Routine HIV Testing in Adolescents and Young Adults Presenting to an Outpatient Clinic in Durban, South Africa

OBJECTIVES Although youth (12-24 years) in Sub-Saharan Africa have a high HIV risk, many have poor access to HIV testing services and are unaware of their status. Our objective was to evaluate the proportion of adolescents (12-17 years) and young adults (18-24 years) who underwent HIV testing and the prevalence among those tested in an urban adult outpatient clinic with a routine HIV testing program in Durban, South Africa. DESIGN We conducted a retrospective cross-sectional analysis of adolescent and young adult outpatient records between February 2008 and December 2009. METHODS We determined the number of unique outpatient visitors, HIV tests, and positive rapid tests among those tested. RESULTS During the study period, 956 adolescents registered in the outpatient clinic, of which 527 (55%) were female. Among adolescents, 260/527 (49%, 95% CI 45-54%) females underwent HIV testing compared to 129/429 (30%, 95% CI 26-35%) males (p<0.01). The HIV prevalence among the 389 (41%, 95% CI 38-44%) adolescents who underwent testing was 16% (95% CI 13-20%) and did not vary by gender (p = 0.99). During this period, there were 2,351 young adult registrations, and of these 1,492 (63%) were female. The proportion consenting for HIV testing was similar among females 980/1,492 (66%, 95% CI 63-68%) and males 543/859 (63%, 95% CI 60-66%, p = 0.25). Among the 1,523 (65%, 95% CI 63-67%) young adults who underwent testing, the HIV prevalence was 22% (95% CI 19-24%) in females versus 14% in males (95% CI 11-17%, p<0.01). CONCLUSIONS Although the HIV prevalence is high among youth participating in an adult outpatient clinic routine HIV program, the uptake of testing is low, especially among 12-17 year old males. There is an urgent need to offer targeted, age-appropriate routine HIV testing to youth presenting to outpatient clinics in epidemic settings.