Disclosures: The authors report no relevant financial disclosures.
December 03, 2020
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Sub-Saharan African men half as likely as women to receive HIV test

Disclosures: The authors report no relevant financial disclosures.
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Men in 20 sub-Saharan African countries were half as likely to receive an HIV test as women but still accounted for 37% of HIV-positive test results, according to a recent study.

“Our HIV Testing Services team was interested in determining the rate of progress toward achieving the first 90 goal for HIV epidemic control set by UNAIDS in United States President’s Emergency Plan for AIDS Relief (PEPFAR)-supported countries, namely that 90% of people living with HIV are aware of their HIV status. We were also interested in ascertaining the HIV testing coverage among adults and the effectiveness and efficiency of various HIV testing strategies at identifying individuals living with previously undiagnosed HIV infections,” Bakary Drammeh, DrPH, of the CDC’s Division of Global HIV & TB, told Healio. “These strategies included provider-initiated testing and counseling (where providers recommend an HIV test as part of routine care) within health facilities, voluntary counseling and testing, mobile testing, and index/contact testing (where HIV testing services are offered to the partners and biologic children of persons with HIV infection).”

In an observational study, the researchers used 2018-2019 data from the PEPFAR program to assess HIV testing coverage and cases among adults aged 15 years of age or older.

According to the study, between October 2018 and September 2019, PEPFAR supported nearly 61 million tests identifying more than 2.6 million adults positive for HIV. Approximately 20% of all testing occurred in South Africa, where more women received tests than men (40,263,510 vs. 20,681,845). Despite the uneven testing, positive result yield was slightly higher among men than women (4.7% vs. 4.1%).

The study also revealed that more than half (51.6%) of all HIV-positive results among men were reported by South Africa, Tanzania and Zambia, with approximately one-third (29.2%) having been reported by South Africa alone.

Additionally, the study showed that provider-initiated counseling and testing (PITC) identified the most people living with HIV (PLHIV) (63.2%) compared with index testing (17.4%), voluntary counseling and testing (VCT) (11%) and mobile testing (8.4%). When broken down by sex, HIV case finding among men followed a similar pattern ⎼⎼ PITC identified 57.7% of HIV-positive men, followed by index testing (21.4%), VCT (11.9%) and mobile testing (9%).

Drammeh and colleagues said that, despite PITC identifying more PLHIV than any other testing strategy, the percentage positivity of index testing was higher than PITC in all countries and for both sexes. The five countries that identified the most PLHIV through index testing were Uganda (34,585), Mozambique (40,681), Kenya (51,717), Zambia (63,587) and Tanzania (116,546).

The researchers believe that these findings will help guide the Ministries of Health in selecting specific testing strategies to increase HIV-testing coverage, as well as identifying persons living with HIV infection.

“Provider-initiated testing and counseling services provided at health facilities identified the largest numbers of individuals living with HIV,” Drammeh said. “However, index testing had the highest positivity rate. These findings suggest that these two strategies should be scaled up to optimize HIV case finding efforts.