HIV self-testing as part of a differentiated HIV testing approach: exploring urban and rural adult experiences from KwaZulu-Natal, South Africa using a cross-over study design

Background: KwaZulu–Natal, South Africa has one of the highest HIV prevalence rates globally. Persons <35 years and men have lower rates of HIV testing. HIV self-testing (HIVST) may overcome many barriers of facility-based HIV testing in order to identify HIV positive young persons and men and link them to care. We investigated whether HIVST distribution was a feasible approach to reach men and assessed the proportion of participants who reported their HIVST results, tested positive and linked to care.Methods: Teams comprised of a nurse, clinic research assistant, and recruiters distributed HIVST kits in rural uMkhanyakude, KwaZulu-Natal from August—November 2018 with a focus on testing men. Workplaces (farms), social venues, taxi ranks, and homesteads were used as HIVST kit distribution points following community sensitisation through community advisory boards and community leaders. HIVST kits, demonstration of use, and small incentives to report testing outcomes were provided. The Department of Health provided confirmatory testing and HIV care at clinics.Results: Over 11 weeks in late 2018, we distributed 2,634 HIVST kits of which 2,113 (80%) were distributed to persons aged <35 years, 2,591 (98%) to men and 356 (14%) to first time testers. Of the HIVST distributed, 2,107 (80%) reported their results to the study team, and 157 (7%) tested positive. Of persons who tested positive, 107/130 (82%) reported having a confirmatory test of which 102/107 (95%) were positive and initiated on ART. No emergencies or social harms were reported.Conclusion: Large scale distribution of HIVST kits targeting men in rural KwaZulu-Natal is feasible and highly effective in reaching men, including those who had not previously tested for HIV. While two-thirds of persons who tested HIV positive initiated ART, additional linkage strategies are needed for those who do not link after HIVST. HIVST should be used as a tool to reach men in order to achieve 95% coverage in the UNAIDS testing and care cascade in KwaZulu-Natal.

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Repeat HIV testing practices in the era of HIV self-testing among adults in KwaZulu-Natal, South Africa

PLoS ONE ◽

10.1371/journal.pone.0212343 ◽

2019 ◽

Vol 14 (2) ◽

pp. e0212343 ◽

Cited By ~ 1

Author(s):

Charlene Harichund ◽

Pinky Kunene ◽

Sinenhlanhla Simelane ◽

Quarraisha Abdool Karim ◽

Mosa Moshabela

Keyword(s):

South Africa ◽

Hiv Testing ◽

Self Testing ◽

Kwazulu Natal ◽

Testing Practices ◽

Repeat Hiv Testing

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Geographical variation in HIV testing in South Africa: Evidence from the 2017 national household HIV survey

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v22i1.1273 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sean Jooste ◽

Musawenkosi Mabaso ◽

Myra Taylor ◽

Alicia North ◽

Yolande Shean ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Secondary Analysis ◽

District Level ◽

Cluster Sampling ◽

North West ◽

Spatial Targeting ◽

Home Based ◽

Self Testing ◽

Kwazulu Natal

Background: Identification of the geographical areas with low uptake of HIV testing could assist in spatial targeting of interventions to improve the uptake of HIV testing.Objectives: The objective of this research study was to map the uptake of HIV testing at the district level in South Africa.Method: The secondary analysis used data from the Human Sciences Research Council’s 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey, where data were collected using a multistage stratified random cluster sampling approach. Descriptive spatial methods were used to assess disparities in the proportion of those ever tested for HIV at the district level in South Africa.Results: The districts with the highest overall coverage of people ever having tested for HIV ( 85%) include West Rand in Gauteng, Lejweleputswa and Thabo Mofutsanyane in Free State, and Ngaka Modiri Molema in North-West. These provinces also had the least variation in HIV testing coverage between their districts. Districts in KwaZulu-Natal had the widest variation in coverage of HIV testing. The districts with the lowest uptake of HIV testing were uMkhanyakude (54.7%) and Ugu (61.4%) in KwaZulu-Natal and Vhembe (61.0%) in Limpopo. Most districts had a higher uptake of HIV testing amongst female than male participants.Conclusion: The uptake of HIV testing across various districts in South Africa seems to be unequal. Intervention programmes must improve the overall uptake of HIV testing, especially in uMkhanyakude and Ugu in KwaZulu-Natal and Vhembe in Limpopo. Interventions must also focus on enhancing uptake of HIV testing amongst male participants in most districts. Strategies that would improve the uptake of HIV testing include HIV self-testing and community HIV testing, specifically home-based testing.

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HIV testing and self‐testing coverage among men and women in South Africa: an exploration of related factors

Tropical Medicine & International Health ◽

10.1111/tmi.13514 ◽

2020 ◽

Author(s):

Oluwafemi Emmanuel Awopegba ◽

Taiwo Olubunmi Ologunowa ◽

Anthony Idowu Ajayi

Keyword(s):

South Africa ◽

Hiv Testing ◽

Related Factors ◽

Men And Women ◽

Self Testing ◽

Testing Coverage

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Cluster randomised controlled trial to determine the effect of peer delivery HIV self-testing to support linkage to HIV prevention among young women in rural KwaZulu-Natal, South Africa: a study protocol

BMJ Open ◽

10.1136/bmjopen-2019-033435 ◽

2019 ◽

Vol 9 (12) ◽

pp. e033435

Author(s):

Oluwafemi Atanda Adeagbo ◽

Nondumiso Mthiyane ◽

Carina Herbst ◽

Paul Mee ◽

Melissa Neuman ◽

...

Keyword(s):

South Africa ◽

Randomised Controlled Trial ◽

Young Women ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Peer Networks ◽

Cluster Randomised ◽

Self Testing ◽

Kwazulu Natal ◽

Randomised Controlled

IntroductionA cluster randomised controlled trial (cRCT) to determine whether HIV self-testing (HIVST) delivered by peers either directly or through incentivised peer-networks, could increase the uptake of antiretroviral therapy and pre-exposure prophylaxis (PrEP) among young women (18 to 24 years) is being undertaken in an HIV hyperendemic area in KwaZulu-Natal, South Africa.Methods and analysisA three-arm cRCT started mid-March 2019, in 24 areas in rural KwaZulu-Natal. Twenty-four pairs of peer navigators working with ~12 000 young people aged 18 to 30 years over a period of 6 months were randomised to: (1) incentivised-peer-networks: peer-navigators recruited participants ‘seeds’ to distribute up to five HIVST packs and HIV prevention information to peers within their social networks. Seeds receive an incentive (20 Rand = US$1.5) for each respondent who contacts a peer-navigator for additional HIVST packs to distribute; (2) peer-navigator-distribution: peer-navigators distribute HIVST packs and information directly to young people; (3) standard of care: peer-navigators distribute referral slips and information. All arms promote sexual health information and provide barcoded clinic referral slips to facilitate linkage to HIV testing, prevention and care services. The primary outcome is the difference in linkage rate between arms, defined as the number of women (18 to 24 years) per peer-navigators month of outreach work (/pnm) who linked to clinic-based PrEP eligibility screening or started antiretroviral, based on HIV-status, within 90 days of receiving the clinic referral slip.Ethics and disseminationThis study was approved by the Institutional Review Boards at the WHO, Switzerland (Protocol ID: STAR CRT, South Africa), London School of Hygiene and Tropical Medicine, UK (Reference: 15 990–1), University of KwaZulu-Natal (BFC311/18) and the KwaZulu-Natal Department of Health (Reference: KZ_201901_012), South Africa. The findings of this trial will be disseminated at local, regional and international meetings and through peer-reviewed publications.Trial registration numberNCT03751826; Pre-results.

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