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Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines

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Abstract

Some people with HIV (PWH) test positive multiple times without initiating antiretroviral therapy (ART). We surveyed 496 ART-eligible PWH following routine HIV testing at three clinics in Soweto and Gugulethu, South Africa in 2014–2015. Among repeat positive testers (RPTs) in this cohort, we compared rates of treatment initiation by prior treatment eligibility and assessed psychosocial predictors of treatment initiation in logistic regression models. RPTs represented 33.8% of PWH in this cohort. Less than half of those who reported eligibility for ART on prior testing started treatment upon retesting, in contrast to two thirds of RPTs who were previously ineligible for treatment who started treatment once they learned of their eligibility. Those who reported coping through substance use were more likely to decline treatment versus those not using substances. PWH who test repeatedly represent a vulnerable population at risk for ART non-initiation who may benefit from interventions addressing individualized coping strategies.

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Funding

This study was funded by Grant Number K23 MH097667 (Katz) from the U.S. National Institute for Mental Health (NIMH), Grant Number T32 A1007433 (Nardell) from the National Institute of Allergy and Infectious Diseases (NIAID), and Grant Number P30MH058107 (Bogart) from the National Institute of Mental Health (NIMH). The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The work reported herein for Dr. Janan Dietrich was made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC Postdoctoral Programme from funding received from the South African National Treasury. The content hereof is the sole responsibility of the authors and do not necessarily represent the official views of the SAMRC or the funders.

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Authors and Affiliations

  1. Division of Global Health Equity, Brigham and Women’s Hospital, Thorn Building 14th Floor, Boston, MA, 02120, USA

    Maria F. Nardell

  2. Harvard Medical School, Boston, USA

    Maria F. Nardell & Ingrid T. Katz

  3. Department of Medicine, Brigham and Women’s Hospital, Boston, USA

    Maria F. Nardell & Ingrid T. Katz

  4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA

    Bethany Hedt-Gauthier

  5. Massachusetts General Hospital Center for Global Health, Boston, USA

    Bethany Hedt-Gauthier & Ingrid T. Katz

  6. Department of Human Development and Family Sciences, University of Delaware, Newark, USA

    Valerie A. Earnshaw

  7. RAND Corporation, Santa Monica, USA

    Laura M. Bogart

  8. Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa

    Janan J. Dietrich, Gugulethu Tshabalala & Glenda Gray

  9. Health Systems Research Unit, South African Medical Research Council, Western Cape, South Africa

    Janan J. Dietrich

  10. Desmond Tutu Health Foundation, University of Cape Town Medical School, Cape Town, South Africa

    Ingrid Courtney & Catherine Orrell

  11. Department of Global Health, Boston University School of Public Health, Boston, USA

    Jacob Bor

  12. Office of the President, South African Medical Research Council, Western Cape, South Africa

    Glenda Gray

  13. Oregon Health & Science University-Portland State University School of Public Health, Portland, USA

    David R. Bangsberg

  14. Harvard Global Health Institute, Cambridge, USA

    Ingrid T. Katz

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  1. Maria F. Nardell
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Contributions

MFN designed and led the analyses in this manuscript with guidance and oversight from BHG, VAE, and ITKIT. Katz designed and led the study with guidance and oversight from CO, GG, LMB, and DRB. GT and IC led the acquisition of the data. JJD, LMB, and VAE contributed to measure selection. MFN wrote the first draft of the manuscript. All authors assisted with writing and revising the manuscript and provided final approval of the version to be published. All agreed to be accountable for all aspects of the work.

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Correspondence to Maria F. Nardell.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The Human Subjects Committees at Partners Healthcare, the University of Witwatersrand Ethics Committee, the Gauteng Department of Health, and the University of Cape Town Human Research Ethics Committee approved the study. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Meetings: These data were presented as an oral presentation at the virtual IAPAC Adherence Conference November 2-3, 2020.

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Nardell, M.F., Hedt-Gauthier, B., Earnshaw, V.A. et al. Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines. AIDS Behav 26, 1366–1376 (2022). https://doi.org/10.1007/s10461-021-03493-5

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