There has been great progress toward addressing the burden of HIV/AIDS including a reduction of new infections and increased coverage of antiretroviral treatment (ART). South Africa is close to meeting the first UNAIDS 90-90-90 target, however, as more people become aware of their status, testing those who are undiagnosed becomes more challenging.
Hillbrow CHC is one for the largest facilities in South Africa, situated in the City of Johannesburg and serving the community of the inner city including many migrants; it has the biggest ART programme in Johannesburg. Recently positivity yield at the facility has been decreasing.
Anova Health Institute as a PEPFAR District Supporting Partner has direct service delivery staff placed at the facility. Anova piloted the use of an HIV risk assessment tool endorsed by PEPFAR/USAID. The tool targets all clients aged 25-50 entering the facility. It is based on 3 questions: knowledge of HIV status; utilization of health services in the past 6 months and sexual practice. Based on the response the client is redirected for HIV testing or prevention services.
We aimed to use routine data to explore the effectiveness of the tool in identifying HIV positive clients more efficiently.
Implementation started in March 2020. 16 of 40 counsellors used the risk assessment tool. A total of n=12545 were screened from March-December 2020. n=7688 clients screened high risk and were tested (61%). We identified n=1581 positives (21% yield). Screening contributed 41% to the total HIV tests done (30674), but 77% of the positives identified. The overall facility positivity yield was 7%.
The use of the HIV risk screening tool promoted targeted testing, minimized random testing and resulted in a high positivity yield. Scaling up the use of the tool to all counsellors at the facility would result in improved testing efficiency.