The Association Between HIV Testing Modality and Antiretroviral Therapy Initiation Among Men Who Have Sex with Men in Selected Provinces of South Africa

Highlights: Public health relevance—How does this work relate to a public health issue? HIV/AIDS remains a major public health issue in South Africa, with key populations such as men who have sex with men experiencing challenges including delayed HIV diagnosis due to structural barriers and stigma. This study is focused on important points of the HIV cascade, including HIV testing, which is the first step that leads to the other steps in the cascade and is eventually responsible for us knowing the health outcomes and transmission rates. Public health significance—Why is this work of significance to public health? The study identifies HIV testing modalities associated with successful antiretroviral therapy initiation in a key population group. The findings of this study may guide efforts to increase early antiretroviral therapy uptake and contribute to reaching the 95-95-95 UNAIDS goals. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? There may be a need for a scale-up of differentiated HIV testing modalities (community based, peer-led, etc.), and these may be incorporated into national HIV testing strategies upon the identification of HIV testing modalities associated with ART initiation across various populations. Despite South Africa being the epicentre of HIV, some progress was made in the fight against HIV, i.e., the implementation of HIV programmes, provision of antiretroviral therapy (ART), etc. However, little is known about the association between HIV testing modalities and ART initiation. This study aimed to determine the association between HIV testing modalities and ART initiation among men who have sex with men (MSM) in selected provinces of South Africa. Following a retrospective cohort design, this study analysed programme data on 3345 MSM aged 16 years and older who were living with HIV and eligible for ART initiation. Logistic regression assessed the association between HIV testing modalities and ART initiation, controlling for age group, location, and the COVID-19 period. All analyses were done using SPSS version 30. Significance was set at p < 0.05. Participants who tested for HIV using the social network strategy (SNS) (98.6%) or index testing (96.3%) showed the highest proportions of ART initiation. Logistic regression showed that MSM who tested for HIV using the SNS had over 12 times higher odds of initiating ART (aOR = 12.166; 95% CI: 7.617–19.430; p < 0.001), compared to those who used a rapid test. A significant association was observed between HIV testing modalities and ART initiation, with SNS and index testing demonstrating higher odds of ART initiation.