Comparison of community-based HIV counselling and testing (CBCT) through index client tracing and other modalities: Outcomes in 13 South African high HIV prevalence districts by gender and age

Abstract

Background To increase HIV case finding in a Community-based HIV counselling and testing (CBCT) programme, an index client tracing modality was implemented to target index clients’ sexual network and household members. Objective To compare index client tracing modality’s outcomes with other CBCT recruitment modalities (mobile, workplace, homebased), 2015–2017. Methods Trained HIV counsellors identified HIV positive clients either through offering HIV tests to children and sexual partners of an HIV index client, or randomly offering HIV tests to anyone available in the community (mobile, home-based or workplace). Socio-demographic information and test results were recorded. Descriptive comparisons of client HIV test uptake and positivity were conducted by method of recruitment—index client tracing vs non-targeted community outreach. Results Of the 1 282 369 people who tested for HIV overall, the index modality tested 3.9% of them, 1.9% in year 1 and 6.0% in year 2. The index modality tested more females than males (55.8% vs 44.2%) overall and in each year; tested higher proportions of children than other modalities: 10.1% vs 2.6% among 1–4 years, 12.2% vs 2.6% among the 5–9 years and 9.6% vs 3.4% among the 10–15 years. The index modality identified higher HIV positivity proportions than other modalities overall (10.3% 95%CI 10.0–10.6 vs. 7.3% 95%CI 7.25–7.36), in year 1 (9.4%; 8.9–9.9 vs 6.5%; 6.45–6.57) and year 2 (10.6%; 10.3–10.9 vs 8.2%; 8.09–8.23). Higher proportions of females (7.5%;7.4–7.5) than males (5.5%;5.4–5.5) tested positive overall. Positivity increased by age up to 49y with year 2’s increased targeting of sexual partners. Overall linkage to care rose from 33.3% in year 1 to 78.9% in year 2. Conclusions Index testing was less effective in reaching large numbers of clients, but more effective in reaching children and identifying HIV positive people than other modalities. Targeting HIV positive people’s partners and children increases HIV case finding.

“I got tested at home, the help came to me”: acceptability and feasibility of home‐based TB testing of household contacts using portable molecular diagnostics in South Africa

“…Home‐based TB testing was not perceived as profoundly new. This could be explained by household contacts exposure to other community‐based testing services, including home‐based HIV counselling and testing, which have been widely implemented in South Africa [57–60]. Similar to qualitative assessments of home‐based HIV testing, we found high levels of acceptability and comfort amongst households.…”

Annual home‐based HIV testing in the Chókwè Health Demographic Surveillance System, Mozambique, 2014 to 2019: serial population‐based survey evaluation

“…Additionally, after two rounds of HBHTS, prevalence of undiagnosed infection remained higher in several subgroups including residents with sexual-and alcohol-related risks, and those who had not tested in five or more years. These findings are consistent with recent studies suggesting that to diagnose ≥95% of young adults and eliminate disparities in undiagnosed infection within 1 to 2 rounds of HBHTS, additional community-based testing strategies are needed such as mobile testing at bars and clubs and use of self-test kits [7,9,10,[20][21][22]. During 2014 to 2019 when HIV prevalence in CHDSS was stable at approximately 24%, HBHTS yield of new diagnoses was slightly higher than the prevalence of undiagnosed infection in the first (7.5% vs. 6.6%), third (2.9% vs. 1.7%), and fifth (1.3% vs. 1.1%) rounds.…”

Development and Fidelity Testing of the Test@Work Digital Toolkit for Employers on Workplace Health Checks and Opt-In HIV Testing

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