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. 2021 Mar 23:9:606376.
doi: 10.3389/fpubh.2021.606376. eCollection 2021.

High HIV Positivity Rates Following Large-Scale HIV Self-Testing Implementation in Zimbabwe, 2018-2020

Auxilia Muchedzi  1 , Mulamuli Mpofu  2 , Fungai H Mudzengerere  1 , Moses Bateganya  3 , Tarirai Mavimba  1 , Hind Satti  3 , Rumbidzai Dhliwayo  1 , Tinashe Zulu  1 , Talent Tapera  1 , Tendai Samushonga  1 , Tendai Nyagura  4 , Getrude Ncube  5 , Taurayi A Tafuma  1
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High HIV Positivity Rates Following Large-Scale HIV Self-Testing Implementation in Zimbabwe, 2018-2020

Auxilia Muchedzi et al. Front Public Health. .

Abstract

Introduction: HIV self-testing (HIV-ST) is an innovative strategy to increase HIV case identification. This analysis shares the outcomes of HIV-ST implementation within the Zimbabwe HIV Care and Treatment (ZHCT) project for the period October 2018-March, 2020. Materials and Methods: We extracted HIV-ST data for the period October 2018 to March 2020 from the project database and assessed (1) the proportion of reactive HIV-ST results; (2) the concordance between reactive HIV-ST results against rapid confirmatory HIV tests using Determine™ and Chembio™ in parallel; and (3) the monthly contribution of HIV-ST to total HIV positive individuals identified within project. The Chi-square test was used to assess for statistical differences in HIV positivity between age groups, by sex and district; as well as the difference in HIV positivity between the HIV-ST and index and mobile testing strategies. Findings: Between October 2018 and March 2020, the ZHCT project distributed 11,983 HIV-ST kits; 11,924 (99.8%) were used and 2,616 (21.9%) were reactive. Of the reactive tests, 2,610 (99.8%) were confirmed HIV positive giving a final positivity rate of 21.9%, and a concordance rate of 99.8% between the HIV-ST results and the confirmatory tests. Proportion of reactive results differed by age-groups (p < 0.001); with the 35-49 years having the highest positivity rate of 25.5%. The contribution of HIV-ST to total new positives increased from 10% in October 2018 to 80% at the end of March 2020 (p < 0.001). Positivity rates from HIV-ST were significantly different by age-groups, sex and district (p = 0.04). Additionally, index and mobile testing had a higher positivity rate compared to HIV-ST (p < 0.001). Conclusion: The ZHCT project has successfully scaled up HIV self-testing which contributed significantly to HIV case finding. Countries should consider using the lessons to scale-up the intervention which will contribute in reaching under-served and undiagnosed populations.

Keywords: HIV; HIV testing; Sub-Saharan Africa; Zimbabwe; self-testing.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
ZHCT HIV-ST cascade.
Figure 2
Figure 2
ZHCT monthly HIV-ST positivity rates: October 2018–March 2020.
Figure 3
Figure 3
Monthly contribution of HIV-ST to total newly identified HIV positive within the ZHCT project.
See this image and copyright information in PMC

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