Comparison of community testing outcomes over south african covid-19 lockdown levels

ABSTRACT

Background: BroadReach Healthcare is a PEPFAR district support partner in four districts in two South African Provinces Mpumalanga (MP) and Kwa-Zulu Natal (KZN). CareWorks and Hospice Palliative Care Association of South Africa (HPCA) are organizations implementing community-based HIV testing services (HTS) under BroadReach Healthcare. During the COVID-19 level-5 lockdown time period, community-based HTS was halted and confined to areas immediately outside of healthcare facilities, and in MP, community-based Lay Counsellors provided HTS in facilities. The aim of this evaluation is to compare HTS rates observed during three 5-week time intervals in 2020 pre-level-5 lockdown (19 February-25 March), during level-5 lockdown (26 March-30 April), and after level-5-lockdown (01 May-06 June). Methods: We conducted an operational evaluation of community and facility data from CareWorks and HPCA HTS completed, HTS with positive results (HTS-TST-POS), and testing yield. Chi-square tests were used to determine statistical significance. Results: Testing decreased in all districts, averaging a 43.1% drop (4,809/11,166) from pre-level-5 lockdown to level-5 lockdown, then rebounded to 91.4% of baseline (10,208/11,166) afterwards (p<0.05). Over the same timescale, HTS-TST-POS decreased by only 6.3% (419 from 447) before reverting to 97.1% (407/447) of its pre-level-5 lockdown performance (p<0.05). This was inconsistent across provinces case finding increased in MP by 64.6% (321 from 195), despite decreased testing, and decreased in KZN by 61.1% (98 from 252). Testing yield was highest during level-5 lockdown in both provinces;averaging 8.7% (419/4,809) compared to 4.0% before (447/11,166) and 4.0% after (407/10,208) level-5 lockdown (p<0.05). MP's testing yield increases far exceeded observed increases in KZN between pre-level-5 lockdown and level-5 lockdown time intervals 9.2% from 3.0% in MP and 7.4% from 5.4% in KZN (p<0.05). Conclusion: The allocation of community-based Lay Counsellors inside and outside of healthcare facilities during the South African COVID-19 level-5 lockdown assisted with finding people who are HIV-positive, and who are presumably at higher risk of developing severe COVID-19 disease.