Comparison of home and clinic-based HIV testing among household members of persons taking antiretroviral therapy in Uganda: results from a randomized trial.

OBJECTIVE: Due to high rates of undiagnosed and untreated HIV infection in Africa, we compared HIV counseling and testing (VCT) uptake among household members of patients receiving antiretroviral therapy. METHODS: HIV-infected persons attending an AIDS clinic were randomized to a home-based or clinic-based antiretroviral therapy program including VCT for household members. Clinic arm participants were given free VCT vouchers and encouraged to invite their household members to the clinic for VCT. Home arm participants were visited, and their household members offered VCT using a 3-test rapid finger-stick testing algorithm. VCT uptake and HIV prevalence were compared. FINDINGS: Of 7184 household members, 3974 (55.3%) were female and 4798 (66.8%) were in the home arm. Home arm household members were more likely to receive VCT than those from the clinic arm (55.8% vs. 10.9%, odds ratio: 10.41, 95% confidence interval: 7.89 to 13.73; P < 0.001), although the proportion of HIV-infected household members was higher in the clinic arm (17.3% vs. 7.1%, odds ratio: 2.76, 95% confidence interval: 1.97 to 3.86, P < 0.001). HIV prevalence among all household members tested in the home arm was 56% compared with 27% in the clinic arm. Of 148 spouses of HIV-infected patients, 69 (46.6%) were uninfected. Persons aged 15-24 were less likely to test than other age groups, and in the home arm, women were more likely to test than men. CONCLUSIONS: Home-based VCT for household members of HIV-infected persons was feasible, associated with lower prevalence, higher uptake, and increased identification of HIV-infected persons than clinic-based provision

Subtropical Epibenthos Varies with Location, Reef Type, and Grazing Intensity

Composition of marine epibenthic communities are influenced by both physical and biotic processes. For instance, the larval supply and cues that influence colonization (physical), as well as the growth and mortality of individuals (biotoic), may differ across location and reef type. Determining the relative influence of these processes is important to understanding how epibenthic communities can develop in a region. Using both a partial caging experiment that controlled grazing by urchins and in situ photographic surveys of epibenthic communities, this study examined the relationship between urchin grazing and the composition of epibenthos on natural limestone and artificial reefs in the eastern Gulf of Mexico (eGOM). In the experiment, tiles that were open to urchin grazing had lower percent cover of algae (−12%) and higher cover of crustose coralline algae (CCA) (13%) than those that excluded urchins. Patterns in tile cover were likely the result of CCA either resisting grazing mortality or recolonizing exposed areas after algae were removed. Variation in colonization was observed between inshore and offshore reef groups. Urchin density was positively correlated with the structural complexity of the habitats, which was higher on artificial reefs than natural ones, a factor that potentially had important effects on several observed patterns. Results from photographic surveys indicated that natural reef communities had higher algal cover and lower cover of invertebrates (e.g., corals and hydroids) than artificial reefs. These findings were consistent with previous work conducted in both temperate and tropical ecosystems, and suggested that grazing from urchins plays an important role in shaping epibenthic community structure in the subtropical eGOM