Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project

Mary Grace Alwano, Pamela Bachanas, Lisa Block, Michelle Roland, Baraedi Sento, Stephanie Behel, Refeletswe Lebelonyane, Kathleen Wirth, Faith Ussery, William Bapati, Catherine Motswere-Chirwa, William Abrams, Gene Ussery, James A Miller, Ebi Bile, Peter Fonjungo, Agisanag Kgwadu, Molly Pretorius Holme, Lisetta Del Castillo, Tendani Gaolathe, Kelebemang Leme, Nokuthula Majingo, Shahin Lockman, Joseph Makhema, Naomi Bock, Janet Moore, Mary Grace Alwano, Pamela Bachanas, Lisa Block, Michelle Roland, Baraedi Sento, Stephanie Behel, Refeletswe Lebelonyane, Kathleen Wirth, Faith Ussery, William Bapati, Catherine Motswere-Chirwa, William Abrams, Gene Ussery, James A Miller, Ebi Bile, Peter Fonjungo, Agisanag Kgwadu, Molly Pretorius Holme, Lisetta Del Castillo, Tendani Gaolathe, Kelebemang Leme, Nokuthula Majingo, Shahin Lockman, Joseph Makhema, Naomi Bock, Janet Moore

Abstract

Introduction: Achieving widespread knowledge of HIV-positive status is a crucial step to reaching universal ART coverage, population level viral suppression, and ultimately epidemic control. We implemented a multi-modality HIV testing approach to identify 90% or greater of HIV-positive persons in the Botswana Combination Prevention Project (BCPP) intervention communities.

Methods: BCPP is a cluster-randomized trial designed to evaluate the impact of combination prevention interventions on HIV incidence in 30 communities in Botswana. Community case finding and HIV testing that included home and targeted mobile testing were implemented in the 15 intervention communities. We described processes for identifying HIV-positive persons, uptake of HIV testing by age, gender and venue, characteristics of persons newly diagnosed through BCPP, and coverage of knowledge of status reached at the end of study.

Results: Of the 61,655 eligible adults assessed in home or mobile settings, 13,328 HIV-positive individuals, or 93% of the estimated 14,270 positive people in the communities were identified through BCPP. Knowledge of status increased by 25% over the course of the study with the greatest increases seen among men (37%) as compared to women (19%) and among youth aged 16-24 (77%) as compared to older age groups (21%). Although more men were tested through mobile than through home-based testing, higher rates of newly diagnosed HIV-positive men were found through home than mobile testing.

Conclusions: Even when HIV testing coverage is high, additional gains can be made using a multi-modality HIV testing strategy to reach different sub-populations who are being missed by non-targeted program activities. Men and youth can be reached and will engage in community testing when services are brought to places they access routinely.

Conflict of interest statement

The authors have declared that no competing interests exist, including the contractors from Northrup Grumman. Our adherence to PLOS ONE policies on sharing data and materials have not been altered.

Figures

Fig 1. Consort diagram of the assessment…
Fig 1. Consort diagram of the assessment of HIV status among participants identified in the Botswana Combination Prevention Project.
Fig 2. Proportion of HIV-positive persons among…
Fig 2. Proportion of HIV-positive persons among persons assessed for HIV by sex & age in 15 intervention communities.
Fig 3. Percentage of new HIV-positive persons…
Fig 3. Percentage of new HIV-positive persons among all HIV-positive persons identified by sex & age in 15 intervention communities.
Fig 4. Increases in population-level knowledge of…
Fig 4. Increases in population-level knowledge of HIV-positive status from study start to study end in the intervention communities by sex and age.

References

    1. UNAIDS. Global HIV & AIDS statistics—2018 fact sheet. Geneva, Switzerland: UNAIDS; 2018.
    1. Petersen M, Balzer L, Kwarisiima D, Sang N, Chamie G, Ayieko J, et al. Association of implementation of a universal testing and treatment intervention with HIV diagnosis, receipt of antirotroviral therapy, and viral suppression in East Africa. JAMA. 2017;317(21):2196–2206. 10.1001/jama.2017.5705
    1. Iwuji CC, Orne-Gliemann J, Larmarange J, Balestre E, Thiebaut R, Tanser F, et al. Universal test and treat and the HIV epidemic in rural South Africa: A phase 4, open-label, community cluster randomised trial. Lancet HIV. 2018;5:e116–25. 10.1016/S2352-3018(17)30205-9
    1. Barnabas R, van Rooyen H, Tumwesigye E, Brantley J, Baeten J, van Heerden A, et al. Uptake of antiretroviral therapy and male circumcision after community-based testing and strategies for linkage to care versus standard clinic referral: a multisite, open-label, randomised controlled trial in South Africa and Uganda. Lancet HIV. 2016;3:e212–20. 10.1016/S2352-3018(16)00020-5
    1. Iwuji CC, Orne-Gliemann J, Larmarange L, Okesola N, Tanser F, Thiebaut R. et al. Uptake of home-based HIV testing, linkage to care, and community attitudes about ART in rural KwaZulu-Natal, South Africa: Descriptive results from the first phase of ANRS 12249 TasP cluster-randomised trial. PLoS Med. 2016;13(8):e1002117 10.1371/journal.pmed.1002117
    1. UNAIDS. Ending AIDS: Progress towards the 90-90-90. Geneva, Switzerland: UNAIDS; 2017.
    1. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528:S77–85. 10.1038/nature16044
    1. Suthar A, Ford N, Bachanas P, Wong V, Rajan J, Saltzman A, et al. Towards universal voluntary HIV testing and counselling: A systematic review and meta-analysis of community-based approaches. PLOS Medicine. 2013;10(8):e1001496 10.1371/journal.pmed.1001496
    1. Hensen B, Taoka S, Lewis JJ, Weiss HA, Hargreaves J. Systematic review of strategies to increase men’s HIV-testing in Sub-Saharan Africa. AIDS. 2014;28:2133–45. 10.1097/QAD.0000000000000395
    1. Shanuabe K, Schaap A, Floyd S, Phiri M, Griffith S, Chaila J, et al. What works–reaching universal HIV testing: lessons from the HPTN 071 (PopART) trial in Zambia. AIDS. 2017;31:1555–64. 10.1097/QAD.0000000000001514
    1. Hayes R, Floyd S, Schaap A, Shanuabe K, Bock P, Sabapathy K, et al. A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster -randomised trial. PLoS Med. 2017;14(5):e1002292 10.1371/journal.pmed.1002292
    1. Gaolathe T, Wirth KE, Holme MP, Makhema J, Moyo S, Chakalisa U, et al. Botswana’s progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virologic suppression goals: A population-based survey. Lancet HIV. 2016;3(5):e221–30. 10.1016/S2352-3018(16)00037-0
    1. Maman D, Chilima B, Masiku C, Ayouda A, Masson S, Szumilin E, et al. Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study. JIAS. 2016;19:20673.
    1. Barnabas R, van Rooyen H, Tumwesigye E, Murnane P, Baeten J, Humphries H, et al. Initiation of antiretroviral therapy and viral suppression after home HIV testing in KwaZulu-Natal, South Africa, and Mbarara district, Uganda. Lancet HIV. 2014;1(2):e68–76. 10.1016/S2352-3018(14)70024-4
    1. van Rooyen H, Barnabas R, Baeten J, Phakathi Z, Joseph P, Krows M, et al. High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2013;64(1):e1–8. 10.1097/QAI.0b013e31829b567d
    1. Chamie G, Clark TD, Kabami J, Kadede K, Ssemondo E, Steinfeld R, et al. A hybrid mobile HIV testing approach for population wide HIV testing in rural East Africa: An observational study. Lancet HIV. 2016;3(3):e111–19. 10.1016/S2352-3018(15)00251-9
    1. Chamie G, Kwarisiima D, Clark TD, Kabami J, Jain V, Geng E, et al. Uptake of community HIV testing during a multi-disease health campaign in rural Uganda. PLoS ONE. 2014;9(1):e84317 10.1371/journal.pone.0084317
    1. Sabapathy K, Van den Bergh R, Fidler S, Hayes R, Ford N. Uptake of home-based voluntary HIV testing in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med. 2012;9(12): e1001351 10.1371/journal.pmed.1001351
    1. Novitsky V, Bussman H, Okui L, Logan A, Moyo S, van Widenfelt E, et al. Estimated age and gender profile of individuals missed by a home-based HIV testing and counseling campiagn in a Botswana community. J. Int. AIDS Soc. 2015;18:19918 10.7448/IAS.18.1.19918
    1. Botswana Statistics. Botswana AIDS Impact Survey (BAIS) IV. Gaborone, Botswana: Statistics Botswana; 2013.
    1. Makhema J, Wirth K, Pretorius Holme M, Gaolathe T, Mmalane M, Kadima E, et al. Universal Testing, Expanded Treatment, and Incidence of HIV Infection in Botswana. N Eng J Med. 2019. Jul 18;381(3):230–42.
    1. Lasry A, Bachanas P, Suraratdecha C, Alwano MG, Behel S, Pals S, et al. Cost of community-based HIV testing activities to reach saturation in Botswana. AIDS Behav. 2019;23(4):875–82. 10.1007/s10461-019-02408-9
    1. UNAIDS. The Gap Report. Geneva, Switzerland: UNAIDS; 2015.
    1. WHO. Consolidated Guidelines on HIV Testing Services. Geneva: World Health Organization; 2015.
    1. Shanuabe K, Schaap A, Chaila M.J, Floyd S, Mackworth-Young C, Hoddinott G, et al. Community intervention improves knowledge of HIV status of adolescents in Zambia: Findings from HPTN 071 –PoPART for Youth Study. AIDS. 2017;31(suppl.3):S221–32.
    1. Karim Q, Baxter C, and Birx D. Prevention of HIV in adolescent girls and young women: Key to an AIDS-Free Generation. J Acquir Immune Defic Syndr. 2017;75:S17–26. 10.1097/QAI.0000000000001316
    1. Choko A, Desmond N, Webb E, Chavula K, Napierala-Mavedzenge S, Gaydos C, et al.The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence settings: A cross-sectional feasibility study in Blantyre, Malawi. PLOS Med. 2011;8(10):e1001102 10.1371/journal.pmed.1001102
    1. Kadede K, Ruel T, Kabami J, Ssemondo E, Sang N, Kwarisiima D, et al. Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya. AIDS. 2016;30(14):2121–26. 10.1097/QAD.0000000000001180

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