Who Needs to Be Targeted for HIV Testing and Treatment in KwaZulu-Natal? Results From a Population-Based Survey

Huerga, Helena; Cutsem, Gilles van; J, Ben Farhat; Reid, Marianne; Bouhenia, Malika; Maman, David; Wiesner, Lubbe; Etard, Jean‐François; Ellman, Tom

doi:10.1097/qai.0000000000001081

Cited by 46 publications

(48 citation statements)

References 23 publications

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“…In Sub‐Saharan Africa, between 20 and 55% of the PLWHIV has been described to be unaware of their HIV‐status . Nevertheless, our results suggest that this proportion may include individuals who are in fact aware of their HIV‐status but prefer not to disclose and to repeat the test.…”

Section: Discussionmentioning

confidence: 69%

“…Several studies have shown a strong association between disclosure, social support and adherence . PLWHIV who experienced positive social support were more likely to disclose their HIV‐status and link and retain in care, while those who perceived stigma or feared disclosing, presented lower levels of access to care . Despite this, very few studies have documented the magnitude of non‐disclosure to health providers and to our knowledge, no studies have measured non‐disclosure to the lay counsellor at the moment of HIV‐testing.…”

Section: Discussionmentioning

confidence: 97%

“…Awareness of HIV infection is the first critical step in the continuum of HIV care. However, it goes far beyond HIV serological testing and includes an understanding of the implications, acceptance of the diagnosis, willingness to disclose their status to health providers, family members and close community and enrol and start in HIV care and treatment. Little is known about the extent and causes of non‐disclosure in different epidemic settings although it has an important impact both at an individual and at a public health level.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

et al. 2018

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IntroductionAwareness of HIV‐infection goes beyond diagnosis, and encompasses understanding, acceptance, disclosure and initiation of the HIV‐care. We aimed to characterize the HIV‐positive population that underwent repeat HIV‐testing without disclosing their serostatus and the impact on estimates of the first UNAIDS 90 target.MethodsThis analysis was nested in a prospective cohort established in southern Mozambique which conducted three HIV‐testing modalities: voluntary counselling and testing (VCT), provider‐initiated counselling and testing (PICT) and home‐based testing (HBT). Participants were given the opportunity to self‐report their status to lay counsellors and HIV‐positive diagnoses were verified for previous enrolment in care. This study included 1955 individuals diagnosed with HIV through VCT/PICT and 11,746 participants of a HBT campaign. Those who did not report their serostatus prior to testing, and were found to have a previous HIV‐diagnosis, were defined as non‐disclosures. Venue‐stratified descriptive analyses were performed and factors associated with non‐disclosure were estimated through log‐binomial regression.ResultsIn the first round of 2500 adults randomized for HBT, 1725 were eligible for testing and 18.7% self‐reported their HIV‐positivity. Of those tested with a positive result, 38.9% were found to be non‐disclosures. Similar prevalence of non‐disclosures was found in clinical‐testing modalities, 29.4% (95% CI 26.7 to 32.3) for PICT strategy and 13.0% (95% CI 10.9 to 15.3) for VCT. Prior history of missed visits (adjusted prevalence ratio (APR) 4.2, 95% CI 2.6 to 6.8), younger age (APR 2.5, 95% CI 1.4 to 4.4) and no prior history of treatment ((APR) 1.4, 95% CI 1.0 to 2.1) were significantly associated with non‐disclosure as compared to patients who self‐reported. When considering non‐disclosures as people living with HIV (PLWHIV) aware of their HIV‐status, the proportion of PLWHIV aware increased from 78.3% (95% CI 74.2 to 81.6) to 86.8% (95% CI 83.4 to 89.6).ConclusionMore than one‐third of individuals testing HIV‐positive did not disclose their previous positive HIV‐diagnosis to counsellors. This proportion varied according to testing modality and age. In the absence of an efficient and non‐anonymous tracking system for HIV‐testers, repeat testing of non‐disclosures leads to wasted resources and may distort programmatic indicators. Developing interventions that ensure appropriate psychosocial support are needed to encourage this population to disclose their status and optimize scarce resources.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

et al. 2018

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“…This study is part of a cross-sectional population-based survey conducted from July to October 2013 that aimed to assess HIV prevalence, incidence and the HIV cascade of care in Mbongolwane and Eshowe, KZN, [6]. Individuals aged 15-59 years old living in the area were eligible for inclusion in the survey.…”

Section: Design and Populationmentioning

confidence: 99%

“…We used data from a population-based HIV survey conducted in Mbongolwane and Eshowe, KwaZuluNatal (KZN), South Africa [6]. In this analysis we compared estimates of ART coverage and viral load suppression rates when we used self-report and/or ARV detection to identify individuals on ART.…”

Section: Introductionmentioning

confidence: 99%

A comparison of self-report and antiretroviral detection to inform estimates of antiretroviral therapy coverage, viral load suppression and HIV incidence in Kwazulu-Natal, South Africa

Huerga¹,

Shiferie²,

Grebe

et al. 2017

BMC Infect Dis

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Background: Accurately identifying individuals who are on antiretroviral therapy (ART) is important to determine ART coverage and proportion on ART who are virally suppressed. ART is also included in recent infection testing algorithms used to estimate incidence. We compared estimates of ART coverage, viral load suppression rates and HIV incidence using ART self-report and detection of antiretroviral (ARV) drugs and we identified factors associated with discordance between the methods.

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Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

et al. 2019

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Introduction “Treat All” – the treatment of all people with HIV, irrespective of disease stage or CD4 cell count – represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub‐Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. Methods The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision‐makers, and HIV community representatives in East, Central, Southern and West Africa. Results and discussion The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders – groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub‐national estimates of the size of key populations and describe those who remain underserved along the HIV‐care continuum; (2) characterize the timeliness of HIV care and short‐ and long‐term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV‐drug resistance and regimen switching; and (4) identify cost‐effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV‐care continuum, particularly among underserved populations. Conclusions Reflecting consensus among a broad group of experts, researchers, policy‐ and decision‐makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.

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Who Needs to Be Targeted for HIV Testing and Treatment in KwaZulu-Natal? Results From a Population-Based Survey

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 46 publications

References 23 publications

Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re‐test during HIV‐testing campaigns in rural Mozambique

A comparison of self-report and antiretroviral detection to inform estimates of antiretroviral therapy coverage, viral load suppression and HIV incidence in Kwazulu-Natal, South Africa

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

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