Finding out myself: using community-based HIV self-testing to reach underserved men and women in Botswana, 2020

BACKGROUND: Currently in Botswana, 92% of all people living with HIV (PLHIV) are aware of their HIV status, 89% are on antiretroviral therapy (ART), and 95% are virally suppressed. Despite excellent progress made toward reaching the first of UNAIDS' 95-95-95 goals (that's 95% of PLHIV know their status), gaps remain with more women tested than men. Since January 2020, the USAID-funded, FHI 360-led Accelerating Progress in Communities (APC 2.0) project rolled out HIV self-testing (HIVST) to reach underserved populations, particularly men. We present the outcomes of community-based rollout of HIVST in five districts of Botswana.
METHODS: APC 2.0 reached clients in construction sites, taxi ranks, public drinking spots, and football fields where men mostly congregate. Trained health care workers used an HTS screening tool that determines eligibility for HIVST based on risk factors. All contacts of index cases and identified high risk men were offered HIVST. We extracted and analyzed APC 2.0 HIVST project data for the period April 1 to December 15, 2020. Data were analyzed using SPSS Version 21.
RESULTS: A total of 1,135 clients were issued HIVST kits, and 753 (66%) were men. Of these men, 90% (679/753) were issued HIVST kits based on screening tool results, while rest 10% (74/753) were contacts of index clients. In total, 191 (16.8%) of 1,135 clients who tested had a reactive result. Females were more likely than males to have a reactive test: reactivity rate =23.2% versus 13.7%, p<0.001. More males in the older age-groups above 25% were reached compared to females, though the latter had a higher reactivity rate (Table 1).


CONCLUSIONS: Implementation of community-based delivery of HIVST identified people not previously identified and reaffirms the higher burden among women. Though reactivity rate was higher amongst females, HIVST helped identify men and could help Botswana meet its testing goals for older men.