title: Community perceptions of repeat HIV-testing: experiences of the ANRS 12249 Treatment as Prevention trial in rural South Africa.
abstract: In the context of the ANRS 12249 Treatment as Prevention (TasP) trial, we investigated perceptions of regular and repeat HIV-testing in rural KwaZulu-Natal (South Africa), an area of very high HIV prevalence and incidence. We conducted two qualitative studies, before (2010) and during the early implementation stages of the trial (2013-2014), to appreciate the evolution in community perceptions of repeat HIV-testing over this period of rapid changes in HIV-testing and treatment approaches. Repeated focus group discussions were organized with young adults, older adults and mixed groups. Repeat and regular HIV-testing was overall well perceived before, and well received during, trial implementation. Yet community members were not able to articulate reasons why people might want to test regularly or repeatedly, apart from individual sexual risk-taking. Repeat home-based HIV-testing was considered as feasible and convenient, and described as more acceptable than clinic-based HIV-testing, mostly because of privacy and confidentiality. However, socially regulated discourses around appropriate sexual behaviour and perceptions of stigma and prejudice regarding HIV and sexual risk-taking were consistently reported. This study suggests several avenues to improve HIV-testing acceptability, including implementing diverse and personalised approaches to HIV-testing and care, and providing opportunities for antiretroviral therapy initiation and care at home.
authors.affiliation: a INSERM U1219 - Centre Inserm Bordeaux Population Health , Université de Bordeaux , Bordeaux , France.|b Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, ISPED , Bordeaux , France.
authors.forename: Joanna
authors.initials: J
authors.lastname: Orne-Gliemann
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Thembelihle
authors.initials: T
authors.lastname: Zuma
authors.affiliation: d HIV/AIDS, STIs and TB Department , Human Sciences Research Council , Pretoria , South Africa.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Chikovore
authors.affiliation: e Human and Social Development Department , Human Sciences Research Council , Pretoria , South Africa.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gillespie
authors.affiliation: f Centre for Rural Health , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Merridy
authors.initials: M
authors.lastname: Grant
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Collins
authors.initials: C
authors.lastname: Iwuji
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.|g Centre Population & Développement (Ceped UMR 196 UPD IRD) , Institut de Recherche pour le Développement , Marseille , France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Larmarange
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.|h Faculty of Medicine and Faculty of Human, Social and Mathematical Sciences , University of Southampton , Southampton , UK.|i Research Department of Infection and Population Health , University College London , London , UK.
authors.forename: Nuala
authors.initials: N
authors.lastname: McGrath
authors.affiliation: j INSERM U1018, CESP, Epidemiology of Occupational and Social Determinants of Health , Villejuif , France.
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.|k Centre for Sexual Health and HIV Research, Research Department of Infection and Population, Faculty of Population Health Sciences , University College London , London , UK.|l Wits RHI, University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: John
authors.initials: J
authors.lastname: Imrie
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010465:Perception; D011287:Prejudice; D015995:Prevalence; D036301:Qualitative Research; D012111:Residence Characteristics; D012309:Risk-Taking; D012424:Rural Population; D012725:Sexual Behavior; D057545:Social Stigma; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; South Africa; UTT; community; testing; treatment as prevention