HIV testing rates and outcomes in a South African community, 2001-2006: implications for expanded screening policies.
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.
April
Michael D
MD
Harvard Medical School, Boston, MA, USA. michael_april@hms.harvard.edu
Walensky
Rochelle P
RP
Chang
Yuchiao
Y
Pitt
Jennifer
J
Freedberg
Kenneth A
KA
Losina
Elena
E
Paltiel
A David
AD
Wood
Robin
R
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