Knowledge, attitudes and practices of oral HIV pre-exposure prophylaxis (PrEP) among healthcare workers in the Ekurhuleni District, South Africa.

BACKGROUND: Prevention of new HIV infections is crucial for controlling the HIV epidemic. Despite HIV pre-exposure prophylaxis (PrEP) being one of the highly effective approaches to preventing HIV, and being freely available through primary healthcare clinics (PHCs), the uptake of HIV PrEP in South Africa (SA) is low. OBJECTIVE: To understand knowledge, attitudes and practices (KAPs) of healthcare workers responsible for generating demand for HIV PrEP services, or identifying clients eligible for HIV PrEP services in PHCs in Ekurhuleni District, South Africa. METHODS: We conducted a cross-sectional interviewer-administered survey among healthcare workers from 45 randomly selected PHCs in Ekurhuleni District. We collected information on participant characteristics and their KAPs regarding HIV PrEP service delivery. KAP scores were developed using a priori cut-off points and participants were categorised into binary levels of KAPs. We performed descriptive and multivariable logistic regression analysis in line with the study objectives. RESULTS: We enrolled 160 study participants from 1 May to 30 June 2022. About two-thirds of the participants (64.4%) were highly knowledgeable about HIV PrEP, and 58.1% self-reported practices that were considered to be good. Notably, 73.1% of participants had negative attitudes toward HIV PrEP delivery. Participants who were aged >50 years had poor HIV PrEP knowledge (adjusted odds ratio (aOR) 0.1; 95% confidence interval (CI) 0.0 - 0.4; p=0.01) compared with participants <30 years old. Participants aged 30 - 40 years had poor HIV knowledge although their association is not statistically significant. Nurses had higher HIV PrEP knowledge (aOR 11.1; 95% CI 3.8 - 32.4, p<0.001) compared with health promoters. Both nurses (aOR=0.2, 95% CI 0.1 - 0.6; p<0.001) and HIV testing service counsellors (aOR 0.3; 95% CI 0.1 - 0.9; p=0.02) had negative attitudes toward HIV PrEP, compared with health promoters. Nurses had better practices in HIV PrEP delivery compared with health promoters (aOR 2.5; 95% CI 1.0 - 5.9; p=0.04). CONCLUSION: Among the healthcare workers tasked with generating demand and identifying clients eligible for HIV PrEP services, low knowledge of HIV PrEP and negative attitudes towards HIV PrEP may be barriers to the uptake of HIV PrEP. Training healthcare workers on HIV PrEP is recommended.

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

BACKGROUND: Mobile community HIV testing can effectively reach undiagnosed people living with HIV in southern Africa. Variable yield in HIV test positivity has been a challenge with high- and low-yield sites often being closely situated. We sought to test whether easy-to-identify, site-level characteristics were associated with HIV positivity yield in a routine mobile HIV testing program. METHODS: We used routine testing program test data augmented with site-level characterization, either of the community or shopping site at which HIV testing was offered. Specifically, we described the local environment and interviewed key informants to gain additional information regarding the availability of HIV and other services in the locale. RESULTS: We included 122 residential and 26 shopping sites with median HIV-positive test yields of 7.6% and 6.9%, respectively. The range for community sites was from 2 to 55% with high and low yields at geographically proximal sites. Factors related to lower income and marginalization, including informal housing and the absence of name-brand stores in shopping venues, were associated with higher HIV-positive testing yield. CONCLUSIONS: Characterization of sites, particularly identifying factors related to marginalization, lack of services, and poverty, can aid in identifying sites with higher HIV-positive yield.

CONTEXTE: Le dépistage communautaire mobile du VIH est un moyen efficace pour atteindre les personnes vivant avec le VIH non diagnostiquées en Afrique australe. Les taux de positivité variables aux tests de dépistage du VIH constituent un défi puisque certains sites aux taux de positivité élevés sont souvent géographiquement proches de sites dont les taux de positivité sont faibles. Nous avons cherché à tester si certaines caractéristiques faciles à identifier et propres aux sites étaient associées aux taux de positivité des tests de dépistage du VIH dans un programme de dépistage du VIH mobile systématique. MÉTHODES: Nous avons utilisé les données des tests du programme de dépistage systématique et procédé à une caractérisation des sites, soit de la communauté soit de la zone commerciale où le dépistage du VIH était proposé. Plus précisément, nous avons décrit l'environnement local et interrogé des informateurs clés afin d'obtenir des informations supplémentaires sur la disponibilité de services anti-VIH et autres dans cette zone. RÉSULTATS: Nous avons inclus 122 résidents et 26 zones commerciales avec un taux médian de positivité aux tests de dépistage du VIH de 7,6% et 6,9%, respectivement. L'étendue allait de 2% à 55% pour les sites communautaires, avec des taux de positivité faibles ou élevés dans des sites géographiquement proches. Les facteurs liés à de faibles revenus et à une marginalisation (par ex., logement informel et absence de magasins de marque dans les zones commerciales) étaient associés à de plus forts taux de positivité aux tests de dépistage du VIH. CONCLUSIONS: La caractérisation des sites, notamment l'identification des facteurs liés à la marginalisation, au manque de services et à la pauvreté, peut aider à identifier les sites où les taux de positivité aux tests de dépistage du VIH sont plus élevés.