Sex Differences in HIV Testing — 20 PEPFAR-Supported Sub-Saharan African Countries, 2019
Bakary Drammeh, Amy Medley, Helen Dale, Anindya K. De, Shane Diekman, Randy Yee, Tiffiany Aholou, Arielle Lasry, Andrew F. Auld, Brittney Baack, Wayne A. Duffus, Ebrahim Shahul, Vincent Wong, Michael Grillo, Teeb Al‐Samarrai, Shabeen Ally, Mtemwa Nyangulu, MCHD2, Rose Nyirenda, Jacobus Olivier, Thato Chidarikire, Nompumelelo Khanyile, Alick Kayange, Oscar Ernest Rwabiyago, Upendo Kategile, Jema Bisimba, Rachel Weber, Gertrude Ncube, Onesimo Maguwu, Ismelda Pietersen, Denis Mali, Edington Dzinotyiweyi, Lisa Nelson, Matovu John Bosco, Dalsone Kwarisiima, Madina Apolot, Samson Anangwe, Leonard Soo, Mary Mugambi, André H. Mbayiha, Placidie Mugwaneza, Samuel S. Malamba, Arlene Phiri, MCD28, Tina Chisenga, Mary Adetinuke Boyd, Chanie Temesgan, Mesfin Shimelis, Teklu Weldegebreal, Mirtie Getachew, Shirish Balachandra, E. Ehui, Willibord Shasha, Nicole Isabelle L. Doumatey, Didier Adjoua, Chidozie Meribe, Jerry Gwamna, Pamela Gado, Ima John-Dada, Elie Mukinda, Luc Ferdinand Kamanga Lukusa, Lucien Kalenga, Sudhir Bunga, Victoria Achyut, John Mondi, Peter Loeto, Goabaone Pankie Mogomotsi, Jenny H. Ledikwe, Puleng Ramphalla, Mphotleng Tlhomola, Justine Mirembe, Tse Nkwoh, Laura T. Eno, Leonard Bonono, Nely Honwana, Noela Chicuecue, Ana Paula Simbine, Inácio Malimane, Lenhle Dube, Munamato Mirira, Phumzile Mndzebele, Alean Frawley, Yolanda Marina Rebello Cardo, Stephanie Behel
Abstract
Despite progress toward controlling the human immunodeficiency virus (HIV) epidemic, testing gaps remain, particularly among men and young persons in sub-Saharan Africa (1). This observational study used routinely collected programmatic data from 20 African countries reported to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) from October 2018 to September 2019 to assess HIV testing coverage and case finding among adults (defined as persons aged ≥15 years). Indicators included number of HIV tests conducted, number of HIV-positive test results, and percentage positivity rate. Overall, the majority of countries reported higher HIV case finding among women than among men. However, a slightly higher percentage positivity was recorded among men (4.7%) than among women (4.1%). Provider-initiated counseling and testing (PITC) in health facilities identified approximately two thirds of all new cases, but index testing had the highest percentage positivity in all countries among both sexes. Yields from voluntary counseling and testing (VCT) and mobile testing varied by sex and by country. These findings highlight the need to identify and implement the most efficient strategies for HIV case finding in these countries to close coverage gaps. Strategies might need to be tailored for men who remain underrepresented in the majority of HIV testing programs.