What are we learning about HIV testing in informal settlements in KwaZulu-Natal, South Africa?

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Background: Recent studies have found high levels of HIV prevalence and risk behaviors in urban informal settlements. Given growing urbanization in sub-Saharan Africa, there is a critical need to assess the successes and challenges of implementing HIV prevention and treatment interventions in these contexts. Methods: We use a representative sample of 1528 adult men (18-35) and women (18-24) from a longitudinal study designed to evaluate the Asibonisane Community Responses (CR) program in KwaZulu-Natal, South Africa. We describe levels and trends in HIV testing, prevalence and treatment during follow-up, and we use fixed effects models to estimate the effects of participation in the CR program on testing. Results: Respondents reported high levels of economic insecurity and mobility. Although 90% had ever been tested for HIV at baseline, a lower proportion (73% of women, 63% of men) had been tested in the last six months. Among those HIV positive, treatment levels were high at baseline, and almost universal by endline in 2019. Program participation led to a 17% increase in the probability of testing for women (p < 0.05) but had no effect on testing for men due, in part, to the fact that the program did not reach men who were least likely to be tested. Men who had migrated to the community recently were less likely to be tested. Conclusions: Near universal HIV treatment for those tested positive for HIV demonstrates positive trends in access to HIV services in these communities. Yet barriers remain to testing, especially for men. This study offers insights into which men and women are least likely to be tested regularly, and whether programs are effectively reaching those groups. Building the global evidence base on these questions is vital to improving outcomes related to HIV prevention and care.






Supporting Operational AIDS Research (Project SOAR)