Gateway Testing: Can HIV Testing Rates Be Increased Through a Tuberculosis Awareness Campaign?

Getting individuals in the door for HIV testing has long been a challenge due to the stigma surrounding the disease. Routine testing during prenatal checkups has greatly increased HIV test rates among women. However, knowledge of serostatus among men and non-pregnant women remains low, even in areas with high HIV prevalence. This study proposes a novel approach to encouraging HIV testing: promoting testing for tuberculosis. Tuberculosis (TB) is less stigmatized than HIV, and can be cured with antibiotics. Willingness to visit a clinic for TB testing is thus expected to be higher than willingness to come for HIV testing. Once admitted, patients can be encouraged to also be tested for HIV, tackling testing for two infectious diseases simultaneously which may also be more cost effective. In South Africa, approximately 73% of newly infected TB patients are co-infected with HIV and TB is the leading cause of death among HIV positive individuals. The proposed study, to be conducted in Durban, South Africa, tests the hypothesis that promoting TB testing could potentially lead to higher HIV test rates than promoting HIV testing directly.