Background: It is estimated that males account for a disproportionately high percentage of the undiagnosed HIV-positive individuals in Botswana. To achieve the UNAIDS 90-90-90 targets and reach epidemic control, innovative strategies are needed to increase HIV case identification among this priority population.
Description: Two strategies were employed to increase HIV case identification amongst men at 26 public health facilities in Botswana: extended hours testing, and use of a warm-line for scheduling testing appointments. Extended hours included evenings and weekends. The warmline was promoted through various traditional and social media outlets.
Lessons learned: Between June-December 2017, 73,258 HIV tests were administered, with 4,542 HIV cases identified in the supported facilities for a yield of 6.2%. The majority of tests (66,203, 90%) and cases (3,907, 86%) were identified during traditional facility hours (yield=5.9%). During extended hours, 7,055 tests were conducted with 635 cases identified (yield=9%). The percentage of males identified during extended hours testing was 63% compared to 37% during traditional testing hours. There were 642 HIV tests conducted following appointments through the warmline, with 86 HIV cases identified (Yield= 13.4%). Sixty percent were male. During standard-hours, it took approximately 20.6 Health Care Assistant (HCA)-hours to identify 1 HIV case. This increased to 31.3 HCA-hours per case during the weekend. This doubled to 62.8 HCA-hours per case during after-hours testing.
Conclusions/Next steps: Innovative strategies such as afterhours and weekend testing and implementation of a warmline are effective at increasing overall HIV case identification as well as case identification among males. While the absolute number of cases identified through these modalities were lower in comparison to HIV testing conducted during traditional hours, these modalities resulted in higher yield and a higher proportion of male cases. These data support the use of extended HIV testing hours and a warmline to supplement HIV testing services during traditional health facility working hours. Attention to linkage to care is a critical consideration for extended hours testing.

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