title: HIV testing rates and outcomes in a South African community, 2001-2006: implications for expanded screening policies.
abstract: BACKGROUND
  Revised World Health Organization recommendations seek to increase HIV testing. We assessed the need for expanded testing in South Africa by examining current testing and treatment trends among a high prevalence population.
  
  
  METHODS
  We determined the numbers of adults receiving HIV testing and antiretroviral treatment (ART) during 2001-2006 using testing registers linked to patient records from 2 health care facilities believed responsible for virtually all HIV services available to the population. We evaluated annual population testing rates using census population counts; proportions of clients testing seropositive (yield); CD4 counts and World Health Organization stage at diagnosis; and ART initiation rates.
  
  
  RESULTS
  HIV testing rates rose from 4% in 2001 to 20% in 2006 (P < 0.001) and were highest among pregnant females receiving provider-initiated testing. Yield for first-time testers decreased from 47% in 2001 to 28% in 2006; annual incidence of seroconversion among initially HIV-negative retesters was 1.9%. Median CD4 counts and World Health Organization stage distributions for newly diagnosed clients remained stable. HIV-infected clients receiving ART within 6 months of eligibility increased from 0% in 2001 to 68% in 2006 (P < 0.001).
  
  
  CONCLUSIONS
  Population testing and ART initiation rates rose dramatically during 2001-2006. Yet, yield remained high, and HIV-infected persons continued to receive late diagnoses. These findings highlight the continuing need for expanded testing and linkage to care.
authors: Harvard Medical School, Boston, MA, USA. michael_april@hms.harvard.edu
authors: Michael D
authors: MD
authors: April
authors: Rochelle P
authors: RP
authors: Walensky
authors: Yuchiao
authors: Y
authors: Chang
authors: Jennifer
authors: J
authors: Pitt
authors: Kenneth A
authors: KA
authors: Freedberg
authors: Elena
authors: E
authors: Losina
authors: A David
authors: AD
authors: Paltiel
authors: Robin
authors: R
authors: Wood
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data / Q000639:trends*; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006291:Health Policy / Q000639:trends*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology; D014944:World Health Organization; D055815:Young Adult