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Impact of Home-Based HIV Testing Services on Progress Toward the UNAIDS 90-90-90 Targets in a Hyperendemic Area of South Africa

Lewis, Lara, MSc*; Maughan-Brown, Brendan, PhD; Grobler, Anneke, PhD*,‡; Cawood, Cherie, MBA§; Khanyile, David, BA§; Glenshaw, Mary, PhD; Kharsany, Ayesha B. M., PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1, 2019 - Volume 80 - Issue 2 - p 135–144
doi: 10.1097/QAI.0000000000001900

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

*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;

Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia;

§Epicentre AIDS Risk Management (Pty) Limited, Cape Town, South Africa; and

Centers for Disease Control and Prevention (CDC), Pretoria, South Africa.

Correspondence to: Brendan Maughan-Brown, PhD, Southern Africa Labour and Development Research Unit, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa (e-mail:

The HIV Incidence Provincial Surveillance System (HIPSS) is funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreement 3U2GGH000372-02 W1. Support was provided to B.M.-B. by the National Research Foundation, South Africa, through the Research Career Advancement Fellowship. A.B.M.K. is supported by a joint South Africa–US Program for Collaborative Biomedical Research, National Institutes of Health grant (R01HD083343).

Presented in part at: Poster at the eighth SA AIDS Conference; June 14, 2017; Durban, South Africa.

The authors have no funding or conflicts of interest to disclose.

L.L. and B.M.-B. authors have contributed equally to the work.

A.B.M.K. is the principal investigator of HIPSS. A.B.M.K., C.C., and D.K., were responsible for HIPSS study operations and quality assurance. L.L. analysed the data. L.L., B.M.B., A.G., and A.B.M.K. contributed to analysis and the interpretation of the data of the first draft. All authors contributed to subsequent drafts and approved the final version of the report.

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Received April 17, 2018

Accepted October 03, 2018

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