Circumcision Programmes as a Platform for HIV Testing

Background: Early detection of HIV status is an important step in ensuring that HIV-infected individuals receive appropriate care and treatment. HIV testing and counselling (HCT) sites at clinics, the workplace, and campaigns are often the primary channel for HIV testing. Circumcision clinics also provide testing and counselling services to large numbers of men of all ages requesting voluntary medical male circumcision (VMMC). The objective of this study was to report HIV positivity in people testing at a stand-alone HCT clinic and a VMMC clinic. Method: A retrospective data review done over two years across two clinics at the Chris Hani Baragwanath Academic Hospital in Soweto: KhulaNdoda a voluntary medical male circumcision clinic and Zazi HCT clinic. Both sites offer a walk-in, free-of-charge HIV testing and counselling service. The results of all men over the age of 10 years, who attended either of the clinics and were HIV-tested, are included in this paper. Results: A total of 17,761 (13,801 VMMC clinic and 3,960 HCT clinic) males were tested. At the VMMC clinic all the people tested were males while the HCT clinic tested 45% (3960/8736) males and 55% (4,776/8,736) females. Overall 7.8% (CI: 7.4-8.2%; 1,385/17,761) of the males tested were newly diagnosed with HIV across both sites: 4.8% (CI: 4.4-5.2%; 670/13,801) at the VMMC clinic and 18% (CI: 16.8-19.2%;715/3,960) at HCT clinic (p<0.05). Among the females that tested at the HCT clinic 29.8% (CI: 28.5-31.1%; 1423/4776) were newly diagnosed with HIV. The overall (both males and females) HIV positivity at the HCT clinic was 24.5% (CI: 23.6-25.4%; 2138/8736). Conclusion: HCT and circumcision sites detect similar numbers but different HIV positivity. Circumcision programs provide an additional platform for young males, who might not go to a HCT clinic to know their HIV status and thus access care and treatment of HIV positive.