Home-Based Counseling and Testing (HCT)
AMPATH believes the most powerful case finding and prevention tool is home-based counseling and testing (HCT). By offering testing in individual homes, AMPATH is more likely to diagnose early disease and provide care that is at once less expensive and more effective at keeping those who are HIV-positive from ever progressing to advanced disease and death.
More than any existing component, this program will move AMPATH's efforts "upstream" to provide intervention before HIV-positive patients are gravely ill, and in many cases before the HIV infections occur. Research performed in both Africa and the U.S. shows that awareness of HIV status greatly reduces risk behaviors. Testing people before they are obviously ill--and before they have infected their partners--will not only move more infected people into treatment earlier, when the treatment can be most effective, but it will also prevent thousands of persons from becoming HIV-positive in the first place.
HCT workers enroll every individual in each community and register them in a database. In addition to testing for HIV, they also screen for tuberculosis and other chronic diseases such as diabetes and hypertension, treat children for intestinal worms, deliver treated bed nets to prevent malaria, and provide nutritional counseling. It costs $1.50 per person to provide all of the services that are covered with HCT, except for the cost of the treated bed nets.
While traditional community and hospital testing methods of case finding may identify a minority of those infected, HCT holds the promise of finding more than 90% of those infected. In partnership with the AbbVie Foundation, AMPATH has conducted HCT programs in multiple communities and enrolled over 550,000 individuals. Enrollment consists of gathering information on each person in every household, including health and demographic details and GPS location information, and assigning each individual a unique identifier. In the most recent phase, 98% of households accepted AMPATH workers into their homes and 99% of the adults in those homes agreed to be tested.