Background: The South African National Strategic Plan (2012-2016) recommeded that screening for HIV must take place in multiple settings including communities, workplace, schools and tertiary institutions. The Society for Family Health franchise network New Start, provides mobile and homebased HIV testing services (HTS) to these populations and facilitates their referral and linkage into care, treatment and medical male circumcision (MMC). Clients that require referral services are provided with a referral letter. 48 hours post-referral the coordinator makes follow-up calls to clients, which includes confirming with the clinic to verify effective linkage.
Methods: We analyzed 163 445 New Start HTS client referral records from October 2014 to September 2015 from four districts. Statistical analysis for quantitative data was conducted using SPSS version 23 and thematic content analysis was used for open ended qualitative data retrived from the same client records.
Results: Overall, 3% (5104/163 445) of all HTS clients were diagnosed HIV positive with 63% (3221) of these being female. Of the positives, 36% (1856) accepted referrals for antiretroviral therapy (ART)/care services, and 80%(1495) of the acceptors completed referrals. Of the HIV positive female clients, 34% accepted referrals as compared to 41% of their male counterparts. 59% of the HIV positive females completed ART referrals compared to 64% of males ( p=0.001).
Of the 4,975 men referred for MMC, 100% accepted referrals and of these 60% completed MMC referrals. Referral completion for MMC was higher among HTS clients reached with mobile services than among clients reached through homebased and static services; 64%, 54%, and 50% respectively (p= 0.035). The main reasons given for not completing referrals were: other competing priorities, being at work, being in school and structural barriers such as lack of transport and psycho-social barriers.
Conclusions: Overall these findings show that acceptance of referral to ART among HIV positive HTS clients is low, though referral completion rates are high. Findings also show that referral completion for MMC was low, while referral acceptance was universal Programs should strengthen referrals for MMC services inter alia address identified barriers to referral acceptance and completion.

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