Background: Home-based, voluntary counselling and testing (HBCT) offers an opportunity to scale up early diagnosis. We aim to evaluate the acceptance of HBCT with POC testing for syphilis and HIV, to estimate the prevalence among individuals tested at home, and to assess the performance of POC testing by health staff using dried tube specimens (DTS) in a remote municipality of the interior of the Amazon region.
Methods: Community health teams from the Family Health Program already in place conducted door-to-door outreach in the urban area of São Gabriel da Cachoeira/Amazonas. Participating households were selected randomly from the catchment area of each community health team. HBCT for syphilis and HIV were offered to all residents aged ≥15 years. For both infections, DTS panels that included samples with negative and positive results were reconstituted and performed by health care workers (HCW).
Results: HBCT was offered to 1752 household individuals and accepted by 1501 (85.6%). Overall median age was 32.0 years, 64.4% were female, 85.1% were indigenous, and none had ever been tested for HIV or syphilis using a rapid test. The respective prevalence in men and women were HIV (0:37% and 0.0%) and syphilis (1.12% and 2.69%). Syphilis prevalence among pregnant women was 2.94%. Eleven HCW tested 43 DTS samples for HIV and 43 for syphilis. The results reported by HCW showed a concordance rate of 55.8% for HIV and 90.7% for syphilis with the reference laboratory.
Conclusions: HBCT was highly acceptable and successful in reaching untested individuals. Although only two cases of HIV were detected, HBCT identified previously undiagnosed syphilis cases, especially among pregnant women. However, efforts should be made to ensure the quality of test performance by non-laboratory personnel. As Brazil moves to scale-up HIV testing, our findings highlight how HBCT can maximize coverage in remote areas with similar characteristics.