Abstract
ObjectivesTo measure HIV prevalence and uptake of HIV counseling and testing (HCT) in a peri-urban South African community. To assess predictors for previous HIV testing and the association between the yield of previously undiagnosed HIV and time of last negative HIV testMethodsA random sample of 10% of the adult population (≥15 years) were invited to attend a mobile HCT service. Study procedures included a questionnaire, HIV testing and CD4 counts. Predictors for previous testing were determined using a binominal model.Results1,144 (88.0%) of 1,300 randomly selected individuals participated in the study. 71.0% (68.3–73.6) had previously had an HIV test and 37.5% (34.6–40.5) had tested in the past 12 months. Men, migrants and older (>35 years) and younger (<20 years) individuals were less likely to have had a previous HIV test. Overall HIV prevalence was 22.7 (20.3–25.3) with peak prevalence of 41.8% (35.8–47.8) in women aged 25.1–35 years and 37.5% (26.7–48.3) in men aged 25.1–45 years. Prevalence of previously undiagnosed HIV was 10.3% (8.5–12.1) overall and 4.5% (2.3–6.6), 8.0% (CI 3.9–12.0) and 20.0% (13.2–26.8) in individuals who had their most recent HIV test within 1, 1–2 and more than 2 years prior to the survey.ConclusionThe high burden of undiagnosed HIV in individuals who had recently tested underscores the importance of frequent repeat testing at least annually. The high prevalence of previously undiagnosed HIV in individuals reporting a negative test in the 12 months preceding the survey indicates a very high incidence. Innovative prevention strategies are needed.
Highlights
HIV counseling and testing (HCT) services are important entry points for prevention and care [1]
Among the 156 individuals who did not participate in the study two had died before the study started, five refused to participate, and the remaining 149 did not attend the mobile HCT service despite multiple visits to their households
Individuals who did not participate in the study were older and more likely to be men (76.2%) compared to individuals who participated in the study
Summary
HIV counseling and testing (HCT) services are important entry points for prevention and care [1]. Studies from different countries have shown that individuals take precautions to protect their partners once they know they are HIV positive [2,3,4] and modeling studies have found HCT to offer substantial clinical benefits and to be cost-effective even in settings where linkage and access to care is limited [5]. HCT uptake is associated with a range of socio-demographic factors, and is generally lower among men, younger and older age groups, those with limited education and income [6,8,9].
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