Scaling-up HIV testing in South African youth-serving clinics

Youth in South Africa are vulnerable to HIV/AIDS with 10.4% of 15-24 yo HIV+. There are large gender disparities (17% females vs 4% males). HIV testing was performed in two municipal clinics in the Cape Town township of Khayelitsha established to serve youth by lay counselors. The clinic provided HIV testing to a maximum of 300 youth per month. The clinics offered HIV primary care and referrals for ARVs.

A new paradigm for HIV testing involved supplementing counselor VCT with nurse delivered testing during clinical care. Implementation planning involved: obtaining buy in from municipal leadership, nurses and counselors, creating plans to optimize patient flow and task shifting of existing staff. A streamlined approach to counseling – ACTS (Advise, Consent, Test, Support) was adapted to meet South African laws and customs. The program was piloted by integrating nurse-performed HIV testing into STI visits.

After implementation of ACTS, HIV testing increased 45% including a 30% increase in testing of STI clients. Additionally, the diagnosis of HIV+ clients increased 69%. Review of 214 HIV+ clients demonstrated ACTS/STI clients were more likely to have a documented CD4 count than VCT clients, (86% vs. 63%) but both groups had poor f/u visit rates ACTS (38%) and VCT (29%).

HIV+ youth who learn their status can access treatment that improves health, prolongs life and prevents transmission. A task-shifting program streamlined routine testing using nurses and then counselors to support HIV+ clients. A citywide scale-up is now underway in Cape Town utilizing the ACTS approach to HIV testing.