Bridging the Gap: Reaching Men for HIV Testing Through Religious Congregations in South Africa

Jobson, Geoffrey; Khoza, Samson; Mbeng, Regina; Befula, Nomsa; Struthers, Helen; Kerongo, Grace; Peters, Remco P. H.

doi:10.1097/qai.0000000000002078

Cited by 12 publications

(13 citation statements)

References 11 publications

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“…Estimating linkage following positive HIVST result is complex, and there is no single measurement strategy that will fit the needs of all HIVST implementers and researchers [ 13 ]. However, studies that successfully estimated linkage to confirmatory testing and HIV care reported a higher linkage to confirmatory testing [ 17 , 18 ]. A cohort study in Kenya that actively promoted linkage to care, reported that linkage to care following HIVST can be comparable to the national proportion of linkage under universal test and treat policy [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Peer-based-distribution among general population might help reach more people than only targeted distribution. Young people and men usually prefer not to go to health facilities for HIV testing and other health services [ 18 , 19 ]. Encouragement by peers can help them to overcome their reluctance to using health facility-based HIV services [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Acceptability of unsupervised peer-based distribution of HIV oral self-testing for the hard-to-reach in rural KwaZulu Natal, South Africa: Results from a demonstration study

et al. 2022

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Background Innovative models to distribute oral HIV self-tests (HIVST) provide an opportunity to increase access to HIV testing, especially for hard-to-reach populations. This study aimed to describe the acceptability of unsupervised peer-distribution of HIVST as a method to scale-up HIV testing. Methods In this study, lay counsellors or community health workers provided HIVST kits to primary recipients (PRs) for distribution to their sexual partners, anyone in their social network (termed secondary recipients) or for self-testing, from September 2018 to March 2020. The study was conducted in Eshowe and Mbongolwane areas in KwaZulu-Natal, South Africa. A structured questionnaire was administered during the recruitment and passive follow-up, when people came for confirmatory HIV testing. Electronic records were retrospectively examined to determine initiation of antiretroviral treatment (ART) for all HIVST users and non-users. Results Among 36,708 people approached to be primary recipients, 9,891 (26.9%) accepted; 31,341 HIVST kits were distributed with a median of three (IQR: 2–4) per peer. PRs were predominately recruited at primary health clinics (PHCs). However, acceptability of HIVST was thrice as high at community-based testing sites compared to PHCs (64.5% vs. 21.0%; p<0.001). During the study period, 34,715 adults were tested for HIV at both PHCs and community-based testing sites; of these, 1,089 individuals reported HIVST use. Among HIVST users, 893 (82.0%) returned to the clinic for confirmatory testing after testing negative on HIVST; 196 (17.9%) were confirmed HIV positive following a positive HIVST. After excluding 36/196 (18.4%) participants for whom clinical records could not be found in electronic register and 25/160 (15.6%) who were already on ART before receiving HIVST, 129/135 (95.5%) initiated ART, whereas 2,362/2685 (88%) of HIV positive HIVST non-users-initiated ART. Conclusion Unsupervised peer-distribution of HIVST was feasible and acceptable, with more than 25% accepting to be peer-distributors. Acceptability of HIVST was thrice as high in community sites compared to clinics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acceptability of unsupervised peer-based distribution of HIV oral self-testing for the hard-to-reach in rural KwaZulu Natal, South Africa: Results from a demonstration study

et al. 2022

View full text Add to dashboard Cite

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“…Overall, home-based interventions, mobile testing, and community-based interventions generally were able to test a greater proportion of individuals, as well as more first-time testers, compared to facility-based interventions [57]. These methods may also reach potentially more marginalized groups including men and young adults better than facility-based testing [41,42,58]. However, there is large variability in outcomes of these studies.…”

Section: Discussionmentioning

confidence: 96%

“…A stand-alone permanent testing center near a transportation hub in Johannesburg, South Africa reached nearly 29,000 individuals in 3.5 years [42]. Parishes were also often involved in testing and successfully tested52% and 76% of men [58,59]. In Tanzania, venuebased testing tested more men (69%) and young adults aged 15-24 years (42%) compared to health facility-based testing and home-based testing [60].…”

Section: Mobile Home and Community Testingmentioning

confidence: 99%

A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries

et al. 2021

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HIV/AIDS remains a looming presence in public health across the world, particularly in Sub-Saharan Africa. The HIV Care Cascade hinges on testing and knowledge of HIV status. Though significant advances have been made in diagnosing people living with HIV (PLHIV), limitations in understanding which strategies are best suited to certain regions or populations have contributed to the uneven distribution in the success of various HIV testing strategies. Here, we present a conceptual framework that outlines effective HIV testing strategies for four target groups. This framework is based on a systematic literature review of articles published from January 1st, 2008, to December 31st, 2019. The effectiveness of HIV testing strategies depends on various factors including the setting, type of test and service providers. Multiple strategies are needed to reach the UNAIDS target of 95% of individuals knowing their HIV status. Expansion of community-based approaches, self-testing and HIV testing services in antenatal care will further improve the state of HIV testing in Sub-Saharan Africa.

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“…One recent example of this took place in Tanzania, where over 300 MPs publicly tested to help promote HIV testing (The East African 2018), and public testing by presidents, members of parliament and other political figures has been a strategy to encourage HIV testing employed across a number of sub-Saharan African countries (Karan, Hartford, and Coates 2017). Applying these principles to other contexts in which men who are in positions of relative power and influence, for example to religious leaders and community leaders (Jobson et al 2019), may be able to test more publicly could encourage and normalise HIV testing. In this way, the power relations within the workplace and other settings can be utilised to challenge HIV related stigma.…”

Section: Discussionmentioning

confidence: 99%

HIV testing attitudes and practices amongst 'wealthy men': qualitative evidence from Tanzania

Deane

Wamoyi

Mgunga

et al. 2021

Culture, Health & Sexuality

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Evidence from nationally representative surveys conducted in sub-Saharan Africa shows that significant proportions of men in the wealthiest quintile report never having tested for HIV. Despite high prevalence rates in this quintile, no research has been conducted on the HIV testing attitudes and practices of wealthier men. This article reports findings from qualitative research conducted with 23 wealthy men in Tanzania. Whilst wealthy men reported barriers to and enablers of HIV testing previously reported by the general population, concerns around loss of social status and community standing were amplified for members of this demographic. Furthermore, HIV stigma among members of this group remains high. However, enhanced access to HIV testing through private clinics, regular healthcare appointments, health insurance schemes and the means to travel to other countries enables wealthy men to avoid stigma. In settings such as the workplace, wealthy men were able to test in public in their roles as 'leaders' to encourage others to test. Future interventions to increase testing amongst men should target settings in which these leadership roles can be taken advantage of. HIV services also need integrating into the health system to remove the need for testing and treatment to be accessed at separate clinics.

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Bridging the Gap: Reaching Men for HIV Testing Through Religious Congregations in South Africa

Cited by 12 publications

References 11 publications

Acceptability of unsupervised peer-based distribution of HIV oral self-testing for the hard-to-reach in rural KwaZulu Natal, South Africa: Results from a demonstration study

Acceptability of unsupervised peer-based distribution of HIV oral self-testing for the hard-to-reach in rural KwaZulu Natal, South Africa: Results from a demonstration study

A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries

HIV testing attitudes and practices amongst 'wealthy men': qualitative evidence from Tanzania

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