Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa

Susan Regan, Elena Losina, Senica Chetty, Janet Giddy, Rochelle P Walensky, Douglas Ross, Helga Holst, Jeffrey N Katz, Kenneth A Freedberg, Ingrid V Bassett, Susan Regan, Elena Losina, Senica Chetty, Janet Giddy, Rochelle P Walensky, Douglas Ross, Helga Holst, Jeffrey N Katz, Kenneth A Freedberg, Ingrid V Bassett

Abstract

Background: Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country.

Methods: We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR's) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model.

Results: Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33-1.68), women (ARR: 1.24, 95% CI: 1.11-1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12-1.45).

Conclusions: In this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Cohort Enrollment and Testing.
Figure 1. Cohort Enrollment and Testing.
Figure 2. Percent with prior HIV test…
Figure 2. Percent with prior HIV test among those HIV negative at enrollment, by gender, age group, and parental status.
Figure 3. Percent with prior HIV test…
Figure 3. Percent with prior HIV test among those HIV negative at enrollment, by self-reported health status (linear trend p<.001>

References

    1. Kiene SM, Bateganya M, Wanyenze R, Lule H, Nantaba H, et al. (2010) Initial outcomes of provider-initiated routine HIV testing and counseling during outpatient care at a rural Ugandan hospital: risky sexual behavior, partner HIV testing, disclosure, and HIV care seeking. AIDS Patient Care STDS 24: 117–126.
    1. Gras L, van Sighem A, Bezemer D, Smit C, Wit F, et al. (2011) Lower mortality and earlier start of combination antiretroviral therapy in patients tested repeatedly for HIV than in those with a positive first test. AIDS 25: 813–818.
    1. Sobrino-Vegas P, Garcia-San Miguel L, Caro-Murillo AM, Miro JM, Viciana P, et al. (2009) Delayed diagnosis of HIV infection in a multicenter cohort: prevalence, risk factors, response to HAART and impact on mortality. Curr HIV Res 7: 224–230.
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365: 493–505.
    1. Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, et al.. (2009) South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008 A Turning Tide Among Teenagers? Cape Town, HSRC Press. 120 p. Available: . Accessed 2013 Mar 13.
    1. South Africa Department of Health (2007) HIV & AIDS and STI Strategic Plan for South Africa 2007–2011. Available: . Accessed 2013 Mar 13.
    1. World Health Organization (WHO), UNAIDS & UNICEF (2009) Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector. Progress Report, 2009. Geneva, WHO. 162 p. Available: . Accessed 2013 Mar 27.
    1. Tabana H, Doherty T, Swanevelder S, Lombard C, Jackson D, et al.. (2012) Knowledge of HIV status prior to a community HIV counseling and testing intervention in a rural district of south Africa: results of a community based survey. BMC Infect Dis 12: 73. Available: . Accessed 2013 Mar 27.
    1. Ostermann J, Reddy EA, Shorter MM, Muiruri C, Mtalo A, et al.. (2011) Who tests, who doesn’t, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania. PLoS One 6: e16488. Available: . 2013 Mar 27.
    1. Obermeyer CM, Osborn M (2007) The utilization of testing and counseling for HIV: a review of the social and behavioral evidence. Am J Public Health 97: 1762–1774.
    1. Schwarcz S, Richards TA, Frank H, Wenzel C, Hsu LC, et al. (2011) Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing. AIDS Care 23: 892–900.
    1. Weiser SD, Heisler M, Leiter K, Percy-de Korte F, Tlou S, et al.. (2006) Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. PLoS Med 3: e261. Available: . Accessed 2013 Mar 27.
    1. Liddicoat RV, Losina E, Kang M, Freedberg KA, Walensky RP (2006) Refusing HIV testing in an urgent care setting: results from the “Think HIV” program. AIDS Patient Care STDS 20: 84–92.
    1. Shisana O, Simbayi LC (2002) Nelson Mandela/HSRC study of HIV/AIDS: South African National HIV Prevalence, Behavioral Risks and Mass Media, Household Survey, 2002. Cape Town, South Africa: Human Sciences Research Council. 121 p. Available: . Accessed 2011 Dec 21.
    1. de Wit JB, Adam PC (2008) To test or not to test: psychosocial barriers to HIV testing in high-income countries. HIV Med 9 Suppl 220–22.
    1. Phakathi Z, Van Rooyen H, Fritz K, Richter L (2011) The influence of antiretroviral treatment on willingness to test: a qualitative study in rural KwaZulu-Natal, South Africa. Afr J AIDS Res 10: 173–180.
    1. Drain PK, Losina E, Parker G, Giddy J, Ross D, et al.. (2013) Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa. PLoS One 8: e55305. Available: . Accessed 2013 Mar 27.
    1. Bassett IV, Giddy J, Nkera J, Wang B, Losina E, et al. (2007) Routine voluntary HIV testing in Durban, South Africa: the experience from an outpatient department. J Acquir Immune Defic Syndr 46: 181–186.
    1. Sherr L, Lopman B, Kakowa M, Dube S, Chawira G, et al. (2007) Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort. AIDS 21: 851–860.
    1. Sambisa W, Curtis S, Mishra V (2010) AIDS stigma as an obstacle to uptake of HIV testing: evidence from a Zimbabwean national population-based survey. AIDS Care 22: 170–186.
    1. Bassett IV, Regan S, Chetty S, Giddy J, Uhler LM, et al. (2010) Who starts antiretroviral therapy in Durban, South Africa?… not everyone who should. AIDS 24 Suppl 1S37–44.
    1. Losina E, Bassett IV, Giddy J, Chetty S, Regan S, et al.. (2010) The “ART” of linkage: pre-treatment loss to care after HIV diagnosis at two PEPFAR sites in Durban, South Africa. PLoS One 5: e9538. Available: . Accessed 2013 Mar 27.
    1. Kranzer K, van Schaik N, Karmue U, Middelkoop K, Sebastian E, et al.. (2011) High prevalence of self-reported undiagnosed HIV despite high coverage of HIV testing: a cross-sectional population based sero-survey in South Africa. PLoS One 6: e25244. Available: . Accessed 2013 Mar 27.
    1. Nglazi MD, van Schaik N, Kranzer K, Lawn SD, Wood R, et al. (2012) An incentivized HIV counseling and testing program targeting hard-to-reach unemployed men in Cape Town, South Africa. J Acquir Immune Defic Syndr 59: e28–34.
    1. Silvestri DM, Modjarrad K, Blevins ML, Halale E, Vermund SH, et al. (2011) A comparison of HIV detection rates using routine opt-out provider-initiated HIV testing and counseling versus a standard of care approach in a rural African setting. J Acquir Immune Defic Syndr 56: e9–32.
    1. Bradley H, Tsui A, Kidanu A, Gillespie D (2011) Client characteristics and HIV risk associated with repeat HIV testing among women in Ethiopia. AIDS Behav 15: 725–733.
    1. Corbett EL, Makamure B, Cheung YB, Dauya E, Matambo R, et al. (2007) HIV incidence during a cluster-randomized trial of two strategies providing voluntary counselling and testing at the workplace, Zimbabwe. AIDS 21: 483–489.
    1. Castilla J, Sobrino P, De La Fuente L, Noguer I, Guerra L, et al. (2002) Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence. AIDS 16: 1945–1951.
    1. Roura M, Watson-Jones D, Kahawita TM, Ferguson L, Ross DA (2013) Provider-initiated testing and counselling programmes in sub-Saharan Africa: a systematic review of their operational implementation. AIDS 27: 617–626.
    1. Topp SM, Li MS, Chipukuma JM, Chiko MM, Matongo E, et al. (2012) Does provider-initiated counselling and testing (PITC) strengthen early diagnosis and treatment initiation? Results from an analysis of an urban cohort of HIV-positive patients in Lusaka, Zambia. J Int AIDS Soc 15: 17352.

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