HIV testing rates and outcomes in a South African community, 2001-2006: implications for expanded screening policies

J Acquir Immune Defic Syndr. 2009 Jul 1;51(3):310-6. doi: 10.1097/qai.0b013e3181a248e6.


Background: Revised World Health Organization recommendations seek to increase HIV testing. We assessed the need for expanded testing in South Africa by examining current testing and treatment trends among a high prevalence population.

Methods: We determined the numbers of adults receiving HIV testing and antiretroviral treatment (ART) during 2001-2006 using testing registers linked to patient records from 2 health care facilities believed responsible for virtually all HIV services available to the population. We evaluated annual population testing rates using census population counts; proportions of clients testing seropositive (yield); CD4 counts and World Health Organization stage at diagnosis; and ART initiation rates.

Results: HIV testing rates rose from 4% in 2001 to 20% in 2006 (P < 0.001) and were highest among pregnant females receiving provider-initiated testing. Yield for first-time testers decreased from 47% in 2001 to 28% in 2006; annual incidence of seroconversion among initially HIV-negative retesters was 1.9%. Median CD4 counts and World Health Organization stage distributions for newly diagnosed clients remained stable. HIV-infected clients receiving ART within 6 months of eligibility increased from 0% in 2001 to 68% in 2006 (P < 0.001).

Conclusions: Population testing and ART initiation rates rose dramatically during 2001-2006. Yet, yield remained high, and HIV-infected persons continued to receive late diagnoses. These findings highlight the continuing need for expanded testing and linkage to care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Serodiagnosis / statistics & numerical data
  • AIDS Serodiagnosis / trends*
  • Adolescent
  • Adult
  • CD4 Lymphocyte Count
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / epidemiology*
  • Health Policy / trends*
  • Humans
  • Male
  • Mass Screening / statistics & numerical data
  • Mass Screening / trends*
  • Middle Aged
  • South Africa / epidemiology
  • World Health Organization
  • Young Adult