California Center for Population Research

Objective: To examine the acceptance of repeat population-based voluntary counseling

and testing (VCT) for HIV in rural Malawi.

Methods: Behavioral and biomarker data were collected in 2004 and 2006 from

approximately 3,000 adult respondents. In 2004, oral swab specimens were collected and

analyzed using enzyme-linked immunosorbent assay (ELISA) and confirmatory Western

blot tests while finger-prick rapid testing was done in 2006. We use cross-tabulations

with chi-square tests and significance tests of proportions to determine the statistical

significance of differences in acceptance of VCT by year, individual characteristics and

HIV risk.

Results: First, over 90% of respondents in each round accepted HIV test, despite

variations in testing protocols. Second, the percentage of individuals who obtained their

test results significantly increased from 67% in 2004 when the results were provided in

randomly selected locations several weeks after the specimens were collected, to 98% in

2006 when they were made available immediately within the home. Third, whereas there

were significant variations in the socio-demographic and behavioral profiles of those who

were successfully contacted for a second HIV test, this was not the case for those who

accepted repeat VCT. This suggests that variations in the success of repeat testing might

come from contacting the individuals rather than from accepting the test or knowing the

results.

Conclusions: Repeat HIV testing at home by trained health care workers from outside

the local area, and with either saliva or blood, is almost universally acceptable in rural

Malawi, and thus likely to be acceptable in similar contexts.