1. Results of the Sukuma Ndoda (“Stand up, Man”) HIV Self-Screening and Assisted Linkage to Care Project in Johannesburg: A Quasi-Experimental Pre–Post Evaluation
- Author
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Lippman, Sheri A, Grignon, Jessica S, Ditshwane, Boitumelo, West, Rebecca L, Gilmore, Hailey J, Mazibuko, Sipho, Mongwe, Livhuwani G, Neilands, Torsten B, Gutin, Sarah A, O’Connor, Cara, Santana, Maideline A, and Majam, Mohammed
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,HIV/AIDS ,Behavioral and Social Science ,Women's Health ,Clinical Research ,Infectious Diseases ,Clinical Trials and Supportive Activities ,Prevention ,Sexually Transmitted Infections ,Health Services ,Infection ,Good Health and Well Being ,Humans ,Male ,HIV Infections ,South Africa ,Adult ,Middle Aged ,Mass Screening ,Young Adult ,Self-Testing ,HIV Testing ,Community Health Workers ,Adolescent ,HIV self-screening ,HIV self-testing ,linkage to care ,men ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundHIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by community health workers (CHWs) is a scalable option to increase testing coverage, diagnosis, and treatment initiation. We provided HIVSS and assisted linkage to care to men not recently tested (within the past 12 months) residing in high-HIV-burden areas of Johannesburg.MethodsCHWs distributed HIVSS in 6 clinic catchment areas. Follow-up to encourage confirmatory testing and antiretroviral therapy initiation was conducted through personal support (PS) or an automated short message service (SMS) follow-up and linkage system in 3 clinic areas each. Using a quasi-experimental pre-post design, we compared differences in the proportion of men testing in the clinic catchment areas during the HIVSS campaign (June-August 2019) to the 3 months prior (March-May 2019) and compared treatment initiations by assisted linkage strategy.ResultsAmong 4793 participants accepting HIVSS, 62% had never tested. Among 3993 participants with follow-up data, 90.6% reported using their HIVSS kit. Testing coverage among men increased by 156%, from under 4% when only clinic-based HIV testing services were available to 9.5% when HIVSS and HIV testing services were available (z = -11.6; P < 0.01). Reported test use was higher for men followed through PS (99% vs. 68% in SMS); however, significantly more men reported reactive self-test results in the SMS group compared with PS (6.4% vs. 2.0%), resulting in more antiretroviral therapy initiations in the SMS group compared with PS (23 vs. 9; P < 0.01).ConclusionsCHW HIVSS distribution significantly increases testing among men. While PS enabled personalized follow-up, reporting differences indicate SMS is more acceptable and better aligned with expectations of privacy associated with HIVSS.
- Published
- 2024