Outcomes from a multimodal, at‐scale community‐based HIV counselling and testing programme in twelve high HIV burden districts in South Africa

Abstract

Introduction: Facility-based HIV testing services (HTS) have been less acceptable and accessible by adolescents, men and key populations in South Africa. Community-based HIV counselling and testing (CBCT) modalities, including mobile unit and homebased testing, have been proposed to decrease barriers to HIV testing uptake. CBCT modalities and approaches may be differentially acceptable to men and women based on age. Implementation of multimodal CBCT services may improve HIV testing rates among adolescents and men, and support the roll-out of prevention services. Methods: A cross-sectional analysis was conducted using aggregate, routine programmatic data collected from 1 October 2015 through 31 March 2017 from a multimodal, at-scale CBCT programme implemented in 12 high-burden districts throughout South Africa. Data collection tools were aligned to reporting standards for the National Department of Health and donor requirements. HIV testing rates (i.e. number of tests performed per 100,000 population using South African census data) and testing proportions by modality were stratified by sex, age groups and heath districts. Descriptive statistics were performed using STATA 13.0. Results: Overall, 944,487 tests were performed during the 1.5-year testing period reported. More tests were conducted among females than males (53.6% vs. 46.4%). Overall, 8206 tests per 100,000 population (95% CI: 8190.2 to 8221.9) were performed; female-to-male (F:M) testing ratio was 1.11. Testing rates were highest among young women age 20 to 24 years (16,328.4; 95% CI: 16,237.9 to 16,419.1) and adolescent girls aged 15 to 19 years (12,817.0; 95% CI: 12,727.9 to 12,906.6). Home-based testing accounted for 61.3% of HIV tests, followed by near-home mobile unit testing (30.2%) and workplace mobile unit testing (4.7%). More women received HTS via home-based testing (F:M ratio = 1.29), whereas more men accessed workplace mobile testing (M:F ratio = 1.35). No sex differential was observed among those accessing near-home mobile testing (F:M ratio = 0.98). Conclusions: Concurrent implementation of multiple, targeted CBCT modalities can reduce sex disparities in HIV testing in South Africa. Given the acceptability and accessibility of these CBCT services to adolescent girls and young women, evident from their high testing rates, leveraging community-based services delivery platforms to increase access to HIV prevention services, including pre-exposure prophylaxis (PrEP), should be considered.

Predictors of attrition among adults in a rural HIV clinic in southern Mozambique: 18-year retrospective study

“…In our sample, men were underrepresented (39%), as published elsewhere 37 . There were few men who went to health facilities to test for HIV and to initiate and adhere to ART 38 , 39 . We fully acknowledge that more women than men take an active role in accessing HIV services, and studies show that their adherence to ART is also higher 40 .…”

Predicting the Risk of Human Immunodeficiency Virus Type 1 (HIV-1) Acquisition in Rural South Africa Using Geospatial Data

“…Models based solely on individual-level covariates could be applied in a clinical setting where geospatial covariates may not be available. In contrast, models based on age and geospatial covariates could guide geographic prioritization of interventions, such as focused community HIV testing campaigns, home-based ART delivery, or community PrEP services [ 29–31 ]. Approaches that combine both geographic and individual factors may be needed to achieve both widespread coverage to those at risk, as well as efficient resource allocation.…”

Acceptability and feasibility of leveraging community‐based HIV counselling and testing platforms for same‐day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa

“…Leveraging CB‐HTS platforms to provide same‐day PrEP initiation services is an important addition to existing HIV prevention and testing behaviours of AGYW. CB‐HTS was shown to be acceptable and available for AGYW [31]. Despite high HIV incidence in this subgroup, PrEP uptake and adherence has remained low [10].…”

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