Title : Retention of clients diagnosed through secondary HIV self-testing: A longitudinal analysis over 12 months in Johannesburg, South Africa

Background: Early retention on HIV treatment remains a challenge in South Africa, with reported 6-month retention ranging from 74% to 85%. Although HIV self-testing (HIVST) improves access to diagnosis, linkage and retention after diagnosis remain concerns. This study assessed 6- and 12-month retention among healthcare users (HCUs) diagnosed through secondary HIVST in Johannesburg, South Africa.

Methods: A retrospective analysis of routine programme data was conducted among clients diagnosed through secondary HIVST between January and October 2023 and followed for 12 months after treatment initiation. Retention was measured at 6 and 12 months. Clients were considered high risk and enrolled in case management, which included enhanced adherence counselling, appointment reminders 24 hours before visits, follow-up after kit distribution, confirmatory testing, and support from a retention counsellor/case manager to link and accompany HCUs into care.

Results: A total of 1,514 HIVST kits were distributed, and 189 HCUs had confirmed HIV diagnoses. At 6 months, 95% (180) remained in care and 90% (162) were virally suppressed at less than 50 copies. At 12 months, 90% (145) remained in care and 90% (131) were virally suppressed.

Conclusion: Despite reaching clients who had not actively sought facility-based HIV testing, the programme achieved high retention and viral suppression compared with existing literature. Findings suggest that intensive psychosocial support, proactive follow-up, and a patient-centred service environment can sustain retention and viral suppression among high-risk populations diagnosed through secondary HIVST.

Mabjala Rosemary Letsoalo is a public health specialist with over 25 years of experience across the public and private healthcare sectors. She holds a Master of Public Health and a Postgraduate Diploma in HIV Management at the Workplace from Sefako Makgatho Health Sciences University. She has presented oral and poster presentations at local and international conferences, contributing to public health discourse and practice. Mabjala is currently a PhD candidate focusing on the development of specialized chronic care models for elderly populations living with HIV and non-communicable diseases in South Africa.