Changes in self‐reported HIV testing during South Africa's 2010/2011 national testing campaign: gains and shortfalls

Abstract

ObjectivesHIV counselling and testing is critical to HIV prevention and treatment efforts. Mass campaigns may be an effective strategy to increase HIV testing in countries with generalized HIV epidemics. We assessed the self-reported uptake of HIV testing among individuals who had never previously tested for HIV, particularly those in high-risk populations, during the period of a national, multisector testing campaign in South Africa (April 2010 and June 2011).DesignThis study was a prospective cohort study.MethodsWe analyzed data from two waves (2010/2011, n=16,893; 2012, n=18,707) of the National Income Dynamics Study, a nationally representative cohort that enabled prospective identification of first-time testers. We quantified the number of adults (15 years and older) testing for the first time nationally. To assess whether the campaign reached previously underserved populations, we examined changes in HIV testing coverage by age, gender, race and province sub-groups. We also estimated multivariable logistic regression models to identify socio-economic and demographic predictors of first-time testing.ResultsOverall, the proportion of adults ever tested for HIV increased from 43.7% (95% confidence interval (CI): 41.48, 45.96) to 65.2% (95% CI: 63.28, 67.10) over the study period, with approximately 7.6 million (95% CI: 6,387,910; 8,782,986) first-time testers. Among black South Africans, the country's highest HIV prevalence sub-group, HIV testing coverage improved among poorer and healthier individuals, thus reducing gradients in testing by wealth and health. In contrast, HIV testing coverage remained lower for men, younger individuals and the less educated, indicating persistent if not widening disparities by gender, age and education. Large geographic disparities in coverage also remained as of 2012.ConclusionsMass provision of HIV testing services can be effective in increasing population coverage of HIV testing. The geographic and socio-economic disparities in programme impacts can help guide best practices for future efforts. These efforts should focus on hard-to-reach populations, including men and less-educated individuals.

Wealth-related inequality in early uptake of HIV testing among pregnant women: an analysis of data from a national cross-sectional survey, South Africa

“… 31 32 In the South African general population, evidence from data in the period around the start of this survey showed poor uptake of HIV testing among the less educated. 33 We see the similar difference here from the χ 2 test but our findings further confirm that this difference among antenatal women is not associated with wealth-related inequality. Knowledge about MTCT was also not significantly associated with wealth-related inequality for HIV testing implying that national efforts on HIV education have not prioritised certain socioeconomic groups over others.…”

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa

“…While not directly comparable with this study, previous studies indicating 8% of SPs received testing suggest expansion of testing capacity and practice. However, despite these likely gains over time, this high-risk group of STI clients had testing rates comparable with the general adult population (65%) in a recent national cohort study 28. As HIV prevention services scale up, high-risk STI clients should be targeted to increase referrals; however, only 6% of male SPs were counselled about male circumcision.…”

Home-based HIV testing: Using different strategies among transgender women in Argentina

“…This could have affected the analysis of the factors associated with the positive results, as these were based on the self-reported measurements. However, previous studies have used selfreported measures with good results [46]. Nonetheless, the presence of a peer health promoter, who is well-known and trusted in the TGW community, may have decreased the extent of social desirability bias and might have minimized the effect.…”