title: Changes in self-reported HIV testing during South Africa's 2010/2011 national testing campaign: gains and shortfalls.
abstract: OBJECTIVE
  HIV counselling and testing is critical to HIV prevention and treatment efforts. Mass campaigns may be an effective strategy to increase HIV testing in countries with generalized HIV epidemics. We assessed the self-reported uptake of HIV testing among individuals who had never previously tested for HIV, particularly those in high-risk populations, during the period of a national, multisector testing campaign in South Africa (April 2010 and June 2011).
  
  
  METHODS
  This study was a prospective cohort study.
  
  
  METHODS
  We analyzed data from two waves (2010/2011, n=16,893; 2012, n=18,707) of the National Income Dynamics Study, a nationally representative cohort that enabled prospective identification of first-time testers. We quantified the number of adults (15 years and older) testing for the first time nationally. To assess whether the campaign reached previously underserved populations, we examined changes in HIV testing coverage by age, gender, race and province sub-groups. We also estimated multivariable logistic regression models to identify socio-economic and demographic predictors of first-time testing.
  
  
  RESULTS
  Overall, the proportion of adults ever tested for HIV increased from 43.7% (95% confidence interval (CI): 41.48, 45.96) to 65.2% (95% CI: 63.28, 67.10) over the study period, with approximately 7.6 million (95% CI: 6,387,910; 8,782,986) first-time testers. Among black South Africans, the country's highest HIV prevalence sub-group, HIV testing coverage improved among poorer and healthier individuals, thus reducing gradients in testing by wealth and health. In contrast, HIV testing coverage remained lower for men, younger individuals and the less educated, indicating persistent if not widening disparities by gender, age and education. Large geographic disparities in coverage also remained as of 2012.
  
  
  CONCLUSIONS
  Mass provision of HIV testing services can be effective in increasing population coverage of HIV testing. The geographic and socio-economic disparities in programme impacts can help guide best practices for future efforts. These efforts should focus on hard-to-reach populations, including men and less-educated individuals.
authors.affiliation: Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa.
authors.forename: Brendan
authors.initials: B
authors.lastname: Maughan-Brown
authors.affiliation: Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa.
authors.forename: Neil
authors.initials: N
authors.lastname: Lloyd
authors.affiliation: Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa.|Department of Global Health, Boston University School of Public Health Boston, MA, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bor
authors.affiliation: Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa.|Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.|Center for Population and Development Studies, Harvard University, Cambridge, MA, USA; avenkataramani@partners.org.
authors.forename: Atheendar S
authors.initials: AS
authors.lastname: Venkataramani
mesh_terms: D000328:Adult; D044383:Black People; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D057566:Self Report; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: HCT; HIV/AIDS; disparities; socio-economic determinants; southern Africa; testing