{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:56:44Z","timestamp":1753869404107,"version":"3.41.2"},"reference-count":43,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T00:00:00Z","timestamp":1545264000000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2018,12]]},"abstract":"Abstract<\/jats:title>Introduction<\/jats:title>Although HIV<\/jats:styled-content> testing services (HTS<\/jats:styled-content>) have been successfully task\u2010shifted to lay counsellors, no model has tested the franchising of HTS<\/jats:styled-content> to lay counsellors as independent small\u2010scale business owners. This paper evaluates the effectiveness of a social franchisee (SF<\/jats:styled-content>) HTS<\/jats:styled-content>\u2010managed pilot project compared to the Foundation for Professional Development (FPD<\/jats:styled-content>) employee\u2010managed HTS<\/jats:styled-content> programme in testing and linking clients to care.<\/jats:p><\/jats:sec>Methods<\/jats:title>Unemployed, formally employed or own business individuals were engaged as franchisees, trained and supported to deliver HTS<\/jats:styled-content> services under a common brand in high HIV<\/jats:styled-content>\u2010prevalent communities in Tshwane district between 2016 and 2017. SF<\/jats:styled-content>s were remunerated per\u2010HIV<\/jats:styled-content> test and received larger payments per\u2010HIV<\/jats:styled-content>\u2010positive client linked to care. In the standard HTS<\/jats:styled-content>, FPD<\/jats:styled-content> employed counsellors received similar training and observed similar standards as in the SF HTS<\/jats:styled-content>, but were remunerated through the normal payroll. We assessed the proportion of clients tested, HIV<\/jats:styled-content> positivity, linkage to care and per\u2010counsellor cost of HIV<\/jats:styled-content> test and linkage to care in the two HTS<\/jats:styled-content> groups.<\/jats:p><\/jats:sec>Results<\/jats:title>The SF HTS<\/jats:styled-content> had 19 HIV<\/jats:styled-content> counsellors while FPD HTS<\/jats:styled-content> employed 20. A combined total of 84,556 clients were tested by SF<\/jats:styled-content>s (50.5%: 95% confidence interval (CI<\/jats:styled-content>) 50.2 to 50.8)) and FPD<\/jats:styled-content> (49.5%: 49.2 to 49.8). SF<\/jats:styled-content>s tested more females than FPD<\/jats:styled-content> (54.1%: 53.6 to 54.6 vs. 48%: 47.7 to 48.7). SF<\/jats:styled-content>s identified more first\u2010time testers than FPD<\/jats:styled-content> (21.5%: 21.1 to 21.9 vs. 8.9%: 8.6 to 9.1). Overall, 8%: 7.9 to 8.2 tested positive with more clients testing positive in the SF<\/jats:styled-content> (10.2%: 9.9 to 10.5) than FPD<\/jats:styled-content> (5.9%: 5.6 to 6.1) group. The SF<\/jats:styled-content>s identified more female HIV<\/jats:styled-content>\u2010positive clients (11.1%: 10.7 to 11.6) than FPD<\/jats:styled-content> (6.5%: 6.2 to 6.9). The SF<\/jats:styled-content>s linked fewer clients to HIV<\/jats:styled-content> care and treatment (60.0%: 58.5 to 61.5) than FPD<\/jats:styled-content> (80.3%: 78.7 to 81.9%). It cost four times less to conduct an HIV<\/jats:styled-content> test using SF<\/jats:styled-content>s ($3.90 per SF HIV<\/jats:styled-content> test) than FPD<\/jats:styled-content> ($13.98) and five times less to link a client to care with SF<\/jats:styled-content>s ($62.74) than FPD<\/jats:styled-content> ($303.13).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>SF HTS<\/jats:styled-content> was effective in identifying more clients, first\u2010time HIV<\/jats:styled-content> testers and more HIV<\/jats:styled-content>\u2010positive people, but less effective in linking clients to care than FPD HTS<\/jats:styled-content>. The SF HTS<\/jats:styled-content> model was cheaper than the FPD<\/jats:styled-content>\u2010employee model. We recommend strengthening SFs particularly their linkage to care activities.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25216","type":"journal-article","created":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T09:45:41Z","timestamp":1545299141000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Social franchising of community\u2010based HIV testing and linkage to HIV care and treatment services: an evaluation of a pilot study in Tshwane, South Africa"],"prefix":"10.1002","volume":"21","author":[{"given":"Simukai","family":"Shamu","sequence":"first","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"},{"name":"School of Public Health University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thato","family":"Farirai","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Locadiah","family":"Kuwanda","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Slabbert","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey","family":"Guloba","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"Johnson","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sikhulile","family":"Khupakonke","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nomea","family":"Masihleho","sequence":"additional","affiliation":[{"name":"USAID Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julius","family":"Kamera","sequence":"additional","affiliation":[{"name":"USAID Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nkhensani","family":"Nkhwashu","sequence":"additional","affiliation":[{"name":"Foundation for Professional Development Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,12,20]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"DorringtonRE JohnsonLF MoollaH.Modelling the impact of HIV in South Africa's provinces.2016[cited 2018 Jan 30]. 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