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Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re-test during HIV-testing campaigns in rural Mozambique
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INTRODUCTION: Awareness of HIV-infection goes beyond diagnosis,
and encompasses understanding, acceptance, disclosure and
initiation of the HIV-care. We aimed to characterize the
HIV-positive population that underwent repeat HIV-testing
without disclosing their serostatus and the impact on estimates
of the first UNAIDS 90 target. METHODS: This analysis was nested
in a prospective cohort established in southern Mozambique which
conducted three HIV-testing modalities: voluntary counselling
and testing (VCT), provider-initiated counselling and testing
(PICT) and home-based testing (HBT). Participants were given the
opportunity to self-report their status to lay counsellors and
HIV-positive diagnoses were verified for previous enrolment in
care. This study included 1955 individuals diagnosed with HIV
through VCT/PICT and 11,746 participants of a HBT campaign.
Those who did not report their serostatus prior to testing, and
were found to have a previous HIV-diagnosis, were defined as
non-disclosures. Venue-stratified descriptive analyses were
performed and factors associated with non-disclosure were
estimated through log-binomial regression. RESULTS: In the first
round of 2500 adults randomized for HBT, 1725 were eligible for
testing and 18.7% self-reported their HIV-positivity. Of those
tested with a positive result, 38.9% were found to be
non-disclosures. Similar prevalence of non-disclosures was found
in clinical-testing modalities, 29.4% (95% CI 26.7 to 32.3) for
PICT strategy and 13.0% (95% CI 10.9 to 15.3) for VCT. Prior
history of missed visits (adjusted prevalence ratio (APR) 4.2,
95% CI 2.6 to 6.8), younger age (APR 2.5, 95% CI 1.4 to 4.4) and
no prior history of treatment ((APR) 1.4, 95% CI 1.0 to 2.1)
were significantly associated with non-disclosure as compared to
patients who self-reported. When considering non-disclosures as
people living with HIV (PLWHIV) aware of their HIV-status, the
proportion of PLWHIV aware increased from 78.3% (95% CI 74.2 to
81.6) to 86.8% (95% CI 83.4 to 89.6). CONCLUSION: More than
one-third of individuals testing HIV-positive did not disclose
their previous positive HIV-diagnosis to counsellors. This
proportion varied according to testing modality and age. In the
absence of an efficient and non-anonymous tracking system for
HIV-testers, repeat testing of non-disclosures leads to wasted
resources and may distort programmatic indicators. Developing
interventions that ensure appropriate psychosocial support are
needed to encourage this population to disclose their status and
optimize scarce resources.
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FUENTE SORO, Laura, et al. Monitoring progress towards the first UNAIDS target:
understanding the impact of people living with HIV who re-test
during HIV-testing campaigns in rural Mozambique. Journal of the International AIDS Society. 2018. Vol. 21, num. 4, pags. e25095. ISSN 1758-2652. [consulted: 13 of August of 2026]. Available at: https://hdl.handle.net/2445/122196