Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;20(10):704-708.
doi: 10.1111/hiv.12787. Epub 2019 Aug 27.

Findings from home-based HIV testing and facilitated linkage after scale-up of test and treat in rural South Africa: young people still missing

K J Baisley  1   2 , J Seeley  1   2 , M J Siedner  2   3 , K Koole  1   2 , P Matthews  2   4 , F Tanser  2 , T Bärnighausen  2   3   5 , T Smit  2 , D Gareta  2 , S Dlamini  2 , K Herbst  2 , Yapa Hm  2   6 , Iwuji Cc  2   7 , Kim Hy  2 , Pillay D  2   4 , Shahmanesh M  2   8
Affiliations

Findings from home-based HIV testing and facilitated linkage after scale-up of test and treat in rural South Africa: young people still missing

K J Baisley et al. HIV Med. 2019 Nov.

Abstract

Objectives: The aim of the study was to estimate rates of linkage to HIV care and antiretroviral treatment (ART) initiation after the introduction of home-based HIV counselling and testing (HBHCT) and telephone-facilitated support for linkage in rural South Africa.

Methods: A population-based prospective cohort study was carried out in KwaZulu Natal, South Africa. All residents aged ≥ 15 years were eligible for HBHCT. Those who tested positive and were not in care were referred for ART at one of 11 public-sector clinics. Individuals who did not attend the clinic within 2 weeks were sent a short message service (SMS) reminder; those who had not attended after a further 2 weeks were telephoned by a nurse counsellor, to discuss concerns and encourage linkage. Kaplan-Meier methods were used to estimate the proportion of newly diagnosed individuals linking to care and initiating ART.

Results: Among 38 827 individuals visited, 26% accepted HBHCT. Uptake was higher in women than in men (30% versus 20%, respectively), but similar in people aged < 30 years and ≥ 30 years (28% versus 26%, respectively). A total of 784 (8%) tested HIV positive, of whom 427 (54%) were newly diagnosed. Within 6 months, 31% of women and 18% of men < 30 years old had linked to care, and 29% and 16%, respectively, had started ART. Among those ≥ 30 years, 41% of women and 38% of men had linked to care within 6 months, and 41% and 35%, respectively, had started ART.

Conclusions: Despite facilitated linkage, rates of timely linkage to care and ART initiation after HBHCT were very low, particularly among young men. Innovations are needed to provide effective HIV care and prevention interventions to young people, and thus maximize the benefits of universal test and treat.

Keywords: South Africa; linkage to care; prevention; testing; treatment; universal test and treat.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Time from HIV diagnosis until attending the clinic for referral to HIV care among 427 individuals who had not been previously diagnosed as HIV-positive
See this image and copyright information in PMC

References

    1. Human Sciences Research Council. South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. 2017 http://www.hsrc.ac.za/en/departments/hiv-aids-stis-and-tb/HAST_National_....
    1. Ruzagira E, Baisley K, Kamali A, Biraro S, Grosskurth H; Working Group on Linkage to HIV Care. Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review. Trop Med Int Health 2017; 22:807–821. - PubMed
    1. Iwuji CC, Orne-Gliemann J, Larmarange J et al. Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial. Lancet HIV 2018; 5:e116–e125. - PubMed
    1. Mavegam BO, Pharr JR, Cruz P, Ezeanolue EE. Effective interventions to improve young adults’ linkage to HIV care in Sub-Saharan Africa: a systematic review. AIDS Care 2017; 29:1198–1204. - PubMed
    1. Petersen M, Balzer L, Kwarsiima D et al. Association of implementation of a universal testing and treatment intervention with HIV diagnosis, receipt of antiretroviral therapy, and viral suppression in East Africa. JAMA 2017; 317:2196–2206. - PMC - PubMed

Publication types

Substances