Results of the Sukuma Ndoda (“Stand up, Man”) HIV self-screening and assisted linkage to care project in Johannesburg: a quasi-experimental pre-post evaluation

Abstract

Background: HIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by community health workers (CHWs) is a scalable option to increase testing coverage, diagnosis, and treatment initiation. We provided HIVSS and assisted linkage to care to men not recently tested (within past 12 months) residing in high-HIV-burden areas of Johannesburg. Methods: CHWs distributed HIVSS in six clinic catchment areas. Follow-up to encourage confirmatory testing and ART initiation was conducted through personal support (PS) or an automated SMS follow-up and linkage system in three clinic areas each. Using a quasi-experimental pre-post design, we compared differences in the proportion of men testing in the clinic catchment areas during the HIVSS campaign (June-Aug 2019) to the three months prior (March-May 2019) and compared treatment initiations by assisted linkage strategy. Results: Among 4,793 participants accepting HIVSS, 62% had never tested. Among 3,993 participants with follow-up data, 90.6% reported using their HIVSS kit. Testing coverage among men increased 156%, from under 4% when only clinic-based HIV testing services (HTS) were available to 9.5% when HIVSS and HTS were available (z=-11.6; p<0.01). Reported test use was higher for men followed through PS (99% vs 68% in SMS); however, significantly more men reported reactive self-test results in the SMS group compared to PS (6.4% vs 2.0%), resulting in more ART initiations in the SMS group compared to PS (23 vs 9; p<0.01). Conclusion: CHW HIVSS distribution significantly increases testing among men. While PS enabled personalized follow-up, reporting differences indicate SMS is more acceptable and better aligned with expectations of privacy associated with HIVSS.