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High retention and appropriate use of insecticide-treated nets distributed to HIV-affected households in Rakai, Uganda: results from interviews and home visits

Lauren Cohee1, Lisa A Mills1*, Joseph Kagaayi2, Ilana Jacobs3, Ronald Galiwango2, James Ludigo2, Joseph Ssekasanvu2 and Steven J Reynolds14

Author Affiliations

1 Johns Hopkins School of Medicine, 1830 East Monument Street #401, Baltimore, MD, USA

2 Rakai Health Sciences Program, Kalisizo, Uganda

3 University of Rochester School of Medicine, Rochester, NY, USA

4 National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

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Malaria Journal 2009, 8:76  doi:10.1186/1475-2875-8-76

Published: 22 April 2009



Distribution of insecticide-treated nets (ITNs) has recently been incorporated into comprehensive care strategies for HIV-positive people in malaria-endemic areas. WHO now recommends free or low-cost distribution of ITNs to all persons in malaria-endemic areas, regardless of age, pregnancy and HIV status. Knowledge about and appropriate use of ITNs among HIV-positive ITN recipients and their household members has not been well characterized.


142 randomly selected adults were interviewed in July–August 2006 to assess knowledge, retention, and appropriate use of ITNs they had received through a PEPFAR-funded comprehensive HIV care programme in rural Uganda.


Among all participants, 102 (72%, CI: 65%–79%) reported they had no ITNs except those provided by the programme. Of 131 participants who stated they were given ≥ 1 ITN, 128 (98%, CI: 96%–100%) stated they still possessed at least one programme-provided ITN. Reported programme-ITN (pITN) use by participants was high: 119 participants (91%, CI: 86%–96%) reported having slept under pITN the night prior to the survey and 115 (88%, CI: 82%–94%) reported sleeping under pITN seven days per week. Being away from home and heat were the most common reasons given for not sleeping under an ITN. A sub-study of thirteen random home visits demonstrated concordance between participants' survey reports and actual use of ITNs in homes.


There was excellent self-reported retention and appropriate use of ITNs distributed as a part of a community-based outpatient HIV care programme. Participants perceived ITNs as useful and were unlikely to have received ITNs from other sources.