Primary healthcare workers’ perspectives on providing HIV testing services during the Covid-19 pandemic.

Background and objectives

South Africa’s COVID‐19 response has impacted health service delivery, including the provision of HIV Testing Services (HTS). A review of program data shows that HIV testing services declined substantially during the first wave. There is limited qualitative information as to how HTS services have been impacted and what adaptive measures have been taken. A deeper understanding of these challenges and adaptations will feed into organizational policies, and support resilience

Method

We conducted key-informant interviews (KIIs) with 27 health care providers in 9 PHC facilities in the Johannesburg Health District (JHB) between September and October 2020. Clinics were selected purposively based on HTS performance (sites that had significant declines and those that showed resilience). Interviews explored: perceived challenges; perceived COVID-19 exposure/vulnerability during HTS implementation; and adaptive strategies.

Results

The main challenges cited were: redeployment of resources to the COVID-19 response, including gazebos and reallocation of staff; community members’ fear of contracting COVID-19 reducing feet through the door of health facilities; and deprioritization of issues other than COVID-19 among managers and clients, making recruitment for testing challenging. The majority of providers perceived themselves to be at high risk of COVID-19 but readily available personal protective equipment and training resolved some safety concerns. Participants reported that the use of HIV Self screening made it possible to test whilst maintaining social distancing and adapting HIV recruitment messages to incorporate risks associated with COVID and undiagnosed HIV persuaded clients to test.

Conclusion

COVID-19 brought disruption to HTS services in several ways. HTS providers had to adapt testing, by using safer testing methods and adapting HIV health talks. Programs need to ensure HIVSS is scaled up, traditional demand creation for HIV testing is modified, and preventive services are prioritized to better respond to subsequent waves.