TURBO, 17 February 2009 (IRIN) - Joel Kirwa, a farmer in Rift Valley Province, western Kenya, has never been tested for HIV; he is usually too busy tending his cattle and fields and rarely visits Turbo town, where the nearest voluntary counselling and testing (VCT) centre is located.

Today, however, a health team is going from door to door in his area, offering HIV counselling and testing to every household. "Home testing is very helpful - it is private, so your results and even the fact that you tested are hidden ... in the normal VCT centres you can meet people who know you and will talk about you," he told IRIN/PlusNews.

Kirwa and his wife were both HIV negative, and he proudly displayed the 'certificate' the counsellor gave him as proof of his status.

The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) ran a pilot project in the Rift Valley Province's Kuresoi Division in 2007, testing 19,000 out of 20,000 eligible people. The official programme has been running since August 2008.

"Prior to the start of HCT [home-based counselling and testing], a majority of the HIV patients have been presenting to the clinic late, when their CD4 cell count [a measure of immunity] is low and they are unable to work," Dr Samson Ndege, the project coordinator, told IRIN/PlusNews.

AMPATH is conducting tests in Turbo, in Uasin Gishu District, and Mautuma, in Lugari District, which have a total population of about 120,000; so far, 45,000 people have been tested, of which 1,483 have been HIV positive.

Anyone over the age of 13 is considered eligible for testing, as well as children under 13 whose mothers are positive; parental consent is required before children can be tested. Personal digital assistants (PDAs) are used for data collection, and coordinates indicating the location of households are marked using a global positioning system.

AMPATH uses community mobilizers, selected by local chiefs, to go from door to door, telling people about the importance of being tested ahead of the counsellor's visit.

"People have become much more receptive and less suspicious," said Peter Musili, a nurse and counsellor with AMPATH. "The word of mouth from those previously tested has been very useful."

Teething problems

Counsellors often have to visit homes more than once. "Many men are normally away from home and may not be found the first time the counsellors visit their homes. It was also difficult to find school-going children at home," Ndege said.

"We encourage them [counsellors] to make appointments, so that couples can be counselled together during subsequent visits. We have also made arrangements so that visits can be made over the weekend to find children who are day-scholars," he added.

"Getting couples to test together has been challenging, especially given the high rate of discordance [when only one of them is positive]. Getting those individuals who test positive to go to the clinic has also been difficult - couples who were not tested together may have problems disclosing their status to their partners."

A recent national survey http://www.retroconference.org/2009/Abstracts/36616.htm found that 43.8 percent of HIV-infected married or cohabitating people had an uninfected partner, but more than three-quarters of all respondents who were part of a couple did not know their partner's HIV status.

Benefits beyond HIV

AMPATH is providing every home in the area with mosquito nets and deworming tablets for children, while counsellors are also collecting data on immunisation and referring parents to health centres where children can be vaccinated.

"We also collect sputum for TB [tuberculosis] tests from individuals who have had coughs for more than two weeks or those who report night sweats and fever," Ndege said.

Door-to-door testing was successfully piloted in Bushenyi District, in western Uganda, between January 2005 and February 2007, reaching 63 percent of all households. A study http://www.retroconference.org/2009/Abstracts/34876.htm on the impact of the programme found that the benefits of home counselling and testing were far-reaching.

"Aside from expanding coverage, door-to-door VCT may significantly improve stigma and disclosure of serostatus, and may also have a prevention effect through improvements in HIV risk behaviour," the authors concluded.

Kenya traditionally relies on voluntary counselling and testing, in which patients visit VCT centres on their own initiative, but official figures estimate that 63.5 percent of Kenyans have never been tested for HIV.

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