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Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 9 Original Research

Patient acceptance of HIV testing services in rural

emergency departments in South Africa

Authors: Background: South Africa faces the highest burden of HIV infection globally. The National
Aditi Rao 1 Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in
Caitlin Kennedy 1
Pamela Mda 2 all healthcare facilities. However, HIV continues to overwhelm the healthcare system.
Thomas C. Quinn Emergency department (ED)-based HCT could address unmet testing needs.
3,4
5,6
David Stead
Bhakti Hansoti Objectives: This study examines the reasons for accepting or declining HCT in South African
1,3
EDs to inform the development of HCT implementation strategies.
Affiliations:
1 Department of International Method: We conducted a prospective observational study in two rural EDs, from June to
Health, Johns Hopkins September 2017. Patients presenting to the ED were systematically approached and offered a
Bloomberg School of point-of-care test in accordance with national guidelines. Patients demographics, presenting
Public Health, Baltimore,
United States of America compaint, medical history and reasons for accepting/declining testing, were recorded. A
pooled analysis is presented.
2 Nelson Mandela Academic
Clinical Research Unit, Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were
Mthatha, South Africa enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and
80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10%
3 Department of Medicine, declined testing. The primary reasons for declining testing were ‘does not want to know status’
Johns Hopkins University (37.6%), ‘in too much pain’ (34%) and ‘does not believe they are at risk’ (19.9%).
School of Medicine, Baltimore,
United States of America Conclusions: Despite national guidelines, a high proportion of individuals remain
undiagnosed, of which a majority are young men. Our study demonstrated high patient
4 Division of Intramural
Research, National Institutes acceptance of ED-based HCT. There is a need for investment and innovation regarding effective
of Allergy and Infectious pain management and confidential service delivery to address patient barriers. Findings
Diseases, National Institutes support a routine, non-targeted HCT strategy in EDs.
of Health, Bethesda,
United States of America Keywords: HIV counselling and testing; South Africa; emergency department; patient
acceptance; implementation research; linkage to care.
5 Department of Medicine,
Frere and Cecilia Makiwane
Hospitals, East London, Introduction
South Africa
South Africa (SA) faces the highest burden of HIV infection globally, with 7.7 million people
6 Department of Medicine, 1,2
Faculty of Health Sciences, living with HIV (PLWH) and prevalence ranging from 12.6% to 27% across the country. In 2018,
1
Walter Sisulu University, SA had 240 000 new HIV infections and 71 000 AIDS-related deaths. The Joint United Nations
East London, South Africa Programme on HIV/AIDS (UNAIDS) adopted the ambitious treatment target of 90-90-90,
wherein by 2020 90% of all PLWH would know their status, 90% of whom would be receiving
Corresponding author: 3
Aditi Rao, sustained antiretroviral therapy (ART), of whom 90% would have achieved viral suppression.
[email protected] Currently, in SA, an estimated 90% of PLWH know their status, of whom 68% are accessing ART,
and 87% of these have achieved viral suppression. Over the past two decades, numerous steps
1
Dates: have been taken by the government to deliver evidence-based interventions focusing on HIV
Received: 15 May 2020
Accepted: 02 June 2020 prevention, treatment, and retention. These efforts include the expansion of condom distribution,
Published: 22 July 2020 a national voluntary medical male circumcision program, prevention of mother-to-child
transmission, as well as initiatives to increase knowledge and awareness of HIV/AIDS in
communities utilising healthcare, in educational infrastructures and social media. However,
2,4
despite sustained efforts and innovative measures, critical coverage gaps remain, with an
estimated 10% of HIV-positive South Africans unaware of their status and with 15% of new
5
global infections occurring in the country. 2
Read online: The first critical step to meeting the 90-90-90 target is HIV testing. Early detection of undiagnosed
Read online:
Scan this QR HIV infection followed by effective linkage to care and treatment extends life expectancy, improves
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mobile device How to cite this article: Rao A, Kennedy C, Mda P, Quinn TC, Stead D, Hansoti B. Patient acceptance of HIV testing services in rural
emergency departments in South Africa. S Afr J HIV Med. 2020;21(1), a1105. https://doi.org/10.4102/sajhivmed.v21i1.1105
to read online.
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Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 202 Open Access