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Nabukalu D, Ponticiello M, Bennett T, Clark S, King R, Mwanga-Amumpaire J, Sundararajan R. Factors associated with HIV testing among traditional healers and their clients in rural Uganda: Results from a cross-sectional study. Int J STD AIDS 2021; 32:1043-1051. [PMID: 33978547 PMCID: PMC8542622 DOI: 10.1177/09564624211015028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Uptake of HIV testing is suboptimal in Uganda, particularly in rural communities. Reaching UNAIDS 95-95-95 goals requires strategies to increase HIV testing among hard-to-reach populations. This cross-sectional study sought to characterize engagement with HIV testing among traditional healers and their clients in rural Uganda. We enrolled 175 traditional healers and 392 adult clients of healers in Mbarara District. The primary outcome for this study was having received an HIV test in the prior 12 months. Most clients (n = 236, 65.9%) had received an HIV test within 12 months, compared to less than half of healers (n = 75, 46.3%) who had not. In multivariate regression models, male clients of healers were half as likely to have tested in the past year, compared with female (adjusted odds ratios (AORs) = 0.43, 95% CI = 0.26-0.70). Increasing age negatively predicted testing within the past year (AOR = 0.95, 95% CI = 0.93-0.97) for clients. Among healers, more sexual partners predicted knowing ones serostatus (AOR = 1.6, 95% CI 1.03-2.48). Healers (AOR = 1.16, 95% CI 1.07-1.26) and clients (AOR = 1.28, 95% CI 1.13-1.34 for clients) with greater numbers of lifetime HIV tests were more likely to have tested in the past year. Traditional healers and their clients lag behind UNAIDS benchmarks and would benefit from programs to increase HIV testing uptake.
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Affiliation(s)
- Doreen Nabukalu
- Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Matthew Ponticiello
- Department of Emergency Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Thomas Bennett
- Department of Emergency Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Sunday Clark
- Department of Emergency Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Rachel King
- Global Health Sciences, 8785University of California San Francisco, San Francisco, CA, USA
| | - Juliet Mwanga-Amumpaire
- Department of Pediatrics and Child Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Radhika Sundararajan
- Department of Emergency Medicine, 12295Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Center for Global Health, New York, NY, USA
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De Anda S, Njoroge A, Njuguna I, Dunbar MD, Abuna F, Macharia P, Betz B, Cherutich P, Bukusi D, Farquhar C, Katz DA. Predictors of First-Time and Repeat HIV Testing Among HIV-Positive Individuals in Kenya. J Acquir Immune Defic Syndr 2020; 85:399-407. [PMID: 33136736 DOI: 10.1097/qai.0000000000002469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a doubling of HIV testing coverage in Kenya over the past decade, approximately 2 in 10 people with HIV remained unaware of their infection in 2018. HIV testing is most effective in identifying people with undiagnosed HIV through frequent and strategic testing in populations at high risk. An assessment of testing frequency and predictors of first-time and repeat testing is critical for monitoring effectiveness of testing strategies. METHODS We conducted a cross-sectional analysis of adults aged ≥18 years who tested HIV-positive at 4 HIV testing and counseling clinics in Kenya from February 2015 to February 2016. We categorized individuals based on testing history, used Wilcoxon rank-sum tests to assess differences in intervals between the most recent and current HIV test, and used log-binomial regression to determine characteristics associated with first-time and repeat testing. RESULTS Among 1136 people testing HIV-positive, 336 (30%) had never tested before and 800 (70%) had, of whom 208 (26%) had previously tested positive. Among previously negative repeat testers, the median intertest interval was 414 days in key/priority populations (interquartile range = 179-1072) vs. 538 in the general population (interquartile range = 228-1299) (P = 0.09). Compared with previously negative repeat testers, being a first-time tester was associated with being age ≥40 years [vs. 18-24; adjusted risk ratio = 1.67, 95% confidence interval (CI): 1.23 to 2.26], men (vs. women; adjusted risk ratio = 1.45, 95% CI: 1.21 to 1.71), and testing through provider-initiated testing and counseling (vs. client initiated; 1.19, 95% CI: 1.00 to 1.40). CONCLUSIONS There is a need to increase HIV testing among older individuals and men, increase testing frequency in key/priority populations, and maintain provider-initiated and facility-based testing to reach first-time testers.
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Affiliation(s)
- Sofia De Anda
- Department of Global Health, University of Washington, Seattle, WA
| | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, WA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Irene Njuguna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Matthew D Dunbar
- Center for Demography and Ecology, University of Washington, Seattle, WA
| | - Felix Abuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Bourke Betz
- Department of Global Health, University of Washington, Seattle, WA
| | | | - David Bukusi
- Voluntary Counseling and Testing (VCT) and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya; and
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Departments of Medicine University of Washington, Seattle, WA
| | - David A Katz
- Departments of Medicine University of Washington, Seattle, WA
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Li MJ, Huang JH. Healthcare Seeking Intention if Diagnosed with HIV Among Young MSM in Taiwan: A Theory-Based Comparison by Voluntary Counseling and Testing Experience. AIDS Behav 2018; 22:2480-2490. [PMID: 29808258 DOI: 10.1007/s10461-018-2169-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The number of HIV cases in Taiwan exceeded 30,000 in 2016. Per the UNAIDS 90-90-90 target, 81% of people living with HIV should receive medication. However, numerous previous studies focused on adherence rather than the initial healthcare seeking intention if diagnosed with HIV (HIV HSI). Based on the Theory of Planned Behavior (TPB), anonymous online survey data were collected from December 2016 through February 2017 from 2709 young MSM (YMSM) ages 15-39. Multivariate logistic regression found the significant factors and strengths of associations with HIV HSI varied by their HIV voluntary counseling and testing (VCT) experience. YMSM without VCT experience perceiving high support from salient others (AOR = 1.28) and high control under facilitating conditions (AOR = 2.73) had higher HIV HSI. YMSM with VCT experience perceiving high control under facilitating (AOR = 1.79) and constraining (AOR = 1.54) conditions had higher HIV HSI. Regardless of VCT experience, YMSM with positive attitudes toward positive healthcare seeking outcomes (AOR = 3.72-3.95) had highest HIV HSI, highlighting the importance of increasing positive outcome expectations in YMSM.
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Wagman JA, Gray RH, Nakyanjo N, McClendon KA, Bonnevie E, Namatovu F, Kigozi G, Kagaayi J, Wawer MJ, Nalugoda F. Process evaluation of the SHARE intervention for preventing intimate partner violence and HIV infection in Rakai, Uganda. EVALUATION AND PROGRAM PLANNING 2018; 67:129-137. [PMID: 29310019 PMCID: PMC6821387 DOI: 10.1016/j.evalprogplan.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/11/2017] [Accepted: 12/19/2017] [Indexed: 06/07/2023]
Abstract
The Safe Homes And Respect for Everyone (SHARE) intervention introduced an intimate partner violence (IPV) prevention approach into Rakai Health Sciences Program, an established HIV research and service organization in Uganda. A trial found exposure to SHARE was associated with reductions in IPV and HIV incidence. This mixed methods process evaluation was conducted between August 2007 and December 2009, with people living in SHARE intervention clusters, to assess awareness about/participation in SHARE, motivators and barriers to involvement, and perceptions of how SHARE contributed to behavior change. Surveys were conducted with 1407 Rakai Community Cohort Study participants. Qualitative interviews were conducted with 20 key informants. Most (77%) were aware of SHARE, among whom 73% participated in intervention activities. Two-thirds of those who participated in SHARE felt it influenced behavior change related to IPV. While some felt confident to take part in new IPV-focused activities of a well-established program, others were suspicious of SHARE's motivations, implying awareness raising is critical. Many activities appealed to the majority (e.g., community drama) while interest in some activities was limited to men (e.g., film shows), suggesting multiple intervention components is ideal for wide-reaching programming. The SHARE model offers a promising, acceptable approach for integrating IPV prevention into HIV and other established health programs in sub-Saharan Africa.
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Affiliation(s)
- Jennifer A Wagman
- University of California San Diego, Center on Gender Equity and Health, Department of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, US.
| | - Ronald H Gray
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 627N. Washington Street, 2nd Floor, Baltimore, MD 21205, United States.
| | - Neema Nakyanjo
- Rakai Health Sciences Program, Uganda Virus Research Institute, Nakiwogo Road, P.O. Box 49, Entebbe, Uganda.
| | - Katherine A McClendon
- University of California Los Angeles, School of Nursing, 700 Tiverton Avenue, Los Angeles, CA 90095, United States.
| | - Erika Bonnevie
- University of California San Diego, Center on Gender Equity and Health, Department of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, US.
| | - Fredinah Namatovu
- Department of Historical, Philosophical and Religious Studies, Umeå University, SE-901 87 Umeå, Sweden.
| | - Grace Kigozi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Nakiwogo Road, P.O. Box 49, Entebbe, Uganda.
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Nakiwogo Road, P.O. Box 49, Entebbe, Uganda.
| | - Maria J Wawer
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 627N. Washington Street, 2nd Floor, Baltimore, MD 21205, United States.
| | - Fred Nalugoda
- Rakai Health Sciences Program, Uganda Virus Research Institute, Nakiwogo Road, P.O. Box 49, Entebbe, Uganda.
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Matovu JKB, Bukuluki PW, Mafigiri DK, Mudondo H. HIV counseling and testing practices among clients presenting at a market HIV clinic in Kampala, Uganda: a cross-sectional study. Afr Health Sci 2017; 17:729-737. [PMID: 29085400 PMCID: PMC5656195 DOI: 10.4314/ahs.v17i3.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Uptake of HIV counseling and testing (HCT) among informal sector workers is not well documented. OBJECTIVE To assess HCT practices among clients presenting for HIV services at a market HIV clinic in Kampala, Uganda. METHODS Between August 1 and September 15, 2009, clients presenting for HIV services at a market HIV clinic were invited to participate in the study. Socio-demographic and HCT data were collected from consenting adults aged 16+ years. Descriptive statistics were performed using STATA version 14.1. RESULTS Of 224 individuals who consented to the interview, n=139 62 % were market vendors while n=85 38 % were engaged in other market-related activities. Majority of the respondents, n=165, 73.7 %, had ever tested for HIV; of these, n=148,89.7 % had ever tested for 2+ times. The main reasons for repeat testing were the need to confirm previous HIV test results, n=126, 85.1% and the belief that the previous HIV test results were false, n=35, 23.6 %. Uptake of couples' HCT was low, n=63, 38.2 %, despite the fact that n=200, 89 % had ever heard of couples' HCT. CONCLUSION These findings indicate high rates of repeat testing but low rates of couples' HCT uptake in this population.
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Affiliation(s)
- Joseph KB Matovu
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul W Bukuluki
- Department of Social Work & Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - David K Mafigiri
- Department of Social Work & Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
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Orne-Gliemann J, Zuma T, Chikovore J, Gillespie N, Grant M, Iwuji C, Larmarange J, McGrath N, Lert F, Imrie J. Community perceptions of repeat HIV-testing: experiences of the ANRS 12249 Treatment as Prevention trial in rural South Africa. AIDS Care 2017; 28 Suppl 3:14-23. [PMID: 27421048 DOI: 10.1080/09540121.2016.1164805] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the context of the ANRS 12249 Treatment as Prevention (TasP) trial, we investigated perceptions of regular and repeat HIV-testing in rural KwaZulu-Natal (South Africa), an area of very high HIV prevalence and incidence. We conducted two qualitative studies, before (2010) and during the early implementation stages of the trial (2013-2014), to appreciate the evolution in community perceptions of repeat HIV-testing over this period of rapid changes in HIV-testing and treatment approaches. Repeated focus group discussions were organized with young adults, older adults and mixed groups. Repeat and regular HIV-testing was overall well perceived before, and well received during, trial implementation. Yet community members were not able to articulate reasons why people might want to test regularly or repeatedly, apart from individual sexual risk-taking. Repeat home-based HIV-testing was considered as feasible and convenient, and described as more acceptable than clinic-based HIV-testing, mostly because of privacy and confidentiality. However, socially regulated discourses around appropriate sexual behaviour and perceptions of stigma and prejudice regarding HIV and sexual risk-taking were consistently reported. This study suggests several avenues to improve HIV-testing acceptability, including implementing diverse and personalised approaches to HIV-testing and care, and providing opportunities for antiretroviral therapy initiation and care at home.
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Affiliation(s)
- Joanna Orne-Gliemann
- a INSERM U1219 - Centre Inserm Bordeaux Population Health , Université de Bordeaux , Bordeaux , France.,b Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, ISPED , Bordeaux , France
| | - Thembelihle Zuma
- c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa
| | - Jeremiah Chikovore
- d HIV/AIDS, STIs and TB Department , Human Sciences Research Council , Pretoria , South Africa
| | - Natasha Gillespie
- e Human and Social Development Department , Human Sciences Research Council , Pretoria , South Africa
| | - Merridy Grant
- f Centre for Rural Health , University of KwaZulu-Natal , Durban , South Africa
| | - Collins Iwuji
- c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa
| | - Joseph Larmarange
- c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.,g Centre Population & Développement (Ceped UMR 196 UPD IRD) , Institut de Recherche pour le Développement , Marseille , France
| | - Nuala McGrath
- c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.,h Faculty of Medicine and Faculty of Human, Social and Mathematical Sciences , University of Southampton , Southampton , UK.,i Research Department of Infection and Population Health , University College London , London , UK
| | - France Lert
- j INSERM U1018, CESP, Epidemiology of Occupational and Social Determinants of Health , Villejuif , France
| | - John Imrie
- c Africa Centre for Population Health , University of KwaZulu-Natal , Durban , South Africa.,k Centre for Sexual Health and HIV Research, Research Department of Infection and Population, Faculty of Population Health Sciences , University College London , London , UK.,l Wits RHI, University of the Witwatersrand , Johannesburg , South Africa
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7
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Aboagye-Sarfo P, Cross J, Mueller U. Intervention time series analysis of voluntary, counselling and testing on HIV infections in West African sub-region: the case of Ghana. J Appl Stat 2017. [DOI: 10.1080/02664763.2016.1177501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Patrick Aboagye-Sarfo
- School of Science, Edith Cowan University, Joondalup, Australia
- Department of Mathematics, Faculty of Physical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - James Cross
- School of Science, Edith Cowan University, Joondalup, Australia
| | - Ute Mueller
- School of Science, Edith Cowan University, Joondalup, Australia
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8
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Buttolph J, Inwani I, Agot K, Cleland CM, Cherutich P, Kiarie JN, Osoti A, Celum CL, Baeten JM, Nduati R, Kinuthia J, Hallett TB, Alsallaq R, Kurth AE. Gender-Specific Combination HIV Prevention for Youth in High-Burden Settings: The MP3 Youth Observational Pilot Study Protocol. JMIR Res Protoc 2017; 6:e22. [PMID: 28274904 PMCID: PMC5434770 DOI: 10.2196/resprot.5833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 11/04/2016] [Accepted: 01/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background Nearly three decades into the epidemic, sub-Saharan Africa (SSA) remains the region most heavily affected by human immunodeficiency virus (HIV), with nearly 70% of the 34 million people living with HIV globally residing in the region. In SSA, female and male youth (15 to 24 years) are at a disproportionately high risk of HIV infection compared to adults. As such, there is a need to target HIV prevention strategies to youth and to tailor them to a gender-specific context. This protocol describes the process for the multi-staged approach in the design of the MP3 Youth pilot study, a gender-specific, combination, HIV prevention intervention for youth in Kenya. Objective The objective of this multi-method protocol is to outline a rigorous and replicable methodology for a gender-specific combination HIV prevention pilot study for youth in high-burden settings, illustrating the triangulated methods undertaken to ensure that age, sex, and context are integral in the design of the intervention. Methods The mixed-methods, cross-sectional, longitudinal cohort pilot study protocol was developed by first conducting a systematic review of the literature, which shaped focus group discussions around prevention package and delivery options, and that also informed age- and sex- stratified mathematical modeling. The review, qualitative data, and mathematical modeling created a triangulated evidence base of interventions to be included in the pilot study protocol. To design the pilot study protocol, we convened an expert panel to select HIV prevention interventions effective for youth in SSA, which will be offered in a mobile health setting. The goal of the pilot study implementation and evaluation is to apply lessons learned to more effective HIV prevention evidence and programming. Results The combination HIV prevention package in this protocol includes (1) offering HIV testing and counseling for all youth; (2) voluntary medical circumcision and condoms for males; (3) pre-exposure prophylaxis (PrEP), conditional cash transfer (CCT), and contraceptives for females; and (4) referrals for HIV care among those identified as HIV-positive. The combination package platform selected is mobile health teams in an integrated services delivery model. A cross-sectional analysis will be conducted to determine the uptake of the interventions. To determine long-term impact, the protocol outlines enrolling selected participants in mutually exclusive longitudinal cohorts (HIV-positive, PrEP, CCT, and HIV-negative) followed by using mobile phone text messages (short message service, SMS) and in-person surveys to prospectively assess prevention method uptake, adherence, and risk compensation behaviors. Cross-sectional and sub-cohort analyses will be conducted to determine intervention packages uptake. Conclusions The literature review, focus groups, and modeling indicate that offering age- and gender- specific combination HIV prevention interventions that include biomedical, behavioral, and structural interventions can have an impact on HIV risk reduction. Implementing this protocol will show the feasibility of delivering these services at scale. The MP3 Youth study is one of the few combination HIV prevention intervention protocols incorporating youth- and gender-specific interventions in one delivery setting. Lessons learned from the design of the protocol can be incorporated into the national guidance for combination HIV prevention for youth in Kenya and other high-burden SSA settings. Trial Registration ClinicalTrials.gov NCT01571128; http://clinicaltrials.gov/ct2/show/NCT01571128?term=MP3+youth&rank=1 (Archived by WebCite at http://www.webcitation.org/6nmioPd54)
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Affiliation(s)
- Jasmine Buttolph
- New York University, College of Nursing Global, New York, NY, United States
| | - Irene Inwani
- University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Kawango Agot
- Impact Research & Development Organization (IRDO), Kisumu, Kenya
| | - Charles M Cleland
- New York University, College of Nursing Global, New York, NY, United States
| | - Peter Cherutich
- Kenya Ministry of Health, National AIDS & STI Control Program (NASCOP), Nairobi, Kenya
| | - James N Kiarie
- University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred Osoti
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Connie L Celum
- University of Washington, School of Public Health, Seattle, WA, United States
| | - Jared M Baeten
- University of Washington, School of Public Health, Seattle, WA, United States
| | - Ruth Nduati
- University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Timothy B Hallett
- Imperial College London, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Ramzi Alsallaq
- New York University, College of Nursing Global, New York, NY, United States
| | - Ann E Kurth
- New York University, College of Nursing Global, New York, NY, and Yale School of Nursing, New Haven, CT, United States
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9
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Rosenberg NE, Hauser BM, Ryan J, Miller WC. The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review. Sex Transm Infect 2016; 92:579-586. [PMID: 27531527 DOI: 10.1136/sextrans-2016-052651] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/27/2016] [Accepted: 07/17/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Annually, millions of people in sub-Saharan Africa (SSA) receive HIV counselling and testing (HCT), a service designed to inform persons of their HIV status and, if HIV uninfected, reduce HIV acquisition risk. However, the impact of HCT on HIV acquisition has not been systematically evaluated. We conducted a systematic review to assess this relationship in SSA. METHODS We searched for articles from SSA meeting the following criteria: an HIV-uninfected population, HCT as an exposure, longitudinal design and an HIV acquisition endpoint. Three sets of comparisons were assessed and divided into strata: sites receiving HCT versus sites not receiving HCT (Strata A), persons receiving HCT versus persons not receiving HCT (Strata B) and persons receiving couple HCT (cHCT) versus persons receiving individual HCT (Strata C). RESULTS We reviewed 1635 abstracts; eight met all inclusion criteria. Strata A consisted of one cluster randomised trial with a non-significant trend towards HCT being harmful: incidence rate ratio (IRR): 1.4. Strata B consisted of five observational studies with non-significant unadjusted IRRs from 0.6 to 1.3. Strata C consisted of two studies. Both displayed trends towards cHCT being more protective than individual HCT (IRRs: 0.3-0.5). All studies had at least one design limitation. CONCLUSIONS In spite of intensive scale-up of HCT in SSA, few well-designed studies have assessed the prevention impacts of HCT. The limited body of evidence suggests that individual HCT does not have a consistent impact on HIV acquisition, and cHCT is more protective than individual HCT.
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Affiliation(s)
- Nora E Rosenberg
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA.,University of North Carolina Project, Lilongwe, Malawi
| | - Blake M Hauser
- University of North Carolina Project, Lilongwe, Malawi.,Department of Environmental Science and Engineering, University of North Carolina, Chapel Hill, USA
| | - Julia Ryan
- University of North Carolina Project, Lilongwe, Malawi.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - William C Miller
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA.,University of North Carolina Project, Lilongwe, Malawi.,Department of Epidemiology, Ohio State University, Columbus, USA
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10
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Carlos S, Nzakimuena F, Reina G, Lopez-Del Burgo C, Burgueño E, Ndarabu A, Osorio A, de Irala J. Factors that lead to changes in sexual behaviours after a negative HIV test: protocol for a prospective cohort study in Kinshasa. BMC Public Health 2016; 16:606. [PMID: 27439981 PMCID: PMC4955130 DOI: 10.1186/s12889-016-3285-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background Considering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo). Methods and design Prospective cohort study from December 2014 until March 2016. People 15–60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up. Discussion This is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.
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Affiliation(s)
- Silvia Carlos
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain. .,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. .,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain.
| | - Francis Nzakimuena
- CECFOR/Monkole Hospital, Kinshasa, Democratic Republic of Congo.,University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Gabriel Reina
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Clinic University of Navarra, Clinical Microbiology Department, Pamplona, Spain
| | - Cristina Lopez-Del Burgo
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain
| | - Eduardo Burgueño
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain.,CECFOR/Monkole Hospital, Kinshasa, Democratic Republic of Congo
| | - Adolphe Ndarabu
- CECFOR/Monkole Hospital, Kinshasa, Democratic Republic of Congo
| | - Alfonso Osorio
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain.,University of Navarra, School of Education and Psychology, Pamplona, Spain
| | - Jokin de Irala
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain
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11
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Stalter R, Chen M, Uwizeye G, Mutunge E, Ahayo A, Mugwaneza P, Shumbusho F, Wesson J. Association of sexual risk behaviour with previous HIV testing among voluntary HIV counselling and testing clients in Kigali, Rwanda. Int J STD AIDS 2015; 27:1317-1325. [PMID: 26568251 DOI: 10.1177/0956462415617590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
Abstract
With increased coverage of voluntary HIV counselling and testing (VCT) in Rwanda and a greater focus on repeat testing of key populations, it is important to understand whether the right clients are returning for repeat testing and if repeat testing is effective at reducing risk. We assessed the association between repeat testing and recent sexual risk behaviours among 1852 first time or repeat HIV testing clients in Kigali who had had sex, using data from a cross-sectional survey. Repeat testing was associated with being female, older and type of occupation. Multivariable analyses indicate that individuals who tested for HIV 1-2 times (aOR = 1.52, 95% CI: 1.08, 2.15) and 3+ times (aOR = 1.51, 95% CI: 1.06, 2.17) previously were more likely to report recent unprotected sex. Those with 3+ previous tests were more likely to have recently had multiple sexual partners (aOR = 2.19, 95% CI: 1.22, 3.92). However, a significant decrease in HIV prevalence is shown as individuals receive more HIV tests in their lifetime (p < 0.001). These findings show that individuals who report high-risk behaviours are returning for repeat tests. However, VCT may not be successful at addressing certain sexual risk behaviours. Therefore more intensive counselling or additional HIV prevention services may be needed.
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Affiliation(s)
| | | | - Glorieuse Uwizeye
- FHI 360, Kigali, Rwanda.,Human Resources for Health (HRH) Program, Ministry of Health, Kigali, Rwanda
| | - Elise Mutunge
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Anita Ahayo
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Placidie Mugwaneza
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Fabienne Shumbusho
- FHI 360, Kigali, Rwanda.,Rwanda Healthcare Federation (RHF), Kigali, Rwanda
| | - Jennifer Wesson
- FHI 360, Kigali, Rwanda.,IntraHealth International, Chapel Hill, North Carolina, USA
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12
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Nash SD, Katamba A, Mafigiri DK, Mbulaiteye SM, Sethi AK. Sex-related alcohol expectancies and high-risk sexual behaviour among drinking adults in Kampala, Uganda. Glob Public Health 2015; 11:449-62. [PMID: 26315308 DOI: 10.1080/17441692.2015.1068824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Alcohol consumption, a risk factor for HIV transmission in sub-Saharan Africa, is considered high in Uganda. A cross sectional study was conducted to determine whether sex-related expectations about the effects of alcohol explain the association between alcohol use and risky sexual behaviours in a population-based sample of adults in Kampala. Associations between alcohol use (current and higher risk drinking) and high-risk sexual behaviours (multiple regular partners and casual sex) were tested. In age-sex-adjusted models, having multiple regular partners was associated with current drinking (odds ratio [OR] = 2.76, 95% confidence intervals [CIs] = 1.15, 6.63) and higher risk drinking (OR = 3.35, 95% CI = 1.28, 8.71). Associations were similar but not statistically significant for having a causal sex partner. Sex-related alcohol outcome expectancy was associated with both alcohol use and high-risk sexual behaviour and attenuated relationships between multiple regular partners and both current drinking (OR = 1.94, 95% CI = 0.57, 6.73) and higher risk drinking (OR = 2.44, 95% CI = 0.68, 8.80). In this setting sexual behaviours related with alcohol consumption were explained, in part, by sex-related expectations about the effects of alcohol. These expectations could be an important component to target in HIV education campaigns.
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Affiliation(s)
- Scott D Nash
- a Trachoma Control Program, The Carter Center , Atlanta , GA , USA
| | - Achilles Katamba
- b Department of Medicine , Makerere University School of Medicine , Kampala , Uganda
| | - David Kaawa Mafigiri
- c Department of Social Work and Social Administration, Center for Social Science Research on AIDS , Makerere University School of Social Sciences , Kampala , Uganda
| | - Sam M Mbulaiteye
- d Division of Cancer Epidemiology and Genetics, Department of Health and Human Services , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Ajay K Sethi
- e Department of Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
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13
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Grabbe KL, Courtenay-Quirk C, Baughman AL, Djomand G, Pedersen B, Lerotholi M, Nkonyana J, Ramphalla-Phatela P, Marum E. Re-Testing and Seroconversion Among HIV Testing and Counseling Clients in Lesotho. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:350-361. [PMID: 26241384 PMCID: PMC4756586 DOI: 10.1521/aeap.2015.27.4.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
HIV testing and counseling (HTC) is an essential component of comprehensive HIV programs. Retrospective HTC program data from 2006 to 2010 were examined to determine patterns of re-testing and seroconversion in Lesotho. Among 104,662 initially negative clients, 6,777 (6.5%) were re-testers. Predictors of re-testing included being male, age ≥ 25 years, divorced/separated, having more than a high school education, being tested as a couple, testing in the year 2006, testing in the capital city, and awareness of partner's recent testing behavior. Among re-testers who seroconverted (N = 259), predictors included being female and having less than a high school education. There is a critical need for more effectively targeting HIV retesting messages to align with WHO (2010) guidelines and identify persons at highest risk for HIV, to increase timely diagnoses and link persons to appropriate HIV prevention, care, and treatment services.
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Affiliation(s)
- Kristina L Grabbe
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cari Courtenay-Quirk
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew L Baughman
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gaston Djomand
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Elizabeth Marum
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Liu YY, Tao HD, Liu J, Fan YG, Zhang C, Li P, Li LJ, Huang Q, Zhao W, Ye DQ. Prevalence and associated factors of HIV infection among men who have sex with men in Hefei, China, 2013-2014: a cross-sectional study. Int J STD AIDS 2015; 27:305-12. [PMID: 25887062 DOI: 10.1177/0956462415580886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate the prevalence and influencing factors of HIV infection among men who have sex with men (MSM) in Hefei, China. A total of 578 MSM were recruited, with a mean age of 28.13 ± 6.91; 70.7% were under 30. The awareness rate was 95.4% (560/587) in the cross-sectional study. Of all the respondents, 73 (12.44%) were seropositive for HIV and 56 (9.54%) for syphilis. Multivariate analysis showed that self-reported sexually transmitted infections (STIs) (AOR = 8.02, 95% CI: 2.58-24.98, P < 0.001), received HIV testing in the past year (AOR = 0.33, 95% CI: 0.19-0.60, P < 0.001) and syphilis (AOR = 3.40, 95% CI: 1.69- 6.85, P = 0.001) were independently associated with HIV infection. It is necessary for post-test counselling to address risk among those who engage in sexual risk behaviours. More efforts are needed to enhance HIV/STI testing and treatment services in China.
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Affiliation(s)
- Yan-Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Hai-Dong Tao
- Department of AIDS Control and Prevention, Luyang District Center for Disease Control and Prevention, Heifei, Anhui, PR China
| | - Juan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Yin-Guang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Chao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Peng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Lian-Ju Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Qing Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Wei Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
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15
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Sankoh O, Arthur S, Nyide B, Weston M. Prevention, treatment and future challenges of HIV/AIDS: A decade of INDEPTH research. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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16
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Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, Nalugoda F, Kagaayi J, Nakigozi G, Serwadda D, Brahmbhatt H. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. LANCET GLOBAL HEALTH 2014; 3:e23-33. [PMID: 25539966 DOI: 10.1016/s2214-109x(14)70344-4] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda. METHODS We used pre-existing clusters of communities randomised as part of a previous family planning trial in this cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group clusters (including two intervention groups from the original trial) received only standard of care HIV services. Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were self-reported experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with ClinicalTrials.gov, number NCT02050763. FINDINGS Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15-49 years. 5337 individuals (in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67-0·92) and sexual IPV (261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67-0·97). Incidence of emotional IPV did not differ (409 [20%] of 2039 vs 311 [18%] of 1737; 0·91, 0·79-1·04). SHARE had no effect on male-reported IPV perpetration. At follow-up 2 (after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 person-years in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46-0·97, p=0·0362). INTERPRETATION SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future work toward HIV prevention, treatment, and care, and SHARE's ecological approach could be adopted, at least partly, as a standard of care for other HIV programmes in sub-Saharan Africa. FUNDING Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President's Emergency Plan for AIDS Relief, Fogarty International Center.
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Affiliation(s)
- Jennifer A Wagman
- Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Marie Thoma
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anthony Ndyanabo
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Fred Nalugoda
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Gertrude Nakigozi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - David Serwadda
- School of Public Health, New Mulago Hospital Complex, Makerere University, Kampala, Uganda
| | - Heena Brahmbhatt
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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HIV prevalence and high-risk sexual behaviours among MSM repeat and first-time testers in China: implications for HIV prevention. J Int AIDS Soc 2014; 17:18848. [PMID: 24993457 PMCID: PMC4082255 DOI: 10.7448/ias.17.1.18848] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 04/14/2014] [Accepted: 04/23/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction Little is known about HIV testing, HIV infection and sexual behaviour among bathhouse patrons in China. This study aims to assess differences in HIV prevalence and high-risk sexual behaviours between repeat and first-time testers among men who have sex with men (MSM) attending bathhouse in Tianjin, China. Methods Between March 2011 and September 2012, a HIV voluntary counselling and testing station was established in a gay bathhouse, which provided HIV testing and conducted a survey among participants recruited through snowball sampling. Differences in demographic and high-risk sexual behaviours between repeat and first-time testers were assessed using the chi-square test. Univariate and multivariate logistic regression analyses were conducted to identify predictors for HIV infection. Results Of the 1642 respondents, 699 (42.6%) were repeat testers and 943 (57.4%) were first-time testers. Among repeat testers, a higher proportion were men aged 18 to 25, single, better educated, had a history of STIs and worked as male sex workers or “money boys” (MBs). Repeat testers were less likely to report having unprotected anal intercourse in the past six months. The overall HIV prevalence was 12.4% (203/1642). There was no difference in HIV prevalence between repeat (11.2%, 78/699) and first-time (13.3%, 125/943) testers. The HIV prevalence increased with age among first-time testers (χtrend2=9.816, p=0.002). First-time MB testers had the highest HIV prevalence of 34.5%. Conclusions MSM attending bathhouse had an alarmingly high HIV infection rate, particularly in MB. Targeted interventions are urgently needed especially focusing on older MSM and MBs.
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18
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Higgins JA, Mathur S, Eckel E, Kelley L, Kelly L, Nakyanjo N, Sekamwa R, Namatovu J, Ddaaki W, Nakubulwa R, Namakula S, Nalugoda F, Santelli JS. Importance of relationship context in HIV transmission: results from a qualitative case-control study in Rakai, Uganda. Am J Public Health 2014; 104:612-20. [PMID: 24524490 DOI: 10.2105/ajph.2013.301670] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We present results from life history interviews with 60 young adults from southern Uganda. Using a novel qualitative case-control design, we compared newly HIV-positive cases with HIV-negative controls matched on age, gender, marital status, and place of residence. Relationship context was the most salient theme differentiating cases from controls. Compared with HIV-negative respondents, recent seroconverters described relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. Results highlight the importance of dyadic approaches to HIV and possibly of couple-based interventions. Using HIV-matched pairs allowed additional understanding of the factors influencing transmission. This hybrid methodological approach holds promise for future studies of sexual health.
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Affiliation(s)
- Jenny A Higgins
- At the time of data collection and analysis, Jenny A. Higgins, Sanyukta Mathur, Elizabeth Eckel, Laura Kelly, and John S. Santelli were with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY. At the time of article preparation, Jenny A. Higgins was with the Department of Gender and Women's Studies, University of Wisconsin-Madison. Neema Nakyanjo, Richard Sekamwa, Josephine Namatovu, William Ddaaki, Rosette Nakubulwa, and Sylvia Namakula are with the Qualitative Research Section, Rakai Health Sciences Program, Kalisizo, Uganda. Fred Nalugoda is with the Kalisizo Field Station, Rakai Health Sciences Program, Kalisizo, Uganda
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Matovu JKB, Denison J, Wanyenze RK, Ssekasanvu J, Makumbi F, Ovuga E, McGrath N, Serwadda D. Trends in HIV counseling and testing uptake among married individuals in Rakai, Uganda. BMC Public Health 2013; 13:618. [PMID: 23816253 PMCID: PMC3702530 DOI: 10.1186/1471-2458-13-618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022] Open
Abstract
Background Despite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda. Methods We analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples’ HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used χ2 tests to assess linear trends in individual and couples’ HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) associated with individual and couples’ HCT uptake. Analysis was done using STATA version 11.0. Results Uptake of couples’ HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (χ2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (χ2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (χ2 for trend = 18.16; P < 0.0001). Uptake of couples’ HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95% CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95% CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95% CI: 1.26, 4.80). Conclusion Uptake of couples’ HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples’ HCT, particularly among younger couples and those with no prior HCT.
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20
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Mulogo EM, Batwala V, Nuwaha F, Aden AS, Baine OS. Cost effectiveness of facility and home based HIV voluntary counseling and testing strategies in rural Uganda. Afr Health Sci 2013; 13:423-9. [PMID: 24235945 DOI: 10.4314/ahs.v13i2.32] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) has been at health facilities. Home based VCT on the other hand, was initiated in the country to improve service coverage. OBJECTIVE To evaluate the cost effectiveness of facility- and home-based HIV VCT strategies in rural southwestern Uganda. METHODS Data on costs and effectiveness of facility- and home-based HIV VCT intervention strategies was collected in two sub-Counties in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of HIV sero-positive clients identified. Incremental Cost-Effectiveness Ratios (ICERs) were calculated from the provider perspective. RESULTS The cost per client tested were US$6.4 for facility based VCT and US$5.0 for home based VCT. The corresponding costs per positive case identified were US$86.5 and US$54.7 respectively. The incremental cost to providers per additional positive case identified by facility based VCT was US$3.5. CONCLUSION Home based VCT was the least costly strategy per client tested and was also cost effective in identifying HIV sero-positive clients in rural areas. This strategy should therefore be promoted to improve service coverage and thereby facilitate early and extensive detection of clients eligible for treatment.
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Cawley C, Wringe A, Isingo R, Mtenga B, Clark B, Marston M, Todd J, Urassa M, Zaba B. Low rates of repeat HIV testing despite increased availability of antiretroviral therapy in rural Tanzania: findings from 2003-2010. PLoS One 2013; 8:e62212. [PMID: 23626791 PMCID: PMC3633850 DOI: 10.1371/journal.pone.0062212] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/10/2013] [Indexed: 11/28/2022] Open
Abstract
Background HIV counselling and testing (HCT) services can play an important role in HIV prevention by encouraging safe sexual behaviours and linking HIV-infected clients to antiretroviral therapy (ART). However, regular repeat testing by high-risk HIV-negative individuals is important for timely initiation of ART as part of the ‘treatment as prevention’ approach. Aim To investigate HCT use during a round of HIV serological surveillance in northwest Tanzania in 2010, and to explore rates of repeat testing between 2003 and 2010. Methods HCT services were provided during the fourth, fifth and sixth rounds of serological surveillance in 2003–2004 (Sero-4), 2006–2007 (Sero-5) and 2010 (Sero-6). HCT services have also been available at a government-run health centre and at other clinics in the study area since 2005. Questionnaires administered during sero-surveys collected information on socio-demographic characteristics, sexual behaviour and reported previous use of HCT services. Results The proportion of participants using HCT increased from 9.4% at Sero-4 to 16.6% at Sero-5 and 25.5% at Sero-6. Among participants attending all three sero-survey rounds (n = 2,010), the proportions using HCT twice or more were low, with 11.1% using the HCT service offered at sero-surveys twice or more, and 25.3% having tested twice or more if reported use of HCT outside of sero-surveys was taken into account. In multivariable analyses, individuals testing HIV-positive were less likely to repeat test than individuals testing HIV-negative (aOR 0.17, 95% CI 0.006–0.52). Discussion/Conclusions Although HCT service use increased over time, it was disappointing that the proportions ever testing and ever repeat-testing were not even larger, considering the increasing availability of HCT and ART in the study area. There was some evidence that HIV-negative people with higher risk sexual behaviours were most likely to repeat test, which was encouraging in terms of the potential to pick-up those at greatest risk of HIV-infection.
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Affiliation(s)
- Caoimhe Cawley
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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22
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Soares PDS, Brandão ER. O aconselhamento e a testagem anti-HIV como estratégia preventiva: uma revisão da literatura internacional, 1999-2011. SAUDE E SOCIEDADE 2012. [DOI: 10.1590/s0104-12902012000400013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Com base em revisão bibliográfica discute-se a literatura produzida nos anos de 1999 a 2011, no campo da saúde coletiva, sobre uma importante estratégia de prevenção da transmissão do HIV: o aconselhamento e testagem anti-HIV. O artigo realiza um balanço da literatura internacional, analisando criticamente os aspectos mais assinalados pela comunidade científica, apontando divergências e convergências entre os estudos e identificando lacunas que possam estimular o desenvolvimento de novas pesquisas neste campo temático. Como resultado, evidenciou-se que os processos de decisão de realizar um teste e a experiência da testagem são discutidos na literatura com abordagens fragmentadas, sejam de ordem individual ou institucional. Para compreender diversas dimensões implicadas na adoção de uma prática preventiva como o teste HIV, é preciso contemplar indicadores sociais tais como gênero, religião, identidade sexual, raça/cor, e relacioná-los às políticas públicas e à operacionalização dos serviços de saúde. O uso expressivo do conceito de risco (aliado às categorias de grupo, comportamento, percepção) e de escalas quantitativas para aferir a percepção individual do risco como uma barreira para a realização do teste ilustra o foco excessivo sobre uma dimensão individual e parcial do problema.
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23
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Mulogo EM, Abdulaziz AS, Guerra R, Bellows B, Baine SO. Self reported risk reduction behavior associated with HIV counseling and testing: a comparative analysis of facility- and home-based models in rural Uganda. AIDS Care 2012; 25:835-42. [PMID: 23082861 DOI: 10.1080/09540121.2012.729805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Home-based human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) in Uganda is being promoted to increase coverage, in addition to main stay approach of service provision through health facilities. The aim of this study was to compare self reported risk reduction behavior among clients receiving facility and home-based HIV VCT within a rural context. Pre-post intervention client surveys were conducted in November 2007 (baseline) and March 2008 (follow up) in southwestern Uganda. The facility-based VCT intervention was provided to 500 clients and home-based VCT to 494 clients at baseline, in 2 different sub-counties. A total of 76% (759/994) of these clients were interviewed at the follow up visit. The respondents who received facility-based VCT were more likely to report abstinence (adjusted Odds Ratio [aOR]=1.47, 95% CI 1.074, 2.02), reducing multi sexual relationships (aOR=3.23, 95% CI 2.02, 5.16) and more frequent use of condoms (aOR=3.14, 95% CI 1.60, 6.18). However, they were less likely to report, discussing HIV (aOR=0.63, 95% CI 0.46, 0.85) with their sexual partner/s and having sex with only one partner (aOR=0.72, 95% CI 0.519-0.99). While facility-based VCT appears to promote abstinence and condom use home-based VCT on the other hand promotes faithfulness and disclosure. VCT services should, therefore, be provided through both models in a complementary relationship and not as surrogates within given settings.
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Affiliation(s)
- Edgar M Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
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Fonner VA, Denison J, Kennedy CE, O'Reilly K, Sweat M. Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries. Cochrane Database Syst Rev 2012; 9:CD001224. [PMID: 22972050 PMCID: PMC3931252 DOI: 10.1002/14651858.cd001224.pub4] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Voluntary counseling and testing (VCT) continues to play a critical role in HIV prevention, care and treatment. In recent years, different modalities of VCT have been implemented, including clinic-, mobile- and home-based testing and counseling. This review assesses the effects of all VCT types on HIV-related risk behaviors in low- and middle-income countries. OBJECTIVES The primary objective of this review is to systematically review the literature examining the efficacy of VCT in changing HIV-related risk behaviors in developing countries across various populations. SEARCH METHODS Five electronic databases - PubMed, Excerpta Medica Database (EMBASE), PsycINFO, Sociological Abstracts, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) - were searched using predetermined key words and phrases. Hand-searching was conducted in four key journals including AIDS, AIDS and Behavior, AIDS Education and Prevention, and AIDS Care; the tables of contents of these four journals during the included time period were individually screened for relevant articles. The reference lists of all articles included in the review were screened to identify any additional studies; this process was iterated until no additional articles were found. SELECTION CRITERIA To be included in the review, eligible studies had to meet the following inclusion criteria: 1) Take place in a low- or middle-income country as defined by the World Bank, 2) Published in a peer-reviewed journal between January 1, 1990 and July 6, 2010, 3) Involve client-initiated VCT, including pre-test counseling, HIV-testing, and post-test counseling, and 4) Use a pre/post or multi-arm design that compares individuals before and after receiving VCT or individuals who received VCT to those who did not, and 5) Report results pertaining to behavioral, psychological, biological, or social HIV-related outcomes. DATA COLLECTION AND ANALYSIS All citations were initially screened and all relevant citations were independently screened by two reviewers to assess eligibility. For all included studies data were extracted by two team members working independently using a standardized form. Differences were resolved through consensus or discussion with the study coordinator when necessary. Study rigor was assessed using an eight point quality score and through the Cochrane Collaboration's Risk of Bias Assessment Tool. Outcomes comparable across studies, including condom use and number of sex partners, were meta-analyzed using random effects models. With respect to both meta-analyses, data were included from multi-arm studies and from pre/post studies if adequate data were provided. Other outcomes, including HIV-incidence, STI incidence/prevalence, and positive and negative life events were synthesized qualitatively. For meta-analysis, all outcomes were converted to the standard metric of the odds ratio. If an outcome could not be converted to an odds ratio, the study was excluded from analysis. MAIN RESULTS An initial search yielded 2808 citations. After excluding studies failing to meet the inclusion criteria, 19 were deemed eligible for inclusion. Of these studies, two presented duplicate data and were removed. The remaining 17 studies were included in the qualitative synthesis and 8 studies were meta-analyzed. Twelve studies offered clinic-based VCT, 3 were employment-based, 1 involved mobile VCT, and 1 provided home-based VCT. In meta-analysis, the odds of reporting increased number of sexual partners were reduced when comparing participants who received VCT to those who did not, unadjusted random effects pooled OR= 0.69 (95% CI: 0.53-0.90, p=0.007). When stratified by serostatus, these results only remained significant for those who tested HIV-positive. There was an insignificant increase in the odds of condom use/protected sex among participants who received VCT compared to those who did not, unadjusted random effects pooled OR=1.39 (95% CI: 0.97-1.99, p=0.076). When stratified by HIV status, this effect became significant among HIV-positive participants, random effects pooled OR= 3.24 (95% CI: 2.29-4.58, p<0.001). AUTHORS' CONCLUSIONS These findings add to growing evidence that VCT can change HIV-related sexual risk behaviors thereby reducing HIV-related risk, and confirming its importance as an HIV prevention strategy. To maximize the effectiveness of VCT, more studies should be conducted to understand which modalities and counseling strategies produce significant reductions in risky behaviors and lead to the greatest uptake of VCT.
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Affiliation(s)
- Virginia A Fonner
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Fiorillo SP, Landman KZ, Tribble AC, Mtalo A, Itemba DK, Ostermann J, Thielman NM, Crump JA. Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania. AIDS Care 2012; 24:1264-71. [PMID: 22375699 DOI: 10.1080/09540121.2012.658751] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
While HIV counseling and testing (HCT) has been considered an HIV preventive measure in Africa, data are limited describing behavior changes following HCT. This study evaluated behavior changes and estimated HIV seroincidence rate among returning HCT clients. Repeat and one-time testing clients receiving HCT services in Moshi, Tanzania were identified. Information about sociodemographic characteristics, HIV-related behaviors and testing reasons were collected, along with HIV serostatus. Six thousand seven hundred and twenty-seven clients presented at least once for HCT; 1235 (18.4%) were HIV seropositive, median age was 29.7 years and 3712 (55.3%) were women. 1382 repeat and 4272 one-time testers were identified. Repeat testers were more likely to be male, older, married, or widowed, and testing because of unfaithful partner or new sexual partner. One-time testers were more likely to be students and testing due to illness. At second test, repeat testers were more likely to report that partners had received HIV testing, not have concurrent partners, not suspect partners have HIV, and have partners who did not have other partners. Clients who intended to change behaviors after the first test were more likely to report having changed behaviors by remaining abstinent (OR 2.58; p<0.0001) or using condoms (OR 2.00; p=0.006) at the second test. HIV seroincidence rate was 1.49 cases/100 person-years (PY). Clients presenting for repeat HCT reported some reduction of risky behavior and improved knowledge of sexual practices and HIV serostatus of their partners. Promoting behavior change through HCT should continue to be a focus of HIV prevention efforts in sub-Saharan Africa.
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Affiliation(s)
- Suzanne P Fiorillo
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, United States
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Changes in sexual risk behavior before and after HIV seroconversion in Southern African women enrolled in a HIV prevention trial. J Acquir Immune Defic Syndr 2011; 57:435-41. [PMID: 21546849 DOI: 10.1097/qai.0b013e318220379b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examine changes in sexual risk behaviors before and after HIV seroconversion in southern African women enrolled in the Methods for Improving Reproductive Health in Africa trial. METHODS HIV testing and counseling, and assessment of sexual behaviors by audio computer-assisted self-interviewing were performed approximately every 3 months. We compared the following sexual behaviors: being sexually active, coital frequency, consistent male condom use, use of any female condoms, anal sex, and >1 sex partner, at study visits before and after HIV seroconversion. RESULTS During the trial, 327 women seroconverted to HIV, contributing 718 pre-HIV and 1110 post-HIV study visits. Women were significantly more likely to report consistent condom use at visits after HIV seroconversion compared with visits before HIV infection [adjusted odds ratio, (AOR): 1.36 (95% confidence interval (CI): 1.11 to 1.67)] and were less likely to have >1 male sex partner after serconversion [AOR: 0.66 (95% CI: 0.48 to 0.91)]. Women reported less frequently being sexually active [AOR: 0.63 (95% CI: 0.39 to 1.02)], fewer episodes of sex [>4 sex acts over the past week AOR: 0.74 (95% CI: 0.60 to 0.91)], and a reduction in anal sex [AOR: 0.58 (95% CI: 0.36 to 0.95)] at visits after HIV seroconversion. The observed reductions in sexual risk behaviors persisted over time. CONCLUSIONS Women significantly decreased their sexual risk behaviors after HIV seroconversion, but these changes were relatively modest, suggesting the need for further secondary prevention. Timely notification of HIV status coupled with prevention messages can contribute to reductions in sexual risk behaviors.
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Enns EA, Brandeau ML, Igeme TK, Bendavid E. Assessing effectiveness and cost-effectiveness of concurrency reduction for HIV prevention. Int J STD AIDS 2011; 22:558-67. [PMID: 21998175 PMCID: PMC3230224 DOI: 10.1258/ijsa.2011.010322] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We estimated the effectiveness and cost-effectiveness of changes in concurrent sexual partnerships in reducing the spread of HIV in sub-Saharan Africa. Using data from Swaziland, Tanzania, Uganda and Zambia, we estimated country-specific concurrency behaviour from sexual behaviour survey data on the number of partners in the past 12 months, and we developed a network model to compare the impact of three behaviour changes on the HIV epidemic: (1) changes in concurrent partnership patterns to strict monogamy; (2) partnership reduction among those with the greatest number of partners; and (3) partnership reduction among all individuals. We estimated the number of new HIV infections over 10 years and the cost per infection averted. Given our assumptions and model structure, we find that reducing concurrency among high-risk individuals averts the most infections and increasing monogamy the least (11.7% versus 8.7% reduction in new infections, on average, for a 10% reduction in concurrent partnerships). A campaign that costs US$1 per person annually is likely cost-saving if it reduces concurrency by 9% on average, given our baseline estimates of concurrency. In sensitivity analysis, the rank ordering of behaviour change scenarios was unaffected by potential over-estimation of concurrency, though the number of infections averted decreased and the cost per HIV infection averted increased. Concurrency reduction programmes may be effective and cost-effective in reducing HIV incidence in sub-Saharan Africa if they can achieve even modest impacts at similar costs to past mass media campaigns in the region. Reduced concurrency among high-risk individuals appears to be most effective in reducing HIV incidence, but concurrency reduction in other risk groups may yield nearly as much benefit.
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Affiliation(s)
- E A Enns
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305, USA.
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Bradley H, Tsui A, Kidanu A, Gillespie D. Client characteristics and HIV risk associated with repeat HIV testing among women in Ethiopia. AIDS Behav 2011; 15:725-33. [PMID: 20644989 DOI: 10.1007/s10461-010-9765-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In Ethiopia, the number of HIV tests administered doubled from 2007 to 2008. However, very little is known about the number of clients testing repeatedly in one year, or their motivations for doing so. We examine repeat HIV testing among 2,027 Ethiopian women attending eight VCT facilities in 2008. Multivariate logistic regression was used to examine associations between repeat HIV testing and demographic, behavioral, and psychosocial characteristics, as well as HIV status. Nearly 40% of clients had tested previously for HIV. Women with high sexual risk are nearly four times more likely than those with no sexual risk to have tested previously, but HIV prevalence was lower among repeat testers (6.5%) than first-time testers (8.5%). Moderate perceived vulnerability, or feeling powerless to prevent HIV infection, is associated with a 50% increased likelihood of being a repeat tester. High perceived behavioral risk is associated with a 40% reduction in the likelihood a woman is testing for at least the second time. Costs associated with repeat testing should be balanced against identification of new HIV cases and prevention benefits.
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Mulogo EM, Abdulaziz AS, Guerra R, Baine SO. Facility and home based HIV Counseling and Testing: a comparative analysis of uptake of services by rural communities in southwestern Uganda. BMC Health Serv Res 2011; 11:54. [PMID: 21375728 PMCID: PMC3060861 DOI: 10.1186/1472-6963-11-54] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 03/04/2011] [Indexed: 11/28/2022] Open
Abstract
Background In Uganda, public human immunodeficiency virus (HIV) Voluntary Counseling and Testing (VCT) services are mainly provided through the facility based model, although the home based approach is being promoted as a strategy for improving access to VCT. However the uptake of VCT varies according to service delivery model and is influenced by a number of factors. The aim of this study therefore, was to compare predictors for uptake of facility and home based VCT in a rural context. Methods A longitudinal study with cross-sectional investigative phases was conducted at two sites (Rugando and Kabingo) in southwestern Uganda between November 2007 (baseline) and March 2008 (follow up). During the baseline visit, facility based VCT was offered at the main health centre in Rugando while home based VCT was offered at the household level in Kabingo and a mixed survey questionnaire administered to the respondents. The results presented in this paper are derived from only the baseline data. Results Nine hundred ninety four (994) respondents were interviewed, of whom 500 received facility based VCT in Rugando and 494 home based VCT in Kabingo during the baseline visit. The respondents had a mean age of 32.2 years (SD 10.9) and were mainly female (68 percent). Clients who received facility based VCT were less likely to be residents of the more rural households (adjusted Odds Ratio (aOR) = 0.14, 95% CI 0.07, 0.22). The clients who received home based VCT were less likely to report having an STI symptom (aOR = 0.63, 95% CI 0.46, 0.86), and more likely to be worried about discrimination if they contracted AIDS (aOR = 1.78, 95% CI 1.22, 2.61). Conclusion The uptake of VCT provided through either the facility or home based models is influenced by client characteristics such as proximity to service delivery points, HIV related symptoms, and fear of discrimination in rural Uganda. Interventions that seek to improve uptake of VCT should provide potential clients with both facility and home based VCT options within a given setting. The clients are then able to select a model for VCT that best fits their characteristics. This is likely to have positive implications for both service coverage and uptake by different sub-groups within particular communities.
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Affiliation(s)
- Edgar M Mulogo
- Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda.
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Who gets tested for HIV in a South African urban township? Implications for test and treat and gender-based prevention interventions. J Acquir Immune Defic Syndr 2011; 56:151-65. [PMID: 21084993 DOI: 10.1097/qai.0b013e318202c82c] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With increasing calls for linking HIV-infected individuals to treatment and care via expanded testing, we examined sociodemographic and behavioral characteristics associated with HIV testing among men and women in Soweto, South Africa. METHODS We conducted a cross-sectional household survey involving 1539 men and 1877 women as part of the community-randomized prevention trial Project ACCEPT/HPTN043 between July 2007 to October 2007. Multivariable logistic regression models, stratified by sex, assessed factors associated with HIV testing and then repeated testing. RESULTS Most women (64.8%) and 28.9% of men reported ever having been tested for HIV, among whom 57.9% reported repeated HIV testing. In multivariable analyses, youth and students had a lower odds of HIV testing. Men and women who had conversations about HIV/AIDS with increasing frequency and who had heard about antiretroviral therapy were more likely to report HIV testing, and repeated testing. Men who had ≥ 12 years of education and who were of high socioeconomic status, and women who were married, who were of low socioeconomic status, and who had children under their care had a higher odds of HIV testing. Women, older individuals, those with higher levels of education, married individuals, and those with children under their care had a higher odds of reporting repeated HIV testing. Uptake of HIV testing was not associated with condom use, having multiple sex partners, and HIV-related stigma. CONCLUSIONS Given the low uptake of HIV testing among men and youth, further targeted interventions could facilitate a test and treat strategy among urban South Africans.
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Reniers G, Helleringer S. Serosorting and the evaluation of HIV testing and counseling for HIV prevention in generalized epidemics. AIDS Behav 2011; 15:1-8. [PMID: 20683650 DOI: 10.1007/s10461-010-9774-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Obare F. Nonresponse in repeat population-based voluntary counseling and testing for HIV in rural Malawi. Demography 2010; 47:651-65. [PMID: 20879682 DOI: 10.1353/dem.0.0115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite the increasing number of population-based surveys in sub-Saharan Africa that provide testing and counselingfor HIV over the past decade, understanding the nature ofnonresponse in these surveys, especially panel HIV surveys, is still limited. This article uses longitudinal HIV data collected from rural Malawi in 2004 and 2006 to examine nonresponse in repeat population-based testing. It shows that nonresponse in repeat testing led to significant bias in the estimates of HIV prevalence and to inconsistent conclusions about the predictors of HIV status. In contrast, previous cross-sectional analyses found that nonresponse does not significantly bias the estimates of HIV prevalence. The difference in conclusions from cross-sectional and longitudinal analyses of nonresponse can be attributed to two factors. the different definitions of what constitutes nonresponse in both contexts, and the risk profiles of the missed populations. In particular, although refusal and temporary absence are the major sources ofnonresponse in the cross-sectional contexts, attrition attributable to mortality and out-migration are additional sources of nonresponse in repeat testing. Evidence shows that out-migrants have higher HIV prevalence than nonmigrants, which could account for significant bias in the estimates ofprevalence among participants in both tests observed in this study.
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Affiliation(s)
- Francis Obare
- Population Study Center, University of Pennsylvania, USA.
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Kabiru CW, Luke N, Izugbara CO, Zulu EM. The correlates of HIV testing and impacts on sexual behavior: evidence from a life history study of young people in Kisumu, Kenya. BMC Public Health 2010; 10:412. [PMID: 20624323 PMCID: PMC2912815 DOI: 10.1186/1471-2458-10-412] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/13/2010] [Indexed: 11/12/2022] Open
Abstract
Background HIV counseling and testing is considered an important component of HIV prevention and treatment. This paper examines the characteristics of young males and females at the time of first reported HIV test, including the influence of recent sexual partnerships, and investigates how HIV testing and the cumulative number of tests are associated with sexual behaviors within six months of testing. Methods The study uses data from a random sample of youth aged 18-24 years living in Kisumu, Kenya, who were interviewed using a 10-year retrospective life history calendar. Cox regression models were used to examine the correlates of the timing of first HIV test. Variance-correction models for unordered repeated events were employed to examine whether having an HIV test in the previous six months and the cumulative number of tests predict unsafe sexual practices in a given month. Results Sixty-four percent of females and 55% of males reported at least one HIV test in the last 10 years and 40% of females were pregnant the month of first test. Significant correlates of first HIV test included marital aspirations among non-pregnant females, unprotected sex in the previous six months among pregnant females, and concurrency in the previous six months among males. Having a recent HIV test was associated with a decreased likelihood of unprotected sex among ever-pregnant females, an increased likelihood of unprotected sex and "risky" sexual partnerships among never-pregnant females, and an increased likelihood of concurrency among males. Repeated HIV testing was associated with a lower likelihood of concurrency among males and involvement in "risky" sexual partnerships among males and never-pregnant females. Conclusions The high rate of pregnancy at first test suggests that promotion of HIV testing as part of prevention of mother-to-child transmission is gaining success. Further research is warranted to examine how and why behavior change is influenced by client- versus provider-initiated testing. The influence of different sexual partnership variables for males and females suggests that interventions to assess risk and promote testing should be gender- and relationship-specific. The findings also suggest that encouraging repeat or routine testing could potentially increase the uptake of safer sexual behaviors.
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Affiliation(s)
- Caroline W Kabiru
- African Population and Health Research Center, 2nd Floor Shelter Afrique Centre, PO Box 10787-00100, Nairobi, Kenya.
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Obare F, Birungi H. The limited effect of knowing they are HIV-positive on the sexual and reproductive experiences and intentions of infected adolescents in Uganda. Population Studies 2010; 64:97-104. [PMID: 20087816 DOI: 10.1080/00324720903427575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper compares the sexual and reproductive experiences and intentions of those adolescents aged 15-19 years in Uganda who are perinatally infected with HIV and know their sero-status with those of adolescents who do not know their sero-status. The analysis comprises a simple comparison of means and proportions, together with the relevant tests of significance, as well as estimation of Cox proportional hazards and random-effects logit models. The findings show that the two groups of adolescents do not differ significantly in terms of timing of sexual debut and whether they intend to have children in the future. However, adolescents who are HIV-positive and know their status are significantly more likely to use a modern method of contraception, including condoms. Nonetheless, the level of condom use among these adolescents is still limited (less than half of those sexually active) and inconsistent (less than half of those in relationships reported always using a condom).
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Helleringer S, Reniers G. Study designs fail to represent the intricate effects of HIV testing and counselling on condom use and HIV transmission in sub-Saharan Africa. Int J Epidemiol 2010; 40:255-6. [PMID: 20457655 DOI: 10.1093/ije/dyq075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Reducing sexual risk behavior among steady heterosexual serodiscordant couples in a testing and counseling program. Sex Transm Dis 2010; 36:621-8. [PMID: 19955873 DOI: 10.1097/olq.0b013e3181aac222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effect of an HIV counseling and testing program targeting steady heterosexual serodiscordant couples. METHODS We studied 564 couples who attended a sexually transmitted infections/HIV clinic in Madrid in the period 1989 to 2007 and participated in couples counseling and testing. Sociodemographic, epidemiologic, clinical, and behavioral information of both partners was obtained before testing the nonindex partner. Sexual practices reported in the first (preintervention) and second visit were compared, as well those reported in 4 additional visits. RESULTS Among the 399 couples who returned for a second visit (71%), the median number of sexual risk practices in the previous 6 months decreased (26.9-0; P <0.001) and the percentage of couples who had not engaged in sexual risk behavior increased (46.1-66.7; P <0.001). This reduction was maintained by the 143 couples who had 4 return visits. The diagnosis of HIV-infection in the index case previous to entering the program was associated with a lower frequency of sexual risk behavior. Independent predictors of postintervention risky sexual behavior included preintervention sexual risk behavior (odds ratio [OR]: 2.8, 95% confidence interval: 1.7-4.4), index case aged over 35 (OR: 2.0, 1.2-3.3), and a recent pregnancy (OR: 3.1, 1.6-6.3). The incidence of HIV seroconversion was 3.9 per 1000 couple-years (1.4-9.7). CONCLUSION The diagnosis of HIV-infection and counseling appears to provide complementary reductions in sexual risk behaviors among serodiscordant steady heterosexual couples at follow-up, but the risk of transmission was not totally eliminated.
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Van der Borght SF, Schim van der Loeff MF, Clevenbergh P, Kabarega JP, Kamo E, van Cranenburgh K, Rijckborst H, Lange JM, Rinke de Wit TF. Long-term voluntary counseling and testing (VCT) uptake dynamics in a multicountry HIV workplace program in sub-Saharan Africa. AIDS Care 2010; 22:195-205. [DOI: 10.1080/09540120903111486] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Stefaan F. Van der Borght
- a Heineken International Health Affairs , 2e Weteringsplantsoen 21, 1017 , ZD , Amsterdam , the Netherlands
| | - Maarten F. Schim van der Loeff
- b Center for Poverty-related Communicable Diseases, Academic Medical Center , University of Amsterdam , Meibergdreef 9 (T0-125), PO Box 22700, 1100 , DE , Amsterdam , the Netherlands
| | - Philippe Clevenbergh
- c PharmAccess Foundation , Meibergdreef 9 (T-220), PO Box 22700, 1100 , DE , Amsterdam , the Netherlands
- d Department of Infectious Diseases , Hôpital Lariboisière, and International Union against Tuberculosis and Lung Diseases , Paris , France
| | | | | | - Katinka van Cranenburgh
- a Heineken International Health Affairs , 2e Weteringsplantsoen 21, 1017 , ZD , Amsterdam , the Netherlands
| | - Henk Rijckborst
- a Heineken International Health Affairs , 2e Weteringsplantsoen 21, 1017 , ZD , Amsterdam , the Netherlands
| | - Joep M. Lange
- b Center for Poverty-related Communicable Diseases, Academic Medical Center , University of Amsterdam , Meibergdreef 9 (T0-125), PO Box 22700, 1100 , DE , Amsterdam , the Netherlands
- c PharmAccess Foundation , Meibergdreef 9 (T-220), PO Box 22700, 1100 , DE , Amsterdam , the Netherlands
| | - Tobias F. Rinke de Wit
- b Center for Poverty-related Communicable Diseases, Academic Medical Center , University of Amsterdam , Meibergdreef 9 (T0-125), PO Box 22700, 1100 , DE , Amsterdam , the Netherlands
- c PharmAccess Foundation , Meibergdreef 9 (T-220), PO Box 22700, 1100 , DE , Amsterdam , the Netherlands
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Obare F, Fleming P, Anglewicz P, Thornton R, Martinson F, Kapatuka A, Poulin M, Watkins S, Kohler HP. Acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi. Sex Transm Infect 2009; 85:139-44. [PMID: 18927181 PMCID: PMC2788818 DOI: 10.1136/sti.2008.030320] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the acceptance of repeat population-based voluntary counselling and testing (VCT) for HIV in rural Malawi. METHODS Behavioural and biomarker data were collected in 2004 and 2006 from approximately 3000 adult respondents. In 2004, oral swab specimens were collected and analysed using ELISA and confirmatory Western blot tests, while finger-prick rapid testing was done in 2006. We used cross-tabulations with chi(2) tests and significance tests of proportions to determine the statistical significance of differences in acceptance of VCT by year, individual characteristics and HIV risk. RESULTS First, over 90% of respondents in each round accepted the HIV test, despite variations in testing protocols. Second, the percentage of individuals who obtained their test results significantly increased from 67% in 2004, when the results were provided in randomly selected locations several weeks after the specimens were collected, to 98% in 2006 when they were made available immediately within the home. Third, whereas there were significant variations in the sociodemographic and behavioural profiles of those who were successfully contacted for a second HIV test, this was not the case for those who accepted repeat VCT. This suggests that variations in the success of repeat testing might come from contacting the individuals rather than from accepting the test or knowing the results. CONCLUSIONS Repeat HIV testing at home by trained healthcare workers from outside the local area, and with either saliva or blood, is almost universally acceptable in rural Malawi and, thus, likely to be acceptable in similar contexts.
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Affiliation(s)
- F Obare
- Population Studies Center, University of Pennsylvania, Philadelphia, USA.
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Kranzer K, McGrath N, Saul J, Crampin AC, Jahn A, Malema S, Mulawa D, Fine PEM, Zaba B, Glynn JR. Individual, household and community factors associated with HIV test refusal in rural Malawi. Trop Med Int Health 2008; 13:1341-50. [PMID: 18983282 DOI: 10.1111/j.1365-3156.2008.02148.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate individual, household and community factors associated with HIV test refusal in a counselling and testing programme offered at population level in rural Malawi. METHODS HIV counselling and testing was offered to individuals aged 18-59 at their homes. Individual variables were collected by interviews and physical examinations. Household variables were determined as part of a previous census. Multivariate models allowing for household and community clustering were used to assess associations between HIV test refusal and explanatory variables. RESULTS Of 2303 eligible adults, 2129 were found and 1443 agreed to HIV testing. Test refusal was less likely by those who were never married [adjusted odds ratio (aOR) 0.50 for men (95% CI 0.32; 0.80) and 0.44 (0.21; 0.91) for women] and by farmers [aOR 0.70 (0.52; 0.96) for men and 0.59 (0.40; 0.87) for women]. A 10% increase in cluster refusal rates increased the odds of refusal by 1.48 (1.32; 1.66) in men and 1.68 (1.32; 2.12) in women. Women counsellors increased the odds of refusal by 1.39 (1.00; 1.92) in men. Predictors of HIV test refusal in women were refusal of the husband as head of household [aOR 15.08 (9.39; 24.21)] and living close to the main road [aOR 6.07 (1.76; 20.98)]. Common reasons for refusal were fear of testing positive, previous HIV test, knowledge of HIV serostatus and the need for more time to think. CONCLUSION Successful VCT strategies need to encourage couples counselling and should involve participation of men and communities.
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