Different strokes for different folks with HIV testing and counselling

Four models of HIV counselling and testing: utilization and test results in South Africa

Mabuto T, Latka MH, Kuwane B, Churchyard GJ, Charalambous S, Hoffmann CJ. PLoS One. 2014 Jul 11. DOI: 10.1371/journal.pone.0102267

Background: HIV Counselling and Testing (HCT) is the point-of-entry for pathways of HIV care and prevention. However, HCT is not reaching many who are HIV infected and this may be related to the HCT provision model. We describe HCT utilization and HIV diagnosis using four models of HCT delivery: clinic-based, urban mobile, rural mobile, and stand-alone.

Methods: Using cross-sectional data from routine HCT provided in South Africa, we described client characteristics and HIV test results from information collected during service delivery between January 2009 and June 2012.

Results: 118 358 clients received services at clinic-based units, 18 597; stand-alone, 28 937; urban mobile, 38 840; and rural mobile, 31 984. By unit, clients were similar in terms of median age (range 28-31), but differed in sex distribution, employment status, prior testing, and perceived HIV risk. Urban mobile units had the highest proportion of male clients (52%). Rural mobile units reached the highest proportion of clients with no prior HCT (61%) and reporting no perceived HIV risk (64%). Overall, 10 862 clients (9.3%) tested HIV-positive.

Conclusions: Client characteristics varied by HCT model. Importantly, rural and urban mobile units reached more men, first-time testers, and clients who considered themselves to be at low risk for HIV.

Abstract  Full-text [free] access

Editor’s notes: This study compared cross-sectional data across four HIV Counselling and Testing (HCT) models during a two and half year time period in South Africa. The study took into account 121 038 individuals who were tested through the four models. Some data were not captured for all individuals. However, this relatively large sample provides valuable information about the characteristics of individuals who took up testing through each of the four models. The study reports strengths for each of the models: men were more likely to be reached through the rural and urban mobile units, as were first time testers and individuals who perceived themselves to be at lower risk for acquiring HIV. Overall, both the mobile units reached more people, with a higher proportion unemployed. However, the standalone model served more employed individuals and could easily refer within the clinic for other health issues. What is clear from this study is that there is a place for each of the models and that options matter for individuals to enable the system to reach as many as possible. One model cannot accommodate everyone. This is similar to the idea that options for contraception, and even more recently for HIV prevention, are important. People have different needs depending on who they are, where they live, and what they do. Providing options which serve the diversity of needs will allow for greater accessibility and acceptability of services. 

HIV testing
Africa
South Africa
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