Abstract
BackgroundSouth Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs.ObjectivesThis study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies.MethodWe conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented.ResultsAcross sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were ‘does not want to know status’ (37.6%), ‘in too much pain’ (34%) and ‘does not believe they are at risk’ (19.9%).ConclusionsDespite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.
Highlights
South Africa (SA) faces the highest burden of HIV infection globally, with 7.7 million people living with HIV (PLWH) and prevalence ranging from 12.6% to 27% across the country.[1,2] In 2018, SA had 240 000 new HIV infections and 71 000 AIDS-related deaths.[1]
A total of 3245 patients presented to the Mthatha Regional Hospital (MRH) Emergency department (ED) between 24 July and 03 September 2017; of these, 1347 (41.5%) patients were approached by HIV counselling and testing (HCT) staff, and 1258 (38.8%) were enrolled in the study (Table 1)
Most patients presented with medical complaints (1278, 67.9%), received a triage designation of ‘urgent’ (1269, 67.5%) and reported having access to primary care services (1696, 90.2%; Table 1)
Summary
South Africa (SA) faces the highest burden of HIV infection globally, with 7.7 million people living with HIV (PLWH) and prevalence ranging from 12.6% to 27% across the country.[1,2] In 2018, SA had 240 000 new HIV infections and 71 000 AIDS-related deaths.[1] The Joint United Nations Programme on HIV/AIDS (UNAIDS) adopted the ambitious treatment target of 90-90-90, wherein by 2020 90% of all PLWH would know their status, 90% of whom would be receiving sustained antiretroviral therapy (ART), of whom 90% would have achieved viral suppression.[3] Currently, in SA, an estimated 90% of PLWH know their status, of whom 68% are accessing ART, and 87% of these have achieved viral suppression.[1] Over the past two decades, numerous steps have been taken by the government to deliver evidence-based interventions focusing on HIV prevention, treatment, and retention.
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