Objectives To identify, diagnose and counsel patients with acute HIV infection (AHI) during routine HIV testing in South Africa.

Methods Patients with sexually transmitted infection and clients undergoing voluntary counselling and testing who were negative on rapid HIV antibody tests at a public youth clinic were recruited to the study and tested using HIV-1 PCR and third-generation ELISA. Results were made available at 1 week. Text message reminders and phone calls were employed to encourage patients to return for results. Patients with AHI were additionally visited at home.

Results 902 participants were enrolled over the course of 1 year, reporting high levels of sexual risk behaviour, including 66.7% who did not use a condom at last sex. Six (0.67%) were diagnosed with AHI. Results and counselling were delivered to 62.3% of participants and all six patients with AHI.

Conclusions It is possible to perform routine diagnosis and counselling for acute HIV infection in a limited-resource setting. Provider outreach to patients may help in delivering results to a high proportion of patients, but will probably add to the already substantial cost of testing.