An Incentivized HIV Counseling and Testing Program Targeting Hard-to-Reach Unemployed Men in Cape Town, South Africa
ABSTRACT In Southern Africa, men access HIV counseling and testing (HCT) services less than women. Innovative strategies are needed to increase uptake of testing among men. This study assessed the effectiveness of incentivized mobile HCT in reaching unemployed men in Cape Town, South Africa.
A retrospective analysis of HCT data collected between August 2008 and August 2010 from adult men accessing clinic-based stationary and non-incentivized and incentivized mobile services. Data from these 3 services were analyzed using descriptive statistics and log-binomial regression models.
A total of 9416 first-time testers were included in the analysis as follows: 708 were clinic based, 4985 were non-incentivized, and 3723 incentivized mobile service testers. A higher HIV prevalence was observed among men accessing incentivized mobile testing [16.6% (617/3723)] compared with those attending non-incentivized mobile [5.5% (277/4985)] and clinic-based services [10.2% (72/708)]. Among men testing at the mobile service, greater proportions of men receiving incentives were self-reported first-time testers (60.1% vs. 42.0%) and had advanced disease (14.9% vs. 7.5%) compared with men testing at non-incentivized mobile services. Furthermore, compared with the non-incentivized mobile service, the incentivized service was associated with a 3-fold greater yield of newly diagnosed HIV infections. This strong association persisted in analyses adjusted for age and first-time versus repeat testing [risk ratio: 2.33 (95% confidence interval: 2.03 to 2.57); P < 0.001].
These findings suggest that incentivized mobile testing services may reach more previously untested men and significantly increase detection of HIV infection in men.
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ABSTRACT: Although youth (12-24 years) in Sub-Saharan Africa have a high HIV risk, many have poor access to HIV testing services and are unaware of their status. Our objective was to evaluate the proportion of adolescents (12-17 years) and young adults (18-24 years) who underwent HIV testing and the prevalence among those tested in an urban adult outpatient clinic with a routine HIV testing program in Durban, South Africa. We conducted a retrospective cross-sectional analysis of adolescent and young adult outpatient records between February 2008 and December 2009. We determined the number of unique outpatient visitors, HIV tests, and positive rapid tests among those tested. During the study period, 956 adolescents registered in the outpatient clinic, of which 527 (55%) were female. Among adolescents, 260/527 (49%, 95% CI 45-54%) females underwent HIV testing compared to 129/429 (30%, 95% CI 26-35%) males (p<0.01). The HIV prevalence among the 389 (41%, 95% CI 38-44%) adolescents who underwent testing was 16% (95% CI 13-20%) and did not vary by gender (p = 0.99). During this period, there were 2,351 young adult registrations, and of these 1,492 (63%) were female. The proportion consenting for HIV testing was similar among females 980/1,492 (66%, 95% CI 63-68%) and males 543/859 (63%, 95% CI 60-66%, p = 0.25). Among the 1,523 (65%, 95% CI 63-67%) young adults who underwent testing, the HIV prevalence was 22% (95% CI 19-24%) in females versus 14% in males (95% CI 11-17%, p<0.01). Although the HIV prevalence is high among youth participating in an adult outpatient clinic routine HIV program, the uptake of testing is low, especially among 12-17 year old males. There is an urgent need to offer targeted, age-appropriate routine HIV testing to youth presenting to outpatient clinics in epidemic settings.PLoS ONE 09/2012; 7(9):e45507. DOI:10.1371/journal.pone.0045507 · 3.53 Impact Factor
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ABSTRACT: Background. There are few data on HIV prevalence and risk factors among inner-city homeless and marginally housed individuals in South Africa. Methods. We recruited 136 adults from a Johannesburg inner-city homeless clinic; mean age was 32.4 years, 129 (95%) were male, and 90 (66%) were of South African nationality. Participants were tested for HIV and answered a short demographic survey. Descriptive statistics and uni- and multivariate regression analyses were used for data analysis. Results. The HIV prevalence in the cohort was 23.5%. Transactional sex, relationship status, number of concurrent sexual partners, condom usage and history of previously treated sexually transmitted infections (STIs), living on the street, the use of alcohol or drugs, and previous exposure to voluntary counselling and testing (VCT), were not significant risk factors for HIV-positivity. Statistically significant HIV risk factors on multivariate analysis included the presence of an STI (odds ratio (OR) 5.6; p<0.01) and unemployment (OR 6.7; p<0.01). South African nationality was a significant risk factor on univariate analysis (OR 2.99; p<0.05), but not on multivariate analysis (OR 2.2; p=0.17). Conclusion. The HIV prevalence in the sample did not differ appreciably from HIV prevalence estimates in other at-risk populations in similar settings, suggesting that homelessness in a South African city alone may not be a significant risk factor for HIV infection. HIV prevention efforts cannot be restricted to behaviour change programmes, but must be more holistic, recognising the protective role that employment has on HIV incidence. S Afr J HIV Med 2012;13(4):174-177. DOI:10.7196/SAJHIVMED.83711/2012; 13(4). DOI:10.7196/sajhivmed.837
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ABSTRACT: The promise of combination HIV prevention-the application of multiple HIV prevention interventions to maximise population-level effects-has never been greater. However, to succeed in achieving significant reductions in HIV incidence, an additional concept needs to be considered: combination implementation. Combination implementation for HIV prevention is the pragmatic, localised application of evidence-based strategies to enable high sustained uptake and quality of interventions for prevention of HIV. In this Review, we explore diverse implementation strategies including HIV testing and counselling models, task shifting, linkage to and retention in care, antiretroviral therapy support, behaviour change, demand creation, and structural interventions, and discusses how they could be used to complement HIV prevention efforts such as medical male circumcision and treatment as prevention. HIV prevention and treatment have arrived at a pivotal moment when combination efforts might result in substantial enough population-level effects to reverse the epidemic and drive towards elimination of HIV. Only through careful consideration of how to implement and operationalise HIV prevention interventions will the HIV community be able to move from clinical trial evidence to population-level effects.The Lancet Infectious Diseases 01/2013; 13(1):65-76. DOI:10.1016/S1473-3099(12)70273-6 · 19.45 Impact Factor