HIV self-testing among previously diagnosed HIV-positive people in Khayelitsha, South Africa; no evidence of harm but may facilitate re-engagement in ART care


BACKGROUND: HIV self-testing (HIVST) can increase access to and uptake of HIV testing services among people living with HIV (PLHIV) who do not know their status, however there is concern that access to HIVST might result in re-testing among PLHIV on antiretroviral therapy (ART) with a risk of false negative results and disengagement from care. We present the results of an out-of-facility model of distribution of oral HIVST kits in the high HIV prevalence setting of Khayelitsha, South Africa.
METHODS: Between November 2017 and December 2018, HIVST kits were distributed at HIV testing outreach events and at a private pharmacy in the community. Consenting participants were instructed to report their result via SMS and those who did not report their result within 10 days were followed-up telephonically. The National Health Laboratory System and the Provincial Health Data System were searched for evidence of HIV services provided to participants in the six months before and after enrollment.
RESULTS: Of 1482 participants enrolled, 29% reported their result via SMS, and a further 48% reported their results when telephoned. Of 163 (11%) participants who were previously diagnosed HIV positive prior to taking the test, 123 reported a result, of which 87% reported a negative result. Of known HIV-positives, 84 were not in ART care prior to the test, with 15 (18%) linking to care post-test. Of 79 who were in ART care prior to the test, 76 (96%) remained in care after taking the test, even though 51 (67%) of these had reported a negative result.
CONCLUSIONS: Our findings suggest that previously diagnosed HIV positive people retest with HIVST if it is available, despite efforts to dissuade them. For those who have disengaged from care this may facilitate re-engagement in care. Self-testing among those already in care, regardless of the reported result, did not disrupt their treatment, and their reasons for doing the test remain unclear. Further work is needed to understand the reasons for re-testing.