Mobile HIV testing in South Africa: maximizing yield through data-guided site selection

Area of Science:

• Public Health
• Epidemiology
• Social Determinants of Health

Background:

• Mobile community HIV testing effectively reaches undiagnosed individuals in southern Africa.
• Variable HIV test positivity yields present a challenge, with high and low yield sites often located nearby.
• Identifying predictable site-level characteristics for HIV positivity yield is crucial for optimizing mobile testing programs.

Purpose of the Study:

• To determine if easily identifiable site-level characteristics are associated with HIV positivity yield in a routine mobile HIV testing program.
• To explore the relationship between community and shopping site characteristics and HIV testing outcomes.

Main Methods:

• Utilized routine HIV testing program data from 122 residential and 26 shopping sites.
• Characterized sites based on local environment and availability of services through key informant interviews.
• Analyzed associations between site characteristics and HIV-positive test yields.

Main Results:

• Median HIV-positive test yields were 7.6% for community sites and 6.9% for shopping sites.
• Observed a wide range of yields (2-55%) at community sites, with high and low yields in close proximity.
• Factors linked to lower income and marginalization, such as informal housing and lack of chain stores, correlated with higher HIV-positive yields.

Conclusions:

• Site characterization, especially identifying factors of marginalization, service scarcity, and poverty, can improve the identification of high-yield HIV testing locations.
• Understanding socio-economic and environmental factors at testing sites can enhance the efficiency of mobile HIV testing strategies.
• This approach can help target resources more effectively to reach populations most in need of HIV testing and services.