Rapid point-of-care CD4 testing at mobile units and linkage to HIV care: an evaluation of community-based mobile HIV testing services in South Africa

Background. We evaluated whether a pilot program providing point-of-care (POC), but not rapid, CD4 testing (BD FACSCount) immediately after testing HIV-positive improved retention in care.Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period) to patients testing positive during January 2008–February 2009 (baseline period). The outcome for those with a≤250cells/mm3when testing HIV-positive was initiating ART<16weeks after HIV testing.Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines). ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer.Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.

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Social franchising of community-based HIV testing and linkage to HIV care and treatment services: an evaluation of a pilot study in Tshwane, South Africa

Journal of the International AIDS Society ◽

10.1002/jia2.25216 ◽

2018 ◽

Vol 21 (12) ◽

pp. e25216

Author(s):

Simukai Shamu ◽

Thato Farirai ◽

Locadiah Kuwanda ◽

Jean Slabbert ◽

Geoffrey Guloba ◽

...

Keyword(s):

South Africa ◽

Pilot Study ◽

Hiv Testing ◽

Hiv Care ◽

Community Based ◽

Social Franchising ◽

Treatment Services ◽

Care And Treatment ◽

Linkage To Hiv Care

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Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among adolescents, young people and adult men in Kasensero fishing community, Rakai, Uganda: a qualitative study

BMC Public Health ◽

10.1186/s12889-020-09714-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Joseph K. B. Matovu ◽

Aminah Nambuusi ◽

Scovia Nakabirye ◽

Rhoda K. Wanyenze ◽

David Serwadda

Keyword(s):

Young People ◽

Hiv Testing ◽

Hiv Care ◽

Hiv Positive ◽

Fishing Community ◽

Adult Men ◽

Self Testing ◽

Testing Uptake ◽

Hiv Testing Services ◽

Linkage To Hiv Care

Abstract Background Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda. Methods This qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7–8 participants were conducted with adolescents and young people (15–24 years) and adult men (25+ years). We collected data on people’s perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.

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A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa

BMC Health Services Research ◽

10.1186/1472-6963-14-350 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 13

Author(s):

Natalie Leon ◽

Catherine Mathews ◽

Simon Lewin ◽

Meg Osler ◽

Andrew Boulle ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Sexually Transmitted Infections ◽

Cape Town ◽

Hiv Care ◽

Sexually Transmitted ◽

Hiv Counselling And Testing ◽

Hiv Testing And Counselling ◽

Linkage To Hiv Care

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Facilitators and Barriers to Linkage to HIV Care among Female Sex Workers Receiving HIV Testing Services at a Community-Based Organization in Periurban Uganda: A Qualitative Study

Journal of Sexually Transmitted Diseases ◽

10.1155/2016/7673014 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Sharon Nakanwagi ◽

Joseph K. B. Matovu ◽

Betty N. Kintu ◽

Frank Kaharuza ◽

Rhoda K. Wanyenze

Keyword(s):

Qualitative Study ◽

Peer Support ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Care ◽

Community Based ◽

Community Based Organization ◽

Hiv Testing Services ◽

Facilitators And Barriers ◽

Linkage To Hiv Care

Introduction. While four in ten female sex workers (FSWs) in sub-Saharan Africa are infected with HIV, only a small proportion is enrolled in HIV care. We explored facilitators and barriers to linkage to HIV care among FSWs receiving HIV testing services at a community-based organization in periurban Uganda. Methods. The cross-sectional qualitative study was conducted among 28 HIV positive FSWs from May to July 2014. Key informant interviews were conducted with five project staff and eleven peer educators. Data were collected on facilitators for and barriers to linkage to HIV care and manually analyzed following a thematic framework approach. Results. Facilitators for linkage to HIV care included the perceived good quality of health services with same-day results and immediate initiation of treatment, community peer support systems, individual’s need to remain healthy, and having alternative sources of income. Linkage barriers included perceived stigma, fear to be seen at outreach HIV clinics, fear and myths about antiretroviral therapy, lack of time to attend clinic, and financial constraints. Conclusion. Linkage to HIV care among FSWs is influenced by good quality friendly services and peer support. HIV service delivery programs for FSWs should focus on enhancing these and dealing with barriers stemming from stigma and misinformation.

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Impact of point-of-care CD4 testing on linkage to HIV care: a systematic review

Journal of the International AIDS Society ◽

10.7448/ias.17.1.18809 ◽

2014 ◽

Vol 17 (1) ◽

pp. 18809 ◽

Cited By ~ 83

Author(s):

Elke Wynberg ◽

Graham Cooke ◽

Amir Shroufi ◽

Steven D Reid ◽

Nathan Ford

Keyword(s):

Systematic Review ◽

Point Of Care ◽

Hiv Care ◽

Linkage To Hiv Care ◽

Cd4 Testing

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Facilitators & Barriers to Implementing Provider-Initiated HIV Counselling and Testing at the Clinic-Level in Ekurhuleni District, South Africa

10.21203/rs.3.rs-454182/v2 ◽

2021 ◽

Author(s):

Nolundi T. Mshweshwe-Pakela ◽

Tonderai Mabuto ◽

Nasiphi Ntombela ◽

Mpho Hlongwane ◽

Griffiths Kubeka ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Healthcare Workers ◽

Low Cost ◽

Clinical Care ◽

Hiv Care ◽

Normalisation Process Theory ◽

Clear Understanding ◽

Medical Care System ◽

Hiv Testing Services

Abstract BackgroundHIV testing is the entry point into the HIV care continuum, and critical for HIV epidemic control. Facility-based HIV testing services (HTS) reach individuals who are already seeking clinical care and engaging with the medical care system. For this reason, individuals diagnosed with HIV during facility-based HIV testing are more likely to continue into HIV care. Efforts have been increasingly made to increase facility-based HIV testing services (HTS), including introducing provider-initiated counselling & testing (PICT), but this strategy remains under-utilized. We aimed to identify key constraints to normalization of PICT implementation in 10 Ekurhuleni District healthcare facilities in South Africa. MethodsIn-depth interviews were conducted with 40 healthcare workers (28 clinicians and 12 lay counsellors). Health care workers were purposefully selected to participate in the interviews, stratified by health facility and work category. Interviews were audio-recorded, transcribed, and translated for analysis. Thematic analysis was guided by the normalisation process theory (NPT). NPT theory explains how practices are routinely embedded within organisational contexts. We used NVivo 10 software for qualitative data management. ResultsBoth clinicians and lay counsellors exhibited clear understanding of the PICT policy – acknowledging its purpose and value. Key barriers to normalisation of PICT among clinicians understanding that HIV testing needs to be offered to all clients yet reporting actual practices of offering HIV testing based on suspicion of HIV. Additionally, clinicians perceived PICT as incongruent with their clinical roles and perceived it to be lay counsellors’ responsibility. The main facilitator was participation of all healthcare workers, specifically the presence of lay counsellors, although they also faced barriers such as a lack of workspace and under-appreciation. ConclusionsUse of NPT helped identify barriers which prevent normalization of PICT and its integration into the routine patient care. These barriers can be modified by low-cost interventions that promotes congruence of PICT to the roles of clinicians and integrate the role of lay counsellors within the patient flow in the facility.

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Poor rates of linkage to HIV care and uptake of treatment after home-based HIV testing among newly diagnosed 15-to-49 year-old men and women in a high HIV prevalence setting in South Africa

AIDS Care ◽

10.1080/09540121.2020.1719025 ◽

2020 ◽

Vol 33 (1) ◽

pp. 70-79 ◽

Cited By ~ 2

Author(s):

Brendan Maughan-Brown ◽

Sean Beckett ◽

Ayesha B. M. Kharsany ◽

Cherie Cawood ◽

David Khanyile ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Hiv Prevalence ◽

Hiv Care ◽

Newly Diagnosed ◽

Men And Women ◽

Home Based ◽

Linkage To Hiv Care ◽

Old Men

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“I would like to be part of the team distributing the kits because I have all the qualities” Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among young people and adult men in Kasensero fishing community, Rakai, Uganda

10.21203/rs.3.rs-28819/v1 ◽

2020 ◽

Author(s):

Joseph KB Matovu ◽

Aminah Nambuusi ◽

Scovia Nakabirye ◽

David Serwadda ◽

Rhoda Wanyenze

Keyword(s):

Young People ◽

Hiv Testing ◽

Formative Research ◽

Hiv Care ◽

Fishing Community ◽

Adult Men ◽

Self Testing ◽

Testing Uptake ◽

Hiv Testing Services ◽

Linkage To Hiv Care

Abstract Background Despite efforts to improve HIV testing and linkage to HIV care among young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care among young people and adult men in Kasensero fishing community in rural Uganda. Methods This was a cross-sectional, qualitative study conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, between May 6 – 10, 2019. Six single-sex focus group discussions (FGDs) comprising 7-8 participants were conducted with young men (15-24 years), young women (15-24 years) and adult men (25+ years). We collected data on people’s perceptions about HIVST and peer-led HIVST; potential acceptability of peer-led HIVST and suggestions on how to implement peer-led HIVST in the community. Peer-led HIVST was defined as an approach that uses a trained lay person to distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience as opposed to placing them at a health facility. Participants suggested that the peer-leader should be a permanent resident, accessible, trustworthy, and good at keeping secrets. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community suggesting that this approach can help to improve uptake of HIV testing services among young people and adult men who are usually missed through conventional HIV testing services.

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