Routine voluntary HIV testing in Durban, South Africa: the experience from an outpatient department.
OBJECTIVE
To evaluate the yield of a routine voluntary HIV testing program compared with traditional provider-referred voluntary counseling and testing (VCT) in a hospital-affiliated outpatient department (OPD) in Durban, South Africa.


METHODS
In a prospective 14-week "standard of care" period, we compared OPD physician logs documenting patient referrals to the hospital VCT site with HIV test registers to measure patient completion of HIV test referral. The standard of care period was followed by a 12-week intervention during which all patients who registered at the OPD were given an educational intervention and offered a rapid HIV test at no charge as part of routine care.


RESULTS
During the standard of care period, OPD physicians referred 435 patients aged > or = 18 years for HIV testing; 137 (31.5%) of the referred patients completed testing at the VCT site within 4 weeks. Among those tested, 102 (74.5%) were HIV infected. During the intervention period, 1414 adults accepted HIV testing and 1498 declined. Of those tested, 463 (32.7%, 95% confidence interval: 30.3 to 35.3) were HIV infected. Routine HIV testing in the OPD identified 39 new HIV cases per week compared with 8 new cases per week with standard of care testing based on physician referral to a VCT site (P < 0.0001).


CONCLUSIONS
Routine voluntary HIV testing in an OPD in South Africa leads to significantly higher rates of detection of HIV disease. This strategy should be implemented more widely in high HIV prevalence areas where treatment is available.
Division of Infectious Disease, Massachusetts General Hospital, Boston, MA 02114, USA. ibassett@partners.org
Ingrid V
IV
Bassett
Janet
J
Giddy
Jacques
J
Nkera
Bingxia
B
Wang
Elena
E
Losina
Zhigang
Z
Lu
Kenneth A
KA
Freedberg
Rochelle P
RP
Walensky
D000328:Adult; D005260:Female; D006078:Government Programs; D015658:HIV Infections / Q000517:prevention & control*; D015497:HIV-1; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D010045:Outpatients; D011446:Prospective Studies; D013019:South Africa; D035141:Voluntary Programs