Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa.

Abstract

Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatmentcenters (SSATCs)are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCsrepresent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission dataexploresself-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol andother drug use. SACENDU data from 2012 to 2017 was analyzed usingchi-square test of independence and logistic regression to examine associations betweenHTS, demographic characteristics and substances of use. Of 87,339 treatment admissions,47.5% (n = 41,481) of patients had not accessedHTSin the prior 12months.HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively).None of the substance use sub-groupsreported a testing rate above 70%.Compared to specific reference groups, logistic regression showed those with lower odds of HTS were:15-19years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); andprimarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reportedHTSamong sub-groups of patients inSSATCs, the integration of HIV services for PWUD should be a priority inSouth Africa and a focus of the national HIV strategy.