INTRODUCTION:
Despite South Africa being the epicentre of HIV, some progress was made in the fight against HIV, i.e. implementation of HIV programmes, provision of antiretroviral therapy (ART) etc. However, little is known about the association between HIV testing modalities and ART initiation. This study aimed to determine the association between HIV testing modalities and ART initiation among adolescent boys and MSM in selected provinces of South Africa.

METHODS:
Following a retrospective cohort design, this study analysed programme data of 3345 adolescent boys and MSM aged 16 years and older who were living with HIV and eligible for ART initiation. Descriptive statistics were used to describe the characteristics of the study population. Logistic regression assessed the association between HIV testing modalities on ART initiation, controlling for age and location. All analyses were done using SPSS version 30. Significance was set at p < 0.05.

RESULTS:
Most of the adolescent boys and MSM were in the 25-34 age group (N=1678; 50.2%), and located in the KwaZulu-Natal eThekwini Metropolitan Municipality (N=985; 29.4%). These were followed by Gauteng‘s Ekurhuleni Metropolitan Municipality with 849 (25.4%). The most commonly used method of HIV testing was rapid testing (N=1721; 51.4%), followed by social network strategy (SNS) (N=1464; 43.8%). Participants who tested for HIV using the SNS (98.6%) or index testing (96.3%) showed the highest proportions of ART initiation. Logistic regression showed that those who tested for HIV using SNS were over 15 times more likely to initiate ART (aOR = 15.087; 95% CI: 9.596–23.718; p < 0.001).

CONCLUSIONS:
A significant association was observed between HIV testing modalities and ART initiation, with SNS and index testing demonstrating higher odds of ART initiation. Future research should assess this association across different key populations and various HIV care continuum stages to develop inclusive and context-specific HIV care delivery models.