Digitally supported HIV self-testing increases facility-based HIV testing capacity in Ekurhuleni, South Africa

Nolundi T Mshweshwe-Pakela; Tonderai Mabuto; Luke Shankland; Alex Fischer; Dikeledi Tsukudu; Christopher J Hoffmann

doi:10.4102/sajhivmed.v23i1.1352

Digitally supported HIV self-testing increases facility-based HIV testing capacity in Ekurhuleni, South Africa

South Afr J HIV Med. 2022 Jun 13;23(1):1352. doi: 10.4102/sajhivmed.v23i1.1352. eCollection 2022.

Authors

Nolundi T Mshweshwe-Pakela^{1

2}, Tonderai Mabuto¹, Luke Shankland³, Alex Fischer³, Dikeledi Tsukudu⁴, Christopher J Hoffmann^{1

5

6}

Affiliations

¹ Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa.
² School of Public Health, University of the Witwatersrand Johannesburg, South Africa.
³ Aviro Health, Cape Town, South Africa.
⁴ Department of Health Systems, The Aurum Institute, Johannesburg, South Africa.
⁵ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America.
⁶ Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America.

Abstract

Background: HIV testing is the first step for linkage to HIV prevention or treatment services. Facility-based HIV testing is the most utilised method, but faces challenges such as limited work space and human resources. Digitally supported HIV self-testing (HIVST) provided in clinics shifts testing to the client, potentially empowering the client, and addresses such constraints.

Objectives: The study primary objective was to determine the feasibility of integrating digitally supported HIVST into the clinic. Secondary objectives were to describe HIV testing volume, populations reached, and antiretroviral treatment (ART) initiation.

Method: We conducted an analysis of prospectively collected data during implementation of digitally supported HIVST in two healthcare facilities based in South Africa from June 2019 to September 2019. We described implementation and client characteristics using HIVST and compared testing before and during implementation.

Results: During the 4-month implementation period there were 35 248 client visits. A total of 6997 (19.9%) of these visits involved HIV testing. Of those testing, 2278 (32.5%) used HIVST. Of the 2267 analysed, 264 (11.6%) were positive: 182 (12%) women and 82 (11%) men. Of those, 230 (95.4%) were confirmed HIV positive and 150 (65%) initiated ART within 14 days. During a four-month pre-implementation period, 14.5% of the clients tested for HIV. Compared to the pre-implementation period, we observed a 25% increase in HIV testing.

Conclusion: Digitally supported HIVST increased the number of clients completing HIV testing in the health facility, without a need to significantly increase staff or space. Facility-based digitally assisted HIVST has the potential to increase HIV testing in high HIV prevalence clinic populations.

Keywords: HIV self-testing; HIV testing; digital support; facility-based HIV testing; linkage to ART.