HIV testing service utilization and linkage to care under UTT in North-West South Africa

Authors

  • Dzunisani B Mhlari Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi street, Pretoria, 0208, South Africa. https://orcid.org/0009-0007-5644-1197
  • Raikane James Seretlo Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi street, Pretoria, 0208, South Africa https://orcid.org/0000-0001-6459-9065
  • Mathildah Mpata Mokgatle Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi street, Pretoria, 0208, South Africa. https://orcid.org/0000-0001-5807-8212

DOI:

https://doi.org/10.20525/ijrbs.v14i4.4029

Keywords:

universal test and treat, human immunodeficiency virus, HIV testing services, PHC Facilities, South Africa

Abstract

The human immunodeficiency virus (HIV) testing services (HTS) are as important as any other healthcare service; hence clients should be encouraged to use them. The Universal Testing and Treatment (UTT) initiative is one of the ways for improving HIV outcomes by commencing rapid antiretroviral medication (ART). An explorative-descriptive qualitative study was followed to understand the motivation for accepting and utilization of HTS through the UTT strategy. The study was conducted in three selected PHC facilities around North-West province, Bojanala district, Kgetleng sub-district. Data was analysed using thematic content with the support of NVivo 12 software. Four main themes with supporting sub-themes emerged. The study findings showed that the majority of participants were not knowledgeable about or aware of the strategy until they tested positive in their clinics. HTS are still underused as participants presented to the facilities only when seriously ill, had symptoms or were pregnant. Some participants accepted their status and treatment because they were already sick and had no choice but to take treatment. Despite the different emotions, others were able to accept their treatment and status. Some disclosed and received support from family, partners and friends, while others had not. Fear of stigmatisation when seen frequently at the clinic was also noted. This article's findings can influence policymakers involved in HIV testing and UTT methods.

Downloads

Download data is not yet available.

References

Arias-Colmenero, T., Pérez-Morente, M. Á., Ramos-Morcillo, A. J., Capilla-Díaz, C., Ruzafa-Martínez, M., & Hueso-Montoro, C. (2020). Experiences and attitudes of people with HIV/AIDS: A systematic review of qualitative studies. International Journal of Environmental Research and Public Health, 17(2), 639. https://doi.org/10.3390/ijerph17020639 DOI: https://doi.org/10.3390/ijerph17020639

Baggaley, R. F., & Hollingsworth, T. D. (2020). How universal does universal test and treat have to be? The Lancet HIV, 7(5), e306-e308. https://doi.org/10.1016/S2352-3018(20)30114-3 DOI: https://doi.org/10.1016/S2352-3018(20)30031-X

Bantie, B., Kassaw Yirga, G., Abate, M. W., Amare, A. T., Nigat, A. B., Tigabu, A., Kerebeh, G., Emiru, T. D., Tibebu, N. S., & Tiruneh, C. M. (2022). Delayed ART initiation in “Test and Treat era” and its associated factors among adults receiving antiretroviral therapy at public health institutions in Northwest Ethiopia: A multicenter cross-sectional study. PLoS One, 17(7), e0271127. https://doi.org/10.1371/journal.pone.0271127 DOI: https://doi.org/10.1371/journal.pone.0271127

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Chan, A. K., Kanike, E., Bedell, R., Mayuni, I., Manyera, R., Mlotha, W., Harries, A. D., van Oosterhout, J. J., & van Lettow, M. (2016). Same day HIV diagnosis and antiretroviral therapy initiation affects retention in Option B+ prevention of mother?to?child transmission services at antenatal care in Zomba District, Malawi. Journal of the International AIDS Society, 19(1), 20672. https://doi.org/10.7448/IAS.19.1.20672 DOI: https://doi.org/10.7448/IAS.19.1.20672

Dlamini, N., Ntuli, B., & Madiba, S. (2021). Perceptions and experiences of participating in PMTCT option B Plus: an explorative study on HIV-positive pregnant women in Eswatini. The Open Public Health Journal, 14(1). https://doi.org/10.2174/1874944502114010027 DOI: https://doi.org/10.2174/1874944502114010425

El-Sadr, W. M., & Goosby, E. (2018). Building on the HIV platform: tackling the challenge of noncommunicable diseases among persons living with HIV. AIDS, 32, S1-S3. https://doi.org/10.1097/QAD.0000000000001790 DOI: https://doi.org/10.1097/QAD.0000000000001886

Filiatreau, L. M., Edwards, J. K., Masilela, N., Gómez-Olivé, F. X., Haberland, N., Pence, B. W., Maselko, J., Muessig, K. E., Kabudula, C. W., & Dufour, M.-S. K. (2023). Understanding the effects of universal test and treat on longitudinal HIV care outcomes among South African youth: a retrospective cohort study. BMC Public Health, 23(1), 1724. https://doi.org/10.1186/s12889-023-17300-5 DOI: https://doi.org/10.1186/s12889-023-16353-9

Ford, N., Migone, C., Calmy, A., Kerschberger, B., Kanters, S., Nsanzimana, S., Mills, E. J., Meintjes, G., Vitoria, M., & Doherty, M. (2018). Benefits and risks of rapid initiation of antiretroviral therapy. AIDS, 32(1), 17-23. https://doi.org/10.1097/QAD.0000000000001783 DOI: https://doi.org/10.1097/QAD.0000000000001671

Gardner, E. M., McLees, M. P., Steiner, J. F., Del Rio, C., & Burman, W. J. (2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases, 52(6), 793-800. https://doi.org/10.1093/cid/cir1053 DOI: https://doi.org/10.1093/cid/ciq243

Garrett, N., Norman, E., Leask, K., Naicker, N., Asari, V., Majola, N., Karim, Q. A., & Karim, S. S. A. (2018). Acceptability of early antiretroviral therapy among South African women. AIDS and Behavior, 22, 1018-1024. https://doi.org/10.1007/s10461-018-2100-7 DOI: https://doi.org/10.1007/s10461-017-1729-2

Girum, T., Yasin, F., Wasie, A., Shumbej, T., Bekele, F., & Zeleke, B. (2020). The effect of “universal test and treat” program on HIV treatment outcomes and patient survival among a cohort of adults taking antiretroviral treatment (ART) in low income settings of Gurage zone, South Ethiopia. AIDS Research and Therapy, 17, 1-9. https://doi.org/10.1186/s12981-020-00261-w DOI: https://doi.org/10.1186/s12981-020-00274-3

Imani, B., Zandi, S., Khazaei, S., & Mirzaei, M. (2021). The lived experience of HIV-infected patients in the face of a positive diagnosis of the disease: A phenomenological study. AIDS Research and Therapy, 18, 1-8. https://doi.org/10.1186/s12981-021-00301-1 DOI: https://doi.org/10.1186/s12981-021-00421-4

Jones, J., Carter, B., Wilkerson, R., & Kramer, C. (2019). Attitudes toward HIV testing, awareness of HIV campaigns, and using social networking sites to deliver HIV testing messages in the age of social media: A qualitative study of young black men. Health Education Research, 34(1), 15-26. https://doi.org/10.1093/her/cyy068 DOI: https://doi.org/10.1093/her/cyy044

Katz, I. T., Dietrich, J., Tshabalala, G., Essien, T., Rough, K., Wright, A. A., Bangsberg, D. R., Gray, G. E., & Ware, N. C. (2015). Understanding treatment refusal among adults presenting for HIV-testing in Soweto, South Africa: A qualitative study. AIDS and Behavior, 19, 704-714. https://doi.org/10.1007/s10461-014-0854-0 DOI: https://doi.org/10.1007/s10461-014-0920-y

Katz, I. T., Essien, T., Marinda, E. T., Gray, G. E., Bangsberg, D. R., Martinson, N. A., & De Bruyn, G. (2011). Antiretroviral therapy refusal among newly diagnosed HIV-infected adults. AIDS, 25(17), 2177-2181. https://doi.org/10.1097/QAD.0b013e32834e4fd2 DOI: https://doi.org/10.1097/QAD.0b013e32834b6464

Knight, L., & Schatz, E. (2022). Social support for improved ART adherence and retention in care among older people living with HIV in urban South Africa: A complex balance between disclosure and stigma. International Journal of Environmental Research and Public Health, 19(18), 11473. https://doi.org/10.3390/ijerph191811473 DOI: https://doi.org/10.3390/ijerph191811473

Kobrak, P., Remien, R. H., Myers, J. E., Salcuni, P., Edelstein, Z., Tsoi, B., & Sandfort, T. (2022). Motivations and barriers to routine HIV testing among men who have sex with men in New York City. AIDS and Behavior, 26(11), 3563-3575. https://doi.org/10.1007/s10461-022-03664-4 DOI: https://doi.org/10.1007/s10461-022-03679-5

Madiba, S. (2021). When pregnancy coincides with positive diagnosis of HIV: Accounts of the process of acceptance of self and motherhood among women in South Africa. International Journal of Environmental Research and Public Health, 18(24), 13006. https://doi.org/10.3390/ijerph182413006 DOI: https://doi.org/10.3390/ijerph182413006

Mahy, M. I., Sabin, K. M., Feizzadeh, A., & Wanyeki, I. (2021). Progress towards 2020 global HIV impact and treatment targets. Journal of the International AIDS Society, 24, e25779. https://doi.org/10.1002/jia2.25779 DOI: https://doi.org/10.1002/jia2.25779

Maluleka, L. M., Hlongwane, N., & Mokgatle, M. M. (2023). Knowledge and perceptions of healthcare workers about the implementation of the universal test and treat guideline in under-resourced, high-HIV prevalence rural settings. Healthcare, 11(5), 793. https://doi.org/10.3390/healthcare11050793 DOI: https://doi.org/10.3390/healthcare11070968

Mbonye, M., Seeley, J., Nalugya, R., Kiwanuka, T., Bagiire, D., Mugyenyi, M., Namale, G., Mayanja, Y., & Kamali, A. (2016). Test and treat: The early experiences in a clinic serving women at high risk of HIV infection in Kampala. AIDS Care, 28(sup3), 33-38. https://doi.org/10.1080/09540121.2016.1184212 DOI: https://doi.org/10.1080/09540121.2016.1164804

McLean, E., Renju, J., Wamoyi, J., Bukenya, D., Ddaaki, W., Church, K., Zaba, B., & Wringe, A. (2017). ‘I wanted to safeguard the baby’: A qualitative study to understand the experiences of Option B+ for pregnant women and the potential implications for ‘test-and-treat’ in four sub-Saharan African settings. Sexually Transmitted Infections, 93(Suppl 3), e052836. https://doi.org/10.1136/sextrans-2017-052836 DOI: https://doi.org/10.1136/sextrans-2016-052972

Meyerson, K., Hoddinott, G., Nicholson, T., & Meehan, S.-A. (2021). Underlying reasons why some people haven’t tested for HIV: A discourse analysis of qualitative data from Cape Town, South Africa. Sahara-J: Journal of Social Aspects of HIV/AIDS, 18(1), 105-112. https://doi.org/10.1080/17290376.2021.1898559 DOI: https://doi.org/10.1080/17290376.2021.1977686

Mi, T., Zhou, G., Li, X., Qiao, S., Yang, X., Shen, Z., & Zhou, Y. (2023). The association between HIV disclosure to family members and quality of life among people living with HIV/AIDS: The indirect effects through social support. Current Psychology, 42(7), 5755-5764. https://doi.org/10.1007/s12144-021-01713-3 DOI: https://doi.org/10.1007/s12144-021-01927-w

Mnyaka, O. R., Mabunda, S. A., Chitha, W. W., Nomatshila, S. C., & Ntlongweni, X. (2021). Barriers to the implementation of the HIV universal test and treat strategy in selected primary care facilities in South Africa’s Eastern Cape Province. Journal of Primary Care & Community Health, 12, 21501327211028706. https://doi.org/10.1177/21501327211028706 DOI: https://doi.org/10.1177/21501327211028706

Mojola, S. A. (2014). Love, money, and HIV: Becoming a modern African woman in the age of AIDS. University of California Press. DOI: https://doi.org/10.1525/california/9780520280939.001.0001

Moshabela, M., Pronyk, P., Williams, N., Schneider, H., & Lurie, M. (2011). Patterns and implications of medical pluralism among HIV/AIDS patients in rural South Africa. AIDS and Behavior, 15, 842-852. https://doi.org/10.1007/s10461-011-9916-6 DOI: https://doi.org/10.1007/s10461-010-9747-3

Mphande, M., Campbell, P., Hoffman, R. M., Phiri, K., Nyirenda, M., Gupta, S. K., Wong, V., & Dovel, K. (2021). Barriers and facilitators to facility HIV self-testing in outpatient settings in Malawi: A qualitative study. BMC Public Health, 21, 1-9. https://doi.org/10.1186/s12889-021-10548-3 DOI: https://doi.org/10.1186/s12889-021-12213-6

Mwisongo, A., Mohlabane, N., Tutshana, B., & Peltzer, K. (2016). Barriers and facilitators associated with HIV testing uptake in South African health facilities offering HIV Counselling and Testing. Health SA Gesondheid, 21(1), 86-95. https://doi.org/10.4102/hsag.v21i1.939 DOI: https://doi.org/10.1016/j.hsag.2015.11.001

Nhassengo, P., Cataldo, F., Magaco, A., Hoffman, R. M., Nerua, L., Saide, M., Cuco, R., Hoek, R., Mbofana, F., & Couto, A. (2018). Barriers and facilitators to the uptake of Test and Treat in Mozambique: A qualitative study on patient and provider perceptions. PLOS ONE, 13(12), e0205919. https://doi.org/10.1371/journal.pone.0205919 DOI: https://doi.org/10.1371/journal.pone.0205919

Nicol, E., Jama, N. A., Mehlomakulu, V., Hlongwa, M., Pass, D., Basera, W., & Bradshaw, D. (2023). Enhancing linkage to HIV care in the “Universal Test and Treat” era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa. BMC Public Health, 23(1), 1756. https://doi.org/10.1186/s12889-023-16803-7 DOI: https://doi.org/10.1186/s12889-023-16576-w

Nicol, E., Mehlomakulu, V., Jama, N. A., Hlongwa, M., Basera, W., Pass, D., & Bradshaw, D. (2023). Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: A qualitative inquiry. BMC Health Services Research, 23(1), 293. https://doi.org/10.1186/s12913-023-09144-w DOI: https://doi.org/10.1186/s12913-023-09281-2

Ross, J., Ingabire, C., Umwiza, F., Gasana, J., Munyaneza, A., Murenzi, G., Nsanzimana, S., Remera, E., Akiyama, M. J., & Anastos, K. M. (2021). How early is too early? Challenges in ART initiation and engaging in HIV care under Treat All in Rwanda: A qualitative study. PLOS ONE, 16(5), e0251645. https://doi.org/10.1371/journal.pone.0251645 DOI: https://doi.org/10.1371/journal.pone.0251645

Sharma, S., Malone, S., Levy, M., Reast, J., Little, K., Hasen, N., & Bell, J. (2019). Understanding barriers to HIV testing and treatment: A study of young men and healthcare providers in KwaZulu-Natal and Mpumalanga. South African Health Review, 2019(1), 125-132. https://www.hst.org.za/publications/South%20African%20Health%20Review%202019.pdf

Sineke, T., Mokhele, I., Langa, J., Mngoma, B., & Onoya, D. (2022). HIV and ART related knowledge among newly diagnosed patients with HIV under the universal-test-and-treat (UTT) policy in Johannesburg, South Africa. AIDS Care, 34(5), 655-662. https://doi.org/10.1080/09540121.2021.1929286 DOI: https://doi.org/10.1080/09540121.2021.1902927

Smith, P. J., Daniels, J., Bekker, L.-G., & Medina-Marino, A. (2023). What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo City Municipality, South Africa. BMC Public Health, 23(1), 418. https://doi.org/10.1186/s12889-023-15569-4 DOI: https://doi.org/10.1186/s12889-023-15306-6

Tshivhase, S., Makuya, T., & Takalani, F. (2022). Understanding reasons for low HIV testing services uptake among tertiary students in a university in South Africa. HIV & AIDS Review. International Journal of HIV-Related Problems, 21(1), 69-76. https://doi.org/10.5114/hiv&aid.2022.118263 DOI: https://doi.org/10.5114/hivar.2022.112698

Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences, 15(3), 398-405. https://doi.org/10.1111/nhs.12048 DOI: https://doi.org/10.1111/nhs.12048

Wekesa, E. (2019). HIV testing experiences in Nairobi slums: The good, the bad and the ugly. BMC Public Health, 19(1), 1600. https://doi.org/10.1186/s12889-019-7837-3 DOI: https://doi.org/10.1186/s12889-019-7975-7

Downloads

Published

2025-07-15

How to Cite

Mhlari, D. B., Seretlo, R. J., & Mokgatle, M. (2025). HIV testing service utilization and linkage to care under UTT in North-West South Africa. International Journal of Research in Business and Social Science (2147- 4478), 14(4), 459–467. https://doi.org/10.20525/ijrbs.v14i4.4029

Issue

Vol. 14 No. 4 (2025): Special issue in June

Section

Related Topics in Social Science

License

Copyright (c) 2025 Dzunisani B Mhlari, Raikane James Seretlo, Mathildah Mpata Mokgatle

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

For all articles published in IJRBS, copyright is retained by the authors. Articles are licensed under an open access Creative Commons CC BY 4.0 license, meaning that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. These conditions allow for maximum use and exposure of the work, while ensuring that the authors receive proper credit.