Anonymous HIV testing with participant-controlled access to results using handheld computers: a new model of HIV testing used in a household survey in rural South Africa.

Anonymous Human Immunodeficiency (HIV) surveys aim to provide unbiased estimates of HIV prevalence and are essential for monitoring the burden of HIV in a population. However anonymous HIV surveys allow only limited linkage with risk factor data and do not allow participants to be informed of their HIV results. This is an important disadvantage in the face of evidence of individual and public health benefits of knowing ones HIV status and the increasing availability of antiretroviral therapy worldwide. In accordance with ethical guidelines anonymous HIV surveys usually refer participants to voluntary counseling and testing (VCT) services where these exist or else set up parallel VCT systems. This means that participants who wish to know their HIV status need to be bled and tested twice. Acceptance rates for such repeat VCT are not known. The World Health Organization (WHO) has recently called for initiatives to increase access to innovative ethical and practical models of HIV testing and counseling. We devised a novel approach to anonymous HIV testing which used handheld computer and encryption technology to allow participants in an HIV sero-survey to confidentially access their results. We describe this system of Linked Anonymous Testing with Participant-controlled Results (LATPCR) and its operational use in a very large household HIV survey in rural South Africa. (excerpt)

[1]  Shandir Ramlagan,et al.  South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey, 2005 , 2008 .

[2]  H. Jaffe,et al.  Revised guidelines for HIV counseling, testing, and referral. , 2001, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[3]  J Ties Boerma,et al.  Estimates of HIV-1 prevalence from national population-based surveys as a new gold standard , 2003, The Lancet.

[4]  J. Menken,et al.  Population‐Based HIV Testing and Counseling in Rural Uganda: Participation and Risk Characteristics , 2001, Journal of acquired immune deficiency syndromes.

[5]  S. Gregorich,et al.  Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial , 2000, The Lancet.

[6]  R. Johnson,et al.  Evidence for the effects of HIV antibody counseling and testing on risk behaviors. , 1991, JAMA.

[7]  B. T. Johnson,et al.  Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997. , 1999, American journal of public health.

[8]  I. Kleinschmidt,et al.  Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey , 2005, AIDS.

[9]  A. Baleta.  Widespread horror over killing of AIDS activist in South Africa , 1999, The Lancet.

[10]  G. Kigozi,et al.  The Rakai Project counselling programme experience , 2002, Tropical medicine & international health : TM & IH.

[11]  B. Lo,et al.  Many people who seek anonymous HIV-antibody testing would avoid it under other circumstances. , 1990, AIDS.

[12]  M. Colvin,et al.  South African national household survey of HIV/AIDS prevalence, behavioural risks and mass media impact--detailed methodology and response rate results. , 2004, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[13]  V. Hosegood,et al.  Household composition and dynamics in KwaZulu Natal, South Africa: mirroring social reality in longitudinal data collection , 2006 .

[14]  V. Hosegood,et al.  Levels and causes of adult mortality in rural South Africa: the impact of AIDS , 2004, AIDS.

[15]  B. Wolff,et al.  Evaluation of a home-based voluntary counselling and testing intervention in rural Uganda. , 2005, Health policy and planning.

[16]  J. Crump,et al.  Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania. , 2006, American journal of public health.

[17]  C. Liesnard,et al.  High HIV prevalence among patients choosing anonymous and free testing in Belgium, 1990–2002 , 2006, International journal of STD & AIDS.

[18]  A. Fairchild,et al.  Ethical issues to be considered in second generation surveillance. , 2004 .

[19]  F. Tanser,et al.  Population and antenatal-based HIV prevalence estimates in a high contracepting female population in rural South Africa , 2007, BMC public health.

[20]  Brecht Claerhout,et al.  Privacy protection for clinical and genomic data: The use of privacy-enhancing techniques in medicine , 2005, Int. J. Medical Informatics.

[21]  Adi Shamir,et al.  A method for obtaining digital signatures and public-key cryptosystems , 1978, CACM.

[22]  L. Fehrs,et al.  TRIAL OF ANONYMOUS VERSUS CONFIDENTIAL HUMAN IMMUNODEFICIENCY VIRUS TESTING , 1988, The Lancet.

[23]  S. Kalichman,et al.  Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. , 2007, Social science & medicine.

[24]  W. Holzemer,et al.  HIV and AIDS Stigma Violates Human Rights in Five African Countries , 2006, Nursing ethics.

[25]  C. Liechty,et al.  The evolving role of HIV counseling and testing in resource-limited settings: HIV prevention and linkage to expanding HIV care access , 2004, Current infectious disease reports.

[26]  M. Mehlman,et al.  The need for anonymous genetic counseling and testing. , 1996, American journal of human genetics.

[27]  B. Varghese,et al.  Cost-effectiveness of HIV counseling and testing in US prisons , 2001, Journal of Urban Health.

[28]  C. Cárcamo,et al.  Lessons learned in the conduct, validation, and interpretation of national population based HIV surveys , 2005, AIDS.

[29]  B. Modan,et al.  Characteristics of clients attending confidential versus anonymous testing clinics for human immunodeficiency virus. , 2001, The Israel Medical Association journal : IMAJ.

[30]  J. Garcia-Calleja,et al.  National population based HIV prevalence surveys in sub-Saharan Africa: results and implications for HIV and AIDS estimates , 2006, Sexually Transmitted Infections.

[31]  R. Saracci,et al.  International Guidelines for Ethical Review of Epidemiological Studies , 1991, Law, medicine & health care : a publication of the American Society of Law & Medicine.

[32]  N. Michael,et al.  Joint United Nations Programme on HIV/AIDS. , 2004, Military medicine.

[33]  Shabbar Jaffar,et al.  Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population-based longitudinal study , 2007, AIDS.

[34]  S. Gregorich,et al.  Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania , 2000, The Lancet.

[35]  ‘So why are you here?’ Assessing risk in HIV prevention and test decision counselling , 2001 .