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Title
HIV testing patterns in two community-based approaches to universal test and treat in the HPTN 071 (PopART) intervention in South Africa
Presenter
Blia Yang
Authors
B. Yang1, R. Sloot1,2, S. Floyd3, F. Esau1, J. Molaolwa1, D. Awoniyi1, Y. Saunders1, P. Siboto1, L. Gqiba-Tunywa1, D. Myburgh1, B. Cimi1, S. Griffith4, P. Bock1, H. Ayles5,6, S. Fidler7, R. Hayes3, N. Beyers1, HPTN 071 (PopART) Study Team
Institutions
1Stellenbosch University, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa, 2Amsterdam Institute of Global Health and Development, Amsterdam, Netherlands, 3London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom, 4FHI360, Durham, South Africa, 5Zambia AIDS Related Tuberculosis Project, University of Zambia, Lusaka, Zambia, 6London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom, 7Imperial College, Department of Infectious Disease Epidemiology, London, United Kingdom

Background: HPTN 071 (PopART) is a community-randomised trial conducted in 21 communities in Zambia and South Africa (SA) with a population of over 1 million, to measure the impact of a combination HIV prevention intervention on population-level HIV incidence; delivered in annual rounds by Community HIV-care Providers (CHiPs), who provide home-based HIV testing services (HTS) door-to-door in the community. In response to a lower proportion of men being reached during home-based HTS (HBHTS), CHiPs offered HTS in tents in areas of high foot traffic. We analysed HTS data to determine whether more men were tested through tent-HTS as compared to HBHTS, and compared other demographic characteristics between HBHTS and tent-HTS to understand HIV testing patterns.
Methods: During annual round three from April 2017-December 2017, when both HBHTS and tent-HTS were offered by CHiPs in six SA communities, tent-HTS was conducted at public transport hubs(4 days), shopping centres(13 days), schools/libraries(6 days), and a community event(1 day). 3-5 tent-HTS events were conducted in each community. HTS was offered through a finger-prick rapid test using the SA National HTS serial testing algorithm. CHiPs collected data on an electronic register. Multivariable logistic regression analysis was used to compare the population reached through HBHTS versus tent-HTS on gender, age, history of prior HIV testing, status as a presumptive TB case, and community.
Results: 32,032 HIV tests were done through HBHTS and 402 during tent-HTS (Table 1 shows characteristics of the population tested). Those testing through tent-HTS were more likely than those testing through HBHTS to be men (aOR 1.9, 95%CI 1.5-2.3), more likely to be from the older age-groups of 25-29/30-39/40-49/50+ (p-values of all aOR''s < 0.01), and more likely to be residents of communities SA5/SA6 (agricultural communities further from Cape Town). HIV positivity was slightly higher during HBHTS as compared to tent-HTS but was not significant (2.1%vs1.7%).
Conclusions: Tent-HTS in high traffic areas proved successful in reaching a higher proportion of men, although the absolute number of additional tests was relatively small. Tent-HTS was relatively more successful in agricultural areas. Studies with larger sample size are required to understand differences in HIV testing patterns between HBHTS and tent-HTS.


Table 1. Characteristics of individuals tested for HIV by lay HIV counsellors at home and in tents in high traffic areas
[Table 1. Characteristics of individuals tested for HIV by lay HIV counsellors at home and in tents in high traffic areas]

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