Abstract

Introduction

Evidence shows that early retention on HIV treatment is a challenge in South Africa. A systematic review estimated an average 6-month retention rate of 85%, and routinely collected data reported 74% of clients engaged 6 months after initiation. HIV self-testing (HIVST) is used to increase access to diagnosis, but linkage to treatment is a concern. This study aimed to measure the retention rate of healthcare users (HCUs) diagnosed through secondary HIVST, as this testing may be reaching a population reluctant to seek healthcare services and therefore at risk of poor retention.

Method

This was a retrospective analysis of routine program data. A cohort of clients diagnosed through secondary HIV-ST from January 2023 to October 2023 was followed for 12 months, and the retention rate was measured at 6 months and 12 months after initiation of treatment. Counselors kept records of every HIVST kit distributed and followed up with primary clients after 72 hours or through calling secondary clients directly. Clients with a positive test were recalled to confirm the HIV diagnoses, and a retention counselor/case manager was allocated to accompany and link HCUs to services. This group was identified as potentially high risk and enrolled in case management for enhanced adherence counseling and given appointment reminders 24 hours before each visit.

 Results

1514 test kits were distributed, 189 HCUs had their diagnoses of HIV confirmed (12%), and 54% (102) were males and 46% (87) were females. After six months, 95% (180) of HCUs were retained in care, 96% (98) were males, and 94% (82) retained in care were females.

 Viral suppression of the HCUs was at 96% (173) with less than 50 copies; 94 were males, and 79 were females. At 12 months, 92% (166) of the HCUs were retained in care, and 95% (157) were virally suppressed.

 Conclusion

In this program setting, despite the population not having sought out HIV testing, we found very high retention and viral suppression rates compared with existing literature. Retention in care and suppression rates can be maintained at the highest level for high-risk populations if intensive psychosocial support is provided and a conducive, effective, and efficient patient-centered environment is created.