1. Management of HIV positive men under testing session Dr. J. Otchere-Darko MD Bophelo Pele Male Circumcision Centre (Orange Farm)

2. Contents Introduction Process Follow-up Conclusion

3. Introduction VCT –started in 2000,now changed to HCT for NSP goal Conducted by Society for Family Health(SFH) with New Start Free service offered as per WHO guidelines HCT: Offered during group male circumcision session(age group:15 years and up) (01 May,2010) Age group for uptake:18 yr -45yr +/- 76% of men approve for testing after HCT Counselling done individually with same counsellor Results ready in +/- 10 – 15 minutes

4. Men tested negative( +/- 97%) Referred for male circumcision and risk reduction reinforced To return after 3 days Men tested positve +/- 3% after HCT and 9% after VCT-males, 18%- females CD4 >200- male circumcision may be done (90%) Extra counselling given about 6 weeks abstinence Men who refuse test (22%) proceed to male circumcision as for “negatives”

5. Men tested positive(Process) CD4 count test done immediately (onsite laboratory) +/- 79%:CD4> 200 cells/ul- wellness counselling re-emphasized -Male circumcision may proceed +/- 21%:CD4< 200 cells/ul-referral to local ARV accredited clinics with a letter (duplicated) TB and STI screening requested on form

6. Follow-up Done by referral co-ordinator Visits: weekly to different sites to collect forms/coupons Telephone calls :to re-emphasise importance of clinic visit Encouraged to bring partners for testing, but uncommon (as most have multiple partners, not stable ones -4% return ) CD4 count repeated at clinic for confirmation Time span for follow-up: 2 weeks Social support needs referred to local social worker

7. Cont’d Findings: +/- 20% local clinic attendance after 1 week : +/- 25% after 2 weeks and ARV’s commenced Most reasons for no clinic follow-up: denial, fear, “shock”, good health,or disbelief in results May return for circumcision once CD4 count or health improves 0% return rate for male circumcision among the men with CD4 count < 200

8. Key challenges Very low clinic follow-up rate Poor clinic services Discordant partners due to window period or true ones Follow-up of partners(multiple partners) CD4 counts: difference between immunological and clinical status

9. Conclusion High testing rate after HCT (+/- 76%)-very encouraging Male circumcision- used as an entry point for HAART as well as HIV testing Low positive result percentage (+/- 8%:maximum for VCT and HCT) Follow-up :can be a challenge but a very important step; but still room to learn

10. Acknowledgements  Prof. Bertran Auvert (University of Versailles)  Dr. Dirk Taljaard (CHAPS)  Dr. Dino Rech (CHAPS)  Cynthia Nhlapo (SFH)  Scott Billy (SFH)  Dr. Kim Dickson (WHO)  Julia Samuelson (WHO)

11. Thank you!!