Experiences of Testing Negative or Positive for HIV in Malawi, South Africa, and Zambia: A Cross-Sectional Study

HIV testing services (HTS) increase HIV status awareness and serve as the gateway to prevention and treatment. Understanding clients' perspectives when accessing facility-based HTS is important to ensure comprehensive service provision, improve linkage to care, and ultimately contribute to better health outcomes. We surveyed a convenience sample of adults testing negative and positive at 42 health facilities in Malawi, South Africa, and Zambia from 9/2022-4/2023, using a structured questionnaire for HTS history, testing reasons, services received, and access to pre-exposure prophylaxis (PrEP) or treatment and qualitative questions for testing experiences. We enrolled 1,142 HTS clients (324 Malawi, 389 South Africa, 429 Zambia). Negative testers (approximately 2/3 of the sample) were more likely than positive testers to have tested previously (82% v 64% Malawi, 88% v 66% South Africa, 86% v 71% Zambia). Among participants who tested positive, ill health was most frequently reported as the reason for testing; negative testers most often reported testing voluntarily (for their information). Most positive testers reported initiating ART, but < 1/3 in Malawi and South Africa and 39% in Zambia said they received adherence counselling. The proportion of negative testers offered PrEP ranged from 27% of females in Malawi to 53% of females in Zambia. Participants in all three countries reported high satisfaction with HTS, but ART adherence counselling was not universally provided and prevention services were not offered to most negative testers. The large proportion of positive testers who had never been tested before and self-reported testing because of ill health remains a concern.