HIV Testing Rates and Outcomes in a South African Community, 2001-2006: Implications for Expanded Screening Policies

Harvard Medical School, Boston, MA, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 08/2009; 51(3):310-6. DOI: 10.1097/QAI.0b013e3181a248e6
Source: PubMed


Revised World Health Organization recommendations seek to increase HIV testing. We assessed the need for expanded testing in South Africa by examining current testing and treatment trends among a high prevalence population.
We determined the numbers of adults receiving HIV testing and antiretroviral treatment (ART) during 2001-2006 using testing registers linked to patient records from 2 health care facilities believed responsible for virtually all HIV services available to the population. We evaluated annual population testing rates using census population counts; proportions of clients testing seropositive (yield); CD4 counts and World Health Organization stage at diagnosis; and ART initiation rates.
HIV testing rates rose from 4% in 2001 to 20% in 2006 (P < 0.001) and were highest among pregnant females receiving provider-initiated testing. Yield for first-time testers decreased from 47% in 2001 to 28% in 2006; annual incidence of seroconversion among initially HIV-negative retesters was 1.9%. Median CD4 counts and World Health Organization stage distributions for newly diagnosed clients remained stable. HIV-infected clients receiving ART within 6 months of eligibility increased from 0% in 2001 to 68% in 2006 (P < 0.001).
Population testing and ART initiation rates rose dramatically during 2001-2006. Yet, yield remained high, and HIV-infected persons continued to receive late diagnoses. These findings highlight the continuing need for expanded testing and linkage to care.

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    • "While there is some evidence of success in turning around generalized HIV epidemics by changing sexual behaviour, this turns out to be most effective in risk groups in concentrated epidemics [25-29]. Several studies show only modest evidence for the effectiveness of counselling and testing activities in generalized epidemics settings compared with concentrated epidemics, but concluded that it should not negate the need to expand them [30-35]. Its great potential should be weighed against other interventions in allocating prevention funding. "
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    • "Voluntary counseling and testing services have been available to all individuals accessing either the local clinic or the hospital since 2001 with provider-initiated testing routinely given to any patient accessing TB services whose HIV status was unknown; this was extended to all pregnant females accessing the hospital or clinic in 2002 and patients accessing STI services in 2007. HIV testing rates rose from 4% of the total population per year in 2001 to 20% in 2006 [15]. The total number of tests performed in the primary health care clinic or hospital among residents of this community was more than 10500 between January 2004 and March 2009 [16]. "
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    • "The increase in HIV test rates documented in certain settings has been partly attributed to a rapid scale-up of provider-initiated testing services [19-21]. However, the roll-out of this testing model has been criticised from an ethical and human rights perspective for paving the way to neglect of informed consent [16,17,22], and for reducing the amount of counselling that accompanies the HIV test [15,23]. "
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