Finding HIV in hard to reach populations: mobile HIV testing and geospatial mapping in Umlazi township, Durban, South Africa

Abstract

Mobile, community-based HIV testing may help achieve universal HIV testing in South Africa. We compared the yield, geographic distribution, and demographic characteristics of populations tested by mobile- and clinic-based HIV testing programs deployed by iThembalabantu Clinic in Durban, South Africa. From July to November 2011, 4,701 subjects were tested; HIV prevalence was 35 % among IPHC testers and 10 % among mobile testers (p < 0.001). Mobile testers varied in mean age (22-37 years) and % males (26-67 %). HIV prevalence at mobile sites ranged from 0 to 26 %. Testers traveled further than the clinic closest to their home; mobile testers were more likely to test ≥5 km away from home. Mobile HIV testing can improve testing access and identify testing sites with high HIV prevalence. Individuals often access mobile testing sites farther from home than their nearest clinic. Geospatial techniques can help optimize deployment of mobile units to maximize yield in hard-to-reach populations.

Keywords: Geospatial analysis; HIV mobile testing; South Africa.

Figure 1. Geospatial distribution and HIV prevalence of mobile testing sites

The grey line delineates the Umlazi Township boundary. The size of the circles show the number of patients tested at the specific mobile sites and the color of the circles illustrate the HIV prevalence at the sites during the study period. Green represents lowest prevalence, red is highest prevalence. Isipingo is not included in this map. IPHC: iThembalabantu “the People’s Hope” Clinic

Figure 2. Distribution of IPHC and mobile testers by distance traveled to test location

This graph shows the distribution of IPHC and mobile testers by the distance between their home and the site of HIV testing. The red line represents the median distance (mobile testers 2.1 km [IQR: 0.8–4.9 km], IPHC testers 2.5 km [IQR: 1.8–3.5 km], p<0.001).