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Designing Human Immunodeficiency Virus Counselling and Testing Services to Maximize Uptake Among High School Learners in South Africa: What Matters?

Strauss, Michael MCom (Econ); George, Gavin PhD; Rhodes, Bruce PhD

Sexually Transmitted Diseases: May 2017 - Volume 44 - Issue 5 - p 290–296
doi: 10.1097/OLQ.0000000000000586
Original Studies

Background Increasing human immunodeficiency virus (HIV) testing in South Africa is vital for the HIV response. Targeting young people is important as they become sexually active and because HIV risk rapidly increases as youth enter their 20s. This study aims to increase the understanding of high school learners' preferences regarding the characteristics of HIV testing service delivery models and to inform policy makers and implementers regarding potential barriers to and facilitators of HIV testing.

Methods An attitudinal survey was used to examine HIV testing preferences among 248 high school learners in KwaZulu-Natal. Statistical tests were used to identify the most favored characteristics of testing service delivery models and examine key differences in preferences based on demographic characteristics and testing history.

Results Most learners were found to prefer testing offered at a clinic on a Saturday (43%), using a finger prick test (59%), conducted by a doctor (61%) who also provides individual counselling (60%). Shorter testing times were preferred, as well as a monetary incentive to cover any associated expenses. Time, location, the type of test, and who conducts the test were most important. However, stratified analysis suggests that preferences diverge, particularly around gender, grade, but also sexual history and previous testing experience.

Conclusions Human immunodeficiency virus testing services can be improved in line with preferences, but there is no single optimal design that caters to the preferences of all learners. It is unlikely that a “one-size-fits-all” approach will be effective to reach HIV testing targets. A range of options may be required to maximize coverage.

Although there are commonalities in the human immunodeficiency virus testing preferences of high school learners in South Africa, it is unlikely that a ‘one-size-fits-all’ approach will succeed in reaching current testing targets.

From the *Health Economics and HIV and AIDS Research Division (HEARD), and †School of Accounting, Economics and Finance, University of KwaZulu-Natal, South Africa

Acknowledgements: Assistance from colleagues from the research team at CAPRISA was invaluable for conducting this study. A big thank you goes specifically to the team arranging and coordinating the school visits and liaising with school principals and teachers. The authors also acknowledge the input from colleagues at the Health Economics and HIV and AIDS Research Division whose comments have helped to shape this piece of work, specifically Kaymarlin Govender, one of the primary investigators on the overarching VMMC study. The authors thank the team of fieldworkers and data capturers and translators, without whose assistance this study would not have been possible. The authors also acknowledge the financial support of the Swedish International Development Cooperation Agency (Sida), who provide core funding to the Health Economics and HIV and AIDS Research Division.

Conflict of Interest: None declared.

Correspondence: Michael Strauss, MCom (Econ), Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal. South Africa. Postal Address: HEARD C/O University of KwaZulu-Natal Westville Campus, Private Bag X54001, Durban, 4000, South Africa. E-mail:; or

Received for publication August 12, 2016, and accepted December 21, 2016.

© Copyright 2017 American Sexually Transmitted Diseases Association