Findings from home‐based <scp>HIV</scp> testing and facilitated linkage after scale‐up of test and treat in rural South Africa: young people still missing

Baisley, KJ; Seeley, Janet; Siedner, MJ; Koole, Olivier; Matthews, Philippa; Tanser, Frank; Bärnighausen, Till; Smit, Theresa; Gareta, Dickman; Dlamini, Siphephelo; Herbst, Kobus; Yapa, H. Manisha; Iwuji, Collins; Hy, Kim; Pillay, Deenan; Shahmanesh, Maryam

doi:10.1111/hiv.12787

Cited by 33 publications

(56 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ART initiation can be improved through a variety of mechanisms, including peer support to adolescents [ 36 , 37 ]; integration of ART with antenatal and family care services [ 38 , 39 •• ]; health services strengthening, community outreach and linkage to facilities [ 15 •• , 23 , 85 ]; and provision of point-of-care services [ 21 , 24 ]. These interventions, however, were not universally successful, and impact varied by context and/or study methods [ 17 , 20 , 30 , 31 ]. For general adult populations, linking PLHIV to care as they receive their diagnosis either by actively facilitating first appointments at an HIV care facility or by providing fast and simplified treatment services such as point-of-care blood tests with rapid ART initiation has been shown to improve uptake of ART [ 15 •• , 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

et al. 2020

View full text Add to dashboard Cite

Purpose of Review We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era. Recent Findings ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Summary Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Timely linkage to care and ART initiation were low. ART initiation was particularly low in youth less than 30 years old (29% women and 16% men) versus older patients (41% women and 35% men) [20].…”

Section: General Adult Populationsmentioning

confidence: 96%

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Since 2017, AHRI started offering home‐based rapid HIV testing to all eligible individuals during annual HIV surveys. The uptake of home‐based rapid HIV testing in 2017 was 26.4% in the overall population and 20.0% among men [29]. The overall aim of the trial is to establish whether the provision of small once‐off financial incentives and a male‐targeted HIV‐specific decision support application increases uptake of HIV testing and linkage to HIV care, thus ultimately reducing population‐level HIV incidence in (particularly young) women.…”

Section: Introductionmentioning

confidence: 99%

Home‐Based Intervention to Test and Start (HITS): a community‐randomized controlled trial to increase HIV testing uptake among men in rural South Africa

Tanser

Kim

Mathenjwa

et al. 2021

J. Intern. AIDS Soc.

View full text Add to dashboard Cite

Introduction The uptake of HIV testing and linkage to care remains low among men, contributing to high HIV incidence in women in South Africa. We conducted the “Home‐Based Intervention to Test and Start” (HITS) in a 2x2 factorial cluster randomized controlled trial in one of the World’s largest ongoing HIV cohorts in rural South Africa aimed at enhancing both intrinsic and extrinsic motivations for HIV testing. Methods Between February and December 2018, in the uMkhanyakude district of KwaZulu‐Natal, we randomly assigned 45 communities (clusters) (n = 13,838 residents) to one of the four arms: (i) financial incentives for home‐based HIV testing and linkage to care (R50 [$3] food voucher each); (ii) male‐targeted HIV‐specific decision support application, called EPIC‐HIV; (iii) both financial incentives and male‐targeted HIV‐specific decision support application and (iv) standard of care (SoC). EPIC‐HIV was developed to encourage and serve as an intrinsic motivator for HIV testing and linkage to care, and individually offered to men via a tablet device. Financial incentives were offered to both men and women. Here we report the effect of the interventions on uptake of home‐based HIV testing among men. Intention‐to‐treat (ITT) analysis was performed using modified Poisson regression with adjustment for clustering of standard errors at the cluster levels. Results Among all 13,838 men ≥ 15 years living in the 45 communities, the overall population coverage during a single round of home‐based HIV testing was 20.7%. The uptake of HIV testing was 27.5% (683/2481) in the financial incentives arm, 17.1% (433/2534) in the EPIC‐HIV arm, 26.8% (568/2120) in the arm receiving both interventions and 17.8% in the SoC arm. The probability of HIV testing increased substantially by 55% in the financial incentives arm (risk ratio (RR)=1.55, 95% CI: 1.31 to 1.82, p < 0.001) and 51% in the arm receiving both interventions (RR = 1.51, 95% CI: 1.21 to 1.87 p < 0.001), compared to men in the SoC arm. The probability of HIV testing did not significantly differ in the EPIC‐HIV arm (RR = 0.96, 95% CI: 0.76 to 1.20, p = 0.70). Conclusions The provision of a small financial incentive acted as a powerful extrinsic motivator substantially increasing the uptake of home‐based HIV testing among men in rural South Africa. In contrast, the counselling and testing application which was designed to encourage and serve as an intrinsic motivator to test for HIV did not increase the uptake of home‐based testing.

show abstract

“…Since January 2017, individuals who sought health care at any one of the 11 PHC's serving the AHRI DSA on weekdays between 7am and 7pm have been registered by a member of AHRI staff, and their self-reported reason for attending clinic recorded, using an electronic system known as ClinicLink 10 . For this analysis, we used ClinicLink data to determine the number of PHC visits made by AHRI DSA residents between 1 April 2017 and 31 March 2018.…”

Section: Data Collectionmentioning

confidence: 99%

Can we find the missing men in clinics? Clinic attendance by sex and HIV status in rural South Africa

et al. 2021

View full text Add to dashboard Cite

Background: HIV-negative men are over-represented in tuberculosis (TB) prevalence surveys including the first South African national TB prevalence survey in 2018. Traditionally, TB screening is focused in clinics. We aimed to determine the frequency of primary healthcare clinic (PHC) attendance among HIV-negative men in a TB-prevalent setting. Methods: Since January 2017, PHC attendees in a rural South African demographic surveillance area (DSA) were asked their reason for attendance. HIV status was defined as positive if tested positive in a DSA sero-survey or attended clinic for HIV care; negative if tested negative between January 2014—December 2017 and no HIV-related visits; and HIV-unknown otherwise. Results: Among 67124 DSA residents (≥15 years), 27038 (40.3%) were men; 14196 (21.2%) were classified HIV-positive, 18892 (28.1%) HIV-negative and 34036 (50.7%) HIV-unknown. Between April 2017 and March 2018, 24382/67124 (36.3%, 95% confidence interval [CI] 36.0–36.7) adults made ≥1 PHC visit, comprising 9805/40086 (24.5%, 95%CI 23.6–25.3) of HIV-negative or unknown women and 3440/27038 (12.7%, 95%CI 11.6–13.8) of HIV-negative or unknown men. Overall, HIV care accounted for 37556/88109 (42.6%) of adult PHC visits. Conclusion: In this rural population, HIV-negative and -unknown men rarely attend PHCs. Improving TB screening in clinics may not reach a key population with respect to undiagnosed TB. Additional strategies are needed to diagnose and treat TB earlier.

show abstract

Findings from home‐based HIV testing and facilitated linkage after scale‐up of test and treat in rural South Africa: young people still missing

Cited by 33 publications

References 12 publications

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

Home‐Based Intervention to Test and Start (HITS): a community‐randomized controlled trial to increase HIV testing uptake among men in rural South Africa

Can we find the missing men in clinics? Clinic attendance by sex and HIV status in rural South Africa

Contact Info

Product

Resources

About