Implementation Research Division, The Aurum Institute, Johannesburg, South Africa.
The University of the Witwatersrand School of Public Health, Johannesburg, South Africa.
J Int AIDS Soc. 2019 Oct;22(10):e25367. doi: 10.1002/jia2.25367.
South Africa (SA) has the world's highest burden of HIV infection (approximately 7.2 million), yet it is estimated that 23.5% women and 31.5% of men are unaware that they are living with HIV. The 2015 national South African HIV testing guidelines mandate the universal offer of HIV testing services (HTS) in all healthcare facilities.
A multi-prong approach was used from January 2017 to June 2017 to evaluate the current implementation of HTS in ten facilities in the Ekurhuleni District of SA. First, we conducted patient exit interviews to quantify engagement in HTS services. Second, we systematically mapped the flow of individual patients through the clinic.
We conducted a total of 2989 exit interviews and followed 568 patients for value stream mapping. Overall self-reported testing acceptance was high at 84.7% (244), but <10% of the patients (288) were offered testing. Female patients were more likely to be offered testing (233/2046, 11.4% vs. 55/943, 5.8% in males; chi-square p < 0.005), and also more likely to accept testing (203/233, 87.1% vs. 41/55, 74.6% in males; chi-square p = 0.02). Value stream mapping revealed that patients offered HIV testing had a total visit time of 51 minutes more (95% CI: 30-72) compared to those not offered testing.
The poor delivery of HTS appears to be due to a failure to recommend HTS and the added time burden placed on those accepting testing. There were significant differences in both the offer and acceptance of testing by gender. Health system issues need to be addressed to improve HTS delivery.
南非（SA）是世界上 HIV 感染负担最重的国家（约 720 万人），但据估计，23.5%的女性和 31.5%的男性不知道自己携带 HIV。2015 年南非全国 HIV 检测指南规定，所有医疗保健机构都必须普遍提供 HIV 检测服务（HTS）。
从 2017 年 1 月至 2017 年 6 月，我们采用多管齐下的方法，评估了南非埃库鲁莱尼地区 10 个设施中 HTS 的当前实施情况。首先，我们进行了患者出口访谈，以量化 HTS 服务的参与情况。其次，我们系统地绘制了个体患者在诊所中的流程。
我们共进行了 2989 次出口访谈，并对 568 名患者进行了价值流映射。总体上，自我报告的检测接受率很高，为 84.7%（244 人），但只有不到 10%的患者（288 人）接受了检测。女性患者更有可能接受检测（233/2046，11.4%比男性的 55/943，5.8%；卡方检验，p<0.005），也更有可能接受检测（203/233，87.1%比男性的 41/55，74.6%；卡方检验，p=0.02）。价值流映射显示，与未接受检测的患者相比，接受 HIV 检测的患者总就诊时间增加了 51 分钟（95%CI：30-72）。
HTS 提供效果不佳似乎是由于未能推荐 HTS，以及接受检测的患者增加了额外的时间负担。性别对检测的提供和接受都有显著影响。需要解决卫生系统问题，以改善 HTS 的提供。
