosch Univ Div Epidemiol & Biostat Cape Town South Africa Univ Management & Technol Dept Life Sci Lahore Pakistan King Edward Mem Hosp Dept Community Med Lahore Pakistan Inst Publ Hlth Dept Publ Hlth Lahore Pakistan Univ Nacl Autonoma Mexico Ctr Policy Populat & Hlth Res Mexico City DF Mexico Univ Nacl Autonoma Mexico Hlth Policy & Populat Res Ctr CIPPS Mexico City DF Mexico U

Background Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings Between 1990 and 2019, the HAQ Index increased overall (by 19.6 points, 95% uncertainty interval 17.9-21.3), as well as among the young (22.5, 19.9-24.7), working (17.2, 15.2-19.1), and post-working (15.1, 13.2-17.0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30.7 (28.6-33.0) on average in low-SDI countries to 83.4 (82.4-84.3) on average in highSDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40.4-89.0), working (33.8-82.8), and post-working (30.4-79.1) group

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Collaborative Effort for a Centralized Worldwide Tuberculosis Relational Sequencing Data Platform

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CLINICAL INFECTIOUS DISEASES 2015年第Sup3期61卷 S141-S146页

作者： Starks, Angela M. Aviles, Enrique Cirillo, Daniela M. Denkinger, Claudia M. Dolinger, David L. Emerson, Claudia Gallarda, Jim Hanna, Debra Kim, Peter S. Liwski, Richard Miotto, Paolo Schito, Marco Zignol, Matteo Ctr Dis Control & Prevent Div TB Eliminat Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA 30329 USA Crit Path Inst Tucson AZ USA Ist Sci San Raffaele Ist Ricovero & Cura Carattere Sci I-20132 Milan Italy Fdn Innovat New Diagnost Geneva Switzerland St Michaels Hosp Li Ka Shing Knowledge Inst Ctr Eth Social & Cultural Risk Toronto ON M5B 1W8 Canada Bill & Melinda Gates Fdn Seattle WA USA NIAID Div AIDS NIH Bethesda MD 20892 USA WHO TB Monitoring & Evaluat Global TB Programme CH-1211 Geneva Switzerland

Continued progress in addressing challenges associated with detection and management of tuberculosis requires new diagnostic tools. These tools must be able to provide rapid and accurate information for detecting resistance to guide selection of the treatment regimen for each patient. To achieve this goal, globally representative genotypic, phenotypic, and clinical data are needed in a standardized and curated data platform. A global partnership of academic institutions, public health agencies, and nongovernmental organizations has been established to develop a tuberculosis relational sequencing data platform (ReSeqTB) that seeks to increase understanding of the genetic basis of resistance by correlating molecular data with results from drug susceptibility testing and, optimally, associated patient outcomes. These data will inform development of new diagnostics, facilitate clinical decision making, and improve surveillance for drug resistance. ReSeqTB offers an opportunity for collaboration to achieve improved patient outcomes and to advance efforts to prevent and control this devastating disease.

关键词： Mycobacterium tuberculosis drug resistance database

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Exploring the use of mobile phone technology for the enhancement of the prevention of mother-to-child transmission of HIV program in Nyanza, Kenya: a qualitative study

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BMC PUBLIC HEALTH 2013年第1期13卷 1-9页

作者： Jennings, Larissa Ong'ech, John Simiyu, Rogers Sirengo, Martin Kassaye, Seble Elizabeth Glaser Pediat AIDS Fdn Res Unit Washington DC 20036 USA Johns Hopkins Bloomberg Sch Publ Hlth Dept Int Hlth Social & Behav Intervent Baltimore MD 21205 USA Elizabeth Glaser Pediat AIDS Fdn Nairobi Kenya Univ Nairobi Kenyatta Natl Hosp Nairobi Kenya Minist Hlth Natl AIDS STD Control Programme Nairobi Kenya Georgetown Univ Div Infect Dis Dept Med Washington DC 20007 USA

Background: Community-based mobile phone programs can complement gaps in clinical services for prevention of mother-to-child transmission (PMTCT) of HIV in areas with poor infrastructure and personnel shortages. However, community and health worker perceptions on optimal mobile phone communication for PMTCT are underexplored. This study examined what specific content and forms of mobile communication are acceptable to support PMTCT. Methods: Qualitative methods using focus groups and in-depth interviews were conducted in two district hospitals in Nyanza Province, Kenya. A total of 45 participants were purposefully selected, including HIV-positive women enrolled in PMTCT, their male partners, community health workers, and nurses. Semi-structured discussion guides were used to elicit participants' current mobile phone uses for PMTCT and their perceived benefits and challenges. We also examined participants' views on platform design and gender-tailored short message service (SMS) messages designed to improve PMTCT communication and male involvement. Results: Most participants had access to a mobile phone and prior experience receiving and sending SMS, although phone sharing was common among couples. Mobile phones were used for several health-related purposes, primarily as voice calls rather than texts. The perceived benefits of mobile phones for PMTCT included linking with health workers, protecting confidentiality, and receiving information and reminders. Men and women considered the gender-tailored SMS as a catalyst for improving PMTCT male involvement and couples' communication. However, informative messaging relayed safely to the intended recipient was critical. In addition, health workers emphasized the continual need for in-person counseling coupled with, rather than replaced by, mobile phone reinforcement. For all participants, integrated and neutral text messaging provided antenatally and postnatally was most preferred, although not all topics or text formats w

关键词： Mobile phone mHealth Short message service SMS HIV Prevention of mother-to-child transmission PMTCT Male involvement

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Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence

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HEPATOLOGY 2013年第4期57卷 1333-1342页

作者： Hanafiah, Khayriyyah Mohd Groeger, Justina Flaxman, Abraham D. Wiersma, Steven T. Johns Hopkins Bloomberg Sch Publ Hlth Baltimore MD USA Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Washington Inst Hlth Metr & Evaluat Seattle WA 98195 USA WHO Global Hepatitis Programme CH-1211 Geneva Switzerland

In efforts to inform public health decision makers, the Global Burden of Diseases, Injuries, and Risk Factors 2010 (GBD2010) Study aims to estimate the burden of disease using available parameters. This study was conducted to collect and analyze available prevalence data to be used for estimating the hepatitis C virus (HCV) burden of disease. In this systematic review, antibody to HCV (anti-HCV) seroprevalence data from 232 articles were pooled to estimate age-specific seroprevalence curves in 1990 and 2005, and to produce age-standardized prevalence estimates for each of 21 GBD regions using a model-based meta-analysis. This review finds that globally the prevalence and number of people with anti-HCV has increased from 2.3% (95% uncertainty interval [UI]: 2.1%-2.5%) to 2.8% (95% UI: 2.6%-3.1%) and >122 million to >185 million between 1990 and 2005. Central and East Asia and North Africa/Middle East are estimated to have high prevalence (>3.5%);South and Southeast Asia, sub-Saharan Africa, Andean, Central, and Southern Latin America, Caribbean, Oceania, Australasia, and Central, Eastern, and Western Europe have moderate prevalence (1.5%-3.5%);whereas Asia Pacific, Tropical Latin America, and North America have low prevalence (<1.5%). Conclusion: The high prevalence of global HCV infection necessitates renewed efforts in primary prevention, including vaccine development, as well as new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. (HEPATOLOGY 2013)

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Economics of monitoring antiretroviral therapy

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LANCET INFECTIOUS DISEASES 2013年第7期13卷 560-561页

作者： Mermin, Jonathan Granich, Reuben Ctr Dis Control & Prevent Div HIV AIDS Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA 30333 USA United Nations Programme HIV AIDS Sci Act Div Geneva Switzerland

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Improving neonatal health in South-East Asia

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PUBLIC HEALTH 2012年第3期126卷 223-226页

作者： Nair, H. Arya, G. Vidnapathirana, J. Tripathi, S. Talukder, S. H. Srivastava, V. Integral Univ Lucknow Uttar Pradesh India Univ Edinburgh Global Hlth Acad Ctr Populat Hlth Sci Edinburgh Midlothian Scotland Publ Hlth Fdn India New Delhi India United Nations Children Fund Lucknow Uttar Pradesh India Minist Hlth Natl STD AIDS Control Programme Colombo Sri Lanka Mahidol Univ Natl Inst Child & Family Dev Bangkok 10700 Thailand Eminence Associates Social Dev Dhaka Bangladesh

The countries in South-east Asia have wide disparities in socio-economic and health indicators. This region accounts for almost one-third of global mortality in neonates and children under 5 years of age, and many countries in the region are unlikely to attain Millennium Development Goal 4. Over the past decade, several countries have initiated innovative projects with the aim of improving child health. This paper examines the innovations in neonatal health in four countries - Bangladesh, India, Sri Lanka and Thailand - and analyses the extent to which these have been successful in meeting their goals. This case study will inform national governments and donor agencies wishing to scale up or modify existing neonatal health interventions. (C) 2011 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

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Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries

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BMC PUBLIC HEALTH 2012年第1期12卷 1-15页

作者： Hardon, Anita Vernooij, Eva Bongololo-Mbera, Grace Cherutich, Peter Desclaux, Alice Kyaddondo, David Ky-Zerbo, Odette Neuman, Melissa Wanyenze, Rhoda Obermeyer, Carla Univ Amsterdam Amsterdam Inst Social Sci Res Amsterdam Netherlands Res Equ & Community Hlth Trust Lilongwe Malawi Minist Hlth Natl AIDS STD Control Programme Nairobi Kenya Univ Paul Cezanne Aix Marseille Inst Rech Dev Dakar Senegal Makerere Univ Dept Social Work Child Hlth & Dev Ctr Kampala Uganda Programme Appui Monde Associatif & Communautaire Ouagadougou Burkina Faso Harvard Univ Sch Publ Hlth Dept Soc Human Dev & Hlth Boston MA 02115 USA Makerere Univ Sch Publ Hlth Kampala Uganda Amer Univ Beirut Fac Hlth Sci Beirut Lebanon

Background: Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods: Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services;2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support;(3) in-depth interviews with key informants and PMTCT healthcare workers;and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests. Results: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret;only 37% had disclosed to their husband. Conclusion: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.

关键词： PMTCT Africa HIV testing Counseling Consent Disclosure

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The Safety Profile and Acceptability of a Disposable Male Circumcision Device in Kenyan Men Undergoing Voluntary Medical Male Circumcision

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JOURNAL OF UROLOGY 2011年第5期186卷 1923-1927页

作者： Musau, Pius Demirelli, Mustafa Muraguri, Nicholas Ndwiga, Francis Wainaina, Daniel Ali, Nabila Amin Moi Univ Sch Med Dept Surg & Anaesthesiol Eldoret Kenya Uasin Gishu Dist Hosp Minist Hlth Eldoret Kenya Natl AIDS STD Control Programme Nairobi Kenya Turkish Profess Circumcisers Assoc Ankara Turkey

Purpose: We established the safety and effectiveness as well as the acceptability of the Alisklamp(R) device for male circumcision among Kenyan men. Materials and Methods: To qualify for this hospital based, prospective, interventional cohort study one needed to be an uncircumcised adult male who was HIV negative with no comorbid factors or genitourinary anomalies precluding circumcision. A total of 58 men were recruited from a population of 90. Outcome measures were the safety profile of Alisklamp and its efficiency and acceptability by participants. Results: All 58 procedures were completed without device malfunction, hemorrhage or undesirable preputial excision. Mean +/- SD procedure time was 2.43 +/- 1.36 minutes and mean device removal time was 15.8 +/- 7.4 seconds. There were 2 adverse events, including mild edema and superficial wound infection related to poor hygiene in 1 case each. All men resumed routine activity immediately after circumcision. Of the 58 participants 25.9% experienced mild nocturnal erectile pains that required no medication. During 6-week followup all men were satisfied with the procedure, tolerated the device well and would recommend it to a friend. Conclusions: Alisklamp has an excellent safety profile and excellent acceptability among men who undergo circumcision using the device. This technique is easy to teach and it would prove to be a handy device to scale up the rate of male circumcision. Based on these findings the device merits a comparative clinical trial.

关键词： penis circumcision, male instrumentation HIV Kenya

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Perceptions of door-to-door HIV counselling and testing in Botswana

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SAHARA J-JOURNAL OF SOCIAL ASPECTS OF HIV-aids 2011年第4期8卷 171-178页

作者： Kroeger, Karen Taylor, Allan Marlow, Heather Fleming, Douglas T. Beyleveld, Vanessa Alwano, Mary Grace Kejelepula, Mabel Tebogo Chilume, Kentsenao Busang Smith, Dawn K. Roels, Thierry H. Kilmarx, Peter H. US Ctr Dis Control & Prevent CDC Div STD Prevent Natl Ctr HIV Viral Hepatitis STD & TB Prevent NCH Atlanta GA USA CDC Global Programme AIDS Epidem Intelligence Serv Atlanta GA 30333 USA Univ N Carolina Dept Maternal & Child Hlth Chapel Hill NC USA S Africa HIV Antenatal Posttest Support Study Durban South Africa Bristol Myers Squibb Co Res & Dev Global Clin Res Metab Dis Princeton NJ USA Premiere Personnel Gaborone Botswana CDC Hlth Reform & Epidemiol Branch Div HIV AIDS Prevent Atlanta GA 30333 USA

Prevalence of HIV infection in Botswana is among the highest in the world, at 23.9% of 15 - 49-year-olds. Most HIV testing is conducted in voluntary counselling and testing centres or medical settings. Improved access to testing is urgently needed. This qualitative study assessed and documented community perceptions about the concept of door-to-door HIV counselling and rapid testing in two of the highest-prevalence districts of Botswana. Community members associated many positive benefits with home-based, door-to-door HIV testing, including convenience, confidentiality, capacity to increase the number of people tested, and opportunities to increase knowledge of HIV transmission, prevention and care through provision of correct information to households. Community members also saw the intervention as increasing opportunities to engage and influence family members and to role model positive behaviours. Participants also perceived social risks and dangers associated with home-based testing including the potential for conflict, coercion, stigma, and psychological distress within households. Community members emphasised the need for individual and community preparation, including procedures to protect confidentiality, provisions for psychological and social support, and links to appropriate services for HIV-positive persons.

关键词： HIV/aids counselling and testing home-based HIV testing Botswana qualitative research

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