Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa.
J Acquir Immune Defic Syndr. 2019 Feb 1;80(2):135-144. doi: 10.1097/QAI.0000000000001900.
In several subgroups of South Africa, the percentage of HIV-positive individuals aware of their status falls well below the UNAIDS 90% target. This study examined the impact that home-based HIV testing services (HBHTS) had on knowledge of status in a hyperendemic area of South Africa.
We analysed data from the second cross-sectional HIV Incidence Provincial Surveillance System survey (2015/2016), a representative sample (n = 10,236) of individuals aged 15-49 years. Participants completed a questionnaire, provided blood samples for laboratory testing (used to estimate HIV prevalence), and were offered HBHTS. The proportion of people living with HIV (n = 3870) made aware of their status through HBHTS was measured, and factors associated with HBHTS uptake were identified.
Knowledge of HIV-positive status at the time of the survey was 62.9% among men and 73.4% among women. Through HBHTS, the percentage of HIV-positive men and women who knew their status rose to 74.2% and 80.5%, respectively. The largest impact was observed among youth (15-24 years). Knowledge of status increased from 36.6% to 59.3% and from 50.8% to 64.8% among young men and women, respectively. In addition, 51.4% of those who had previously never tested received their first test. Key reasons for declining HBHTS among undiagnosed HIV-positive individuals included fear and self-report of an HIV-negative status.
HBHTS was effective in increasing awareness of HIV-positive status, particularly among youth, men, and those who had never tested. HBHTS could have a marked impact on progress toward the UNAIDS 90-90-90 targets within these subgroups.
在南非的几个亚群中，意识到自己感染状况的 HIV 阳性个体比例远低于联合国艾滋病规划署（UNAIDS）设定的 90%目标。本研究旨在评估在南非一个高度流行地区开展家庭为基础的 HIV 检测服务（HBHTS）对知晓自身感染状况的影响。
我们分析了 2015/2016 年第二次横断面 HIV 发病率省级监测系统调查的数据，该调查是一个年龄在 15-49 岁的代表性样本（n=10236）。参与者完成了一份问卷，提供了用于实验室检测（用于估计 HIV 流行率）的血液样本，并接受了 HBHTS 服务。通过 HBHTS 知晓自身感染状况的 HIV 阳性人数（n=3870）得到了测量，并确定了与 HBHTS 参与度相关的因素。
在调查时，男性中知晓自身 HIV 阳性状况的比例为 62.9%，女性中为 73.4%。通过 HBHTS，知晓自身 HIV 阳性状况的男性和女性比例分别上升至 74.2%和 80.5%。其中，年轻人（15-24 岁）的受益最大。男性和女性青年知晓自身感染状况的比例分别从 36.6%增加到 59.3%和从 50.8%增加到 64.8%。此外，51.4%的从未接受过检测的人首次接受了检测。未被诊断出 HIV 阳性的个体拒绝 HBHTS 的主要原因包括对 HIV 检测的恐惧和自我报告的 HIV 阴性状态。
HBHTS 能有效提高 HIV 阳性状况的知晓率，特别是在年轻人、男性和从未接受过检测的人群中。HBHTS 可能会对这些亚组中实现联合国艾滋病规划署 90-90-90 目标产生显著影响。
