Linkage to HIV Care Among Adolescents and Young Adults Reporting a Positive HIV Self-Test in OR Tambo District, Eastern Cape, South Africa

Background: HIV self-testing (HIVST) can improve access to HIV testing among adolescents and young adults (AYAs); however, gaps remain in post-test linkage to care. This study examined post-HIVST outcomes and factors associated with reported linkage to HIV care among AYAs in the Eastern Cape, South Africa. Methods: A facility-based cross-sectional study was conducted among 170 AYAs aged 15–24 years who had used HIVST within the preceding five months. Socio-demographic characteristics, HIVST results, post-test care-seeking, and linkage to HIV care were assessed. Bivariate analyses and Firth penalized logistic regression were used to identify factors associated with reported linkage to HIV care among participants reporting a positive HIVST result. Results: Of 156 participants who disclosed their HIVST result, 67 (42.9%) reported a positive result. Among these, 29 (43.3%) sought confirmatory testing, 38 (56.7%) sought care within 1–4 weeks, and 53 (79.1%) reported linkage to HIV care. More than half (55.2%) reported that counselling was not offered, and 59.7% perceived linkage-to-care services as not easily accessible. In multivariable analysis, female participants had higher odds of reporting linkage to HIV care than male participants (AOR = 5.54, 95% CI: 1.49–20.67, p = 0.011). Conclusions: Among AYAs with previous HIVST use, important gaps were observed in confirmatory testing and timely care-seeking. Male AYAs may require targeted support to improve engagement with HIV care services.