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Acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi
  1. F Obare1,2,
  2. P Fleming1,
  3. P Anglewicz1,
  4. R Thornton3,
  5. F Martinson1,
  6. A Kapatuka4,
  7. M Poulin1,
  8. S Watkins1,5,
  9. H-P Kohler1
  1. 1
    Population Studies Center, University of Pennsylvania, Philadelphia, USA
  2. 2
    Population Council, Nairobi, Kenya
  3. 3
    Population Studies Center, University of Michigan, Michigan, USA
  4. 4
    University of North Carolina Project, Lilongwe, Malawi
  5. 5
    California Center for Population Research, University of California, Los Angeles, USA
  1. Francis Obare, Population Council, PO Box 17643, Nairobi 00500, Kenya; fonyango{at}


Objective: To examine the acceptance of repeat population-based voluntary counselling and testing (VCT) for HIV in rural Malawi.

Methods: Behavioural and biomarker data were collected in 2004 and 2006 from approximately 3000 adult respondents. In 2004, oral swab specimens were collected and analysed using ELISA and confirmatory Western blot tests, while finger-prick rapid testing was done in 2006. We used cross-tabulations with χ2 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 the 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 sociodemographic and behavioural 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 healthcare 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.

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  • Additional materials are published online only at

  • Funding: This work was supported by National Institutes of Health (NIH)/National Institute of Child Health and Human Development (NICHD) grants: NICHD-RO1 HD044228-01 and NICHD-RO1HD/MH41713-0.

  • Competing interests: None.

  • Ethics approval: Approved by the institutional review boards at the College of Medicine Research Ethics Committee (COMREC) in Malawi and the University of Pennsylvania in the United States.

  • Contributors: FO worked as a Graduate Student Assistant in the 2004 and 2006 MDICP surveys and prepared the manuscript and carried out the relevant analyses. PF served as the Research Director in the two surveys and worked closely with FO in preparing the manuscript. PA coordinated the biomarker collection in 2004, served as Fieldwork Director in 2006 and prepared the data for the paper. RT was responsible for the incentive experiment and the provision of VCT in 2004, and contributed towards the preparation of the manuscript, especially the sections on incentives and obtaining of the test results in 2004. FM was responsible for managing the laboratory analysis of HIV and STI samples and for reviewing the HIV testing protocol in 2004. AK was responsible for training the nurses and VCT counsellors in 2004 and 2006, respectively. MP served as Fieldwork Director in 2004 and contributed towards the preparation of the manuscript. SW and H-PK were the Principal Investigators in 2004 and 2006, and contributed to the analytic design and the writing of the manuscript.