National HIV testing and diagnosis coverage in sub-Saharan Africa

Maheu‐Giroux, Mathieu; Marsh, Kimberly; Doyle, Carla M.; Godin, Arnaud; Delaunay, Charlotte Lanièce; Johnson, Leigh F.; Jahn, Andreas; Kouamé, Abo; Mbofana, Francisco; Boily, Marie-Claude; Buckeridge, David L.; Hankins, Catherine; Eaton, Jeffrey W.

doi:10.1097/qad.0000000000002386

Cited by 51 publications

(37 citation statements)

References 40 publications

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“…First, the Southern and Eastern African regions are most affected by HIV in the world ( S7 Table ) and are home to the largest number of people living with HIV (20.6 million) [ 1 ]. In line with this, several countries in the region such as Botswana, Kenya, Uganda, Malawi, and Rwanda have not only implemented national campaigns to encourage uptake of HIV testing and counselling (HTC), they have also implemented effective and efficient PMTCT, ensuring that most pregnant women are tested for HIV and those diagnosed are placed on treatment [ 33 – 35 ]. They have deployed community-based testing, which supports provider-initiated testing.…”

Section: Discussionmentioning

confidence: 99%

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

Awopegba¹,

Kalu

Seidu

et al. 2020

PLoS ONE

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Background Prenatal screening of pregnant women for HIV is central to eliminating mother-to-child-transmission (MTCT) of HIV. While some countries in sub-Saharan Africa (SSA) have scaled up their prevention of MTCT programmes, ensuring a near-universal prenatal care HIV testing, and recording a significant reduction in new infection among children, several others have poor outcomes due to inadequate testing. We conducted a multi-country analysis of demographic and health surveys (DHS) to assess the coverage of HIV testing during pregnancy and also examine the factors associated with uptake. Methods We analysed data of 64,933 women from 16 SSA countries with recent DHS datasets (2015–2018) using Stata version 16. Adjusted and unadjusted logistic regression models were used to examine correlates of prenatal care uptake of HIV testing. Statistical significance was set at p<0.05. Results Progress in scaling up of prenatal care HIV testing was uneven across SSA, with only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. While inequality in access to HIV testing among pregnant women is pervasive in most SSA countries and particularly in West and Central Africa sub-regions, a few countries, including Rwanda, South Africa, Zimbabwe, Malawi and Zambia have managed to eliminate wealth and rural-urban inequalities in access to prenatal care HIV testing. Conclusion Our findings highlight the between countries and sub-regional disparities in prenatal care uptake of HIV testing in SSA. Even though no country has universal coverage of prenatal care HIV testing, East and Southern African regions have made remarkable progress towards ensuring no pregnant woman is left untested. However, the West and Central Africa regions had low coverage of prenatal care testing, with the rich and well educated having better access to testing, while the poor rarely tested. Addressing the inequitable access and coverage of HIV testing among pregnant women is vital in these sub-regions.

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Section: Discussionmentioning

confidence: 99%

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

Awopegba¹,

Kalu

Seidu

et al. 2020

PLoS ONE

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“… 11 Aggregate HIV testing services data including the number of HIV tests done and number of HIV diagnoses are routinely collected, but reports are often not deduplicated and rates of retesting and re-diagnosis can be high. 12 , 13 Household surveys provide cross-sectional data about testing history by HIV status at roughly 5-year intervals in most countries, but only a few surveys directly ask respondents if they are aware of their HIV status, a sensitive question that has high potential for non-disclosure. 14 These challenges are compounded by imprecise estimates for the number of new infections by age, sex, and geographical area, and by incomplete ascertainment of mortality among the previously diagnosed and undiagnosed population.…”

Section: Introductionmentioning

confidence: 99%

“…We synthesised data from 40 sub-Saharan African countries about HIV testing history from population-based surveys, HIV testing programme data, and HIV epidemic indicators using a mathematical model. 12 In addition to trends in knowledge of status and diagnosis gaps, we estimated time from HIV infection to diagnosis, probability of being tested before reaching a given time since infection or CD4 cell count, percentage of tests found positive, diagnosis yield, and proportion of new diagnoses among positive tests.…”

Section: Introductionmentioning

confidence: 99%

Trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa, 2000–20: a modelling study using survey and HIV testing programme data

et al. 2021

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Summary Background Monitoring knowledge of HIV status among people living with HIV is essential for an effective national HIV response. This study estimates progress and gaps in reaching the UNAIDS 2020 target of 90% knowledge of status, and the efficiency of HIV testing services in sub-Saharan Africa, where two thirds of all people living with HIV reside. Methods For this modelling study, we used data from 183 population-based surveys (including more than 2·7 million participants) and national HIV testing programme reports (315 country-years) from 40 countries in sub-Saharan Africa as inputs into a mathematical model to examine trends in knowledge of status among people living with HIV, median time from HIV infection to diagnosis, HIV testing positivity, and proportion of new diagnoses among all positive tests, adjusting for retesting. We included data from 2000 to 2019, and projected results to 2020. Findings Across sub-Saharan Africa, knowledge of status steadily increased from 5·7% (95% credible interval [CrI] 4·6–7·0) in 2000 to 84% (82–86) in 2020. 12 countries and one region, southern Africa, reached the 90% target. In 2020, knowledge of status was lower among men (79%, 95% CrI 76–81) than women (87%, 85–89) across sub-Saharan Africa. People living with HIV aged 15–24 years were the least likely to know their status (65%, 62–69), but the largest gap in terms of absolute numbers was among men aged 35–49 years, with 701 000 (95% CrI 611 000–788 000) remaining undiagnosed. As knowledge of status increased from 2000 to 2020, the median time to diagnosis decreased from 9·6 years (9·1–10) to 2·6 years (1·8–3·5), HIV testing positivity declined from 9·0% (7·7–10) to 2·8% (2·1–3·9), and the proportion of first-time diagnoses among all positive tests dropped from 89% (77–96) to 42% (30–55). Interpretation On the path towards the next UNAIDS target of 95% diagnostic coverage by 2025, and in a context of declining positivity and yield of first-time diagnoses, disparities in knowledge of status must be addressed. Increasing knowledge of status and treatment coverage among older men could be crucial to reducing HIV incidence among women in sub-Saharan Africa, and by extension, reducing mother-to-child transmission. Funding Steinberg Fund for Interdisciplinary Global Health Research (McGill University); Canadian Institutes of Health Research; Bill & Melinda Gates Foundation; Fonds the recherche du Québec—Santé; UNAIDS; UK Medical Research Council; MRC Centre for Global Infectious Disease Analysis; UK Foreign, Commonwealth & Development Office.

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“…Our study had a number of limitations. First, we cannot be sure that encounters with a positive test result documented were new diagnoses of HIV infection, as stigma and social desirability bias may lead some clients to report their previous test result as negative even if it was positive 43 . Second, social desirability bias may also have resulted in over-reporting of previous HIV test uptake.…”

Section: Discussionmentioning

confidence: 99%

Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017

et al. 2021

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Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of first-time testing (FTT), late retesting (previous test more than one year ago for GP or three months for KP), and test positivity at three voluntary counselling and testing (VCT) centres in coastal Kenya. Methods: Routine VCT data covering 2006-2017 was collected from three VCT centres in Kilifi County. We analysed HIV testing history and test results from encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 24,728 test encounters (32% FTT), we observed declines in HIV positivity (proportion of encounters where the result was positive) among GP men, GP women, first-time testers and MSM but not among FSW. The proportion of encounters for FTT and late retesting decreased for both GP and KP but remained much higher in KP than GP. HIV positivity was higher at FTT and late retesting encounters; at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment and sexually transmitted infection (STI) symptoms. HIV positivity was lower in GP men, never married clients and those less than 35 years of age. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: HIV positive test results were most common at encounters with first-time testers and late re-testers. While the proportion of encounters at which late retesting was reported decreased steadily over the period reviewed, efforts are needed to increase retesting among the most at-risk populations.

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National HIV testing and diagnosis coverage in sub-Saharan Africa

Cited by 51 publications

References 40 publications

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

Trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa, 2000–20: a modelling study using survey and HIV testing programme data

Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017

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