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Sambou ML, Dai J, Zhao X, Hong T, Basnet TB, Marley G, Sambou A, Fadoua EH, Naveed M. Determinants of Voluntary Counseling and Testing Service Uptake Among Adult Sub-Saharan Africans: A Systematic Review and Meta-Analysis. Public Health Rev 2022; 43:1604065. [PMID: 35992751 PMCID: PMC9381697 DOI: 10.3389/phrs.2022.1604065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
Objective: To examine the major determinants of VCT service uptake among adults in SSA. Methods: Electronic databases were searched to identify eligible English language publications. Reporting of the study selection procedure was done according to PRISMA and the selected articles were also critically appraised. Results: We found 8 significant determinants of VCT uptake among adults in SSA, such as less physical access [OR (Odds ratio): 0.77 (95% CI (Confidence interval): 0.62–0.96), p < 0.01], older age [OR: 1.36 (95% CI: 1.08–1.73), p < 0.01], higher education level [OR: 1.60 (95% CI: 1.24–2.05), p < 0.01], high knowledge of HIV and VCT awareness [OR: 1.40 (95% CI: 1.03–1.90), p < 0.01], unprotected sexual practices [OR: 1.75 (95% CI: 1.18–2.58), p < 0.01], discussion on HIV among partners and others [OR: 1.76 (95% CI: 1.10–2.81), p < 0.01], other STIs [OR: 1.40 (95% CI: 1.00–1.98), p < 0.01], and divorced/separated [OR: 1.39 (95% CI: 1.12–1.72), p < 0.01]. Conclusion: This study showed that 8 determinants were significantly associated with VCT service uptake in SSA. Thus, HIV interventions and policy initiatives should be tailored to these determinants to ensure scale-up of VCT service uptake in SSA.
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Affiliation(s)
| | - Juncheng Dai
- *Correspondence: Muhammed Lamin Sambou, ; Juncheng Dia,
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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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Nyabuti MN, Petersen ML, Bukusi EA, Kamya MR, Mwangwa F, Kabami J, Sang N, Charlebois ED, Balzer LB, Schwab JD, Camlin CS, Black D, Clark TD, Chamie G, Havlir DV, Ayieko J. Characteristics of HIV seroconverters in the setting of universal test and treat: Results from the SEARCH trial in rural Uganda and Kenya. PLoS One 2021; 16:e0243167. [PMID: 33544717 PMCID: PMC7864429 DOI: 10.1371/journal.pone.0243167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/14/2020] [Indexed: 12/05/2022] Open
Abstract
Background Additional progress towards HIV epidemic control requires understanding who remains at risk of HIV infection in the context of high uptake of universal testing and treatment (UTT). We sought to characterize seroconverters and risk factors in the SEARCH UTT trial (NCT01864603), which achieved high uptake of universal HIV testing and ART coverage in 32 communities of adults (≥15 years) in rural Uganda and Kenya. Methods In a pooled cohort of 117,114 individuals with baseline HIV negative test results, we described those who seroconverted within 3 years, calculated gender-specific HIV incidence rates, evaluated adjusted risk ratios (aRR) for seroconversion using multivariable targeted maximum likelihood estimation, and assessed potential infection sources based on self-report. Results Of 704 seroconverters, 63% were women. Young (15–24 years) men comprised a larger proportion of seroconverters in Western Uganda (18%) than Eastern Uganda (6%) or Kenya (10%). After adjustment for other risk factors, men who were mobile [≥1 month of prior year living outside community] (aRR:1.68; 95%CI:1.09,2.60) or who HIV tested at home vs. health fair (aRR:2.44; 95%CI:1.89,3.23) were more likely to seroconvert. Women who were aged ≤24 years (aRR:1.91; 95%CI:1.27,2.90), mobile (aRR:1.49; 95%CI:1.04,2.11), or reported a prior HIV test (aRR:1.34; 95%CI:1.06,1.70), or alcohol use (aRR:2.07; 95%CI:1.34,3.22) were more likely to seroconvert. Among survey responders (N = 607, 86%), suspected infection source was more likely for women than men to be ≥10 years older (28% versus 8%) or a spouse (51% vs. 31%) and less likely to be transactional sex (10% versus 16%). Conclusion In the context of universal testing and treatment, additional strategies tailored to regional variability are needed to address HIV infection risks of young women, alcohol users, mobile populations, and those engaged in transactional sex to further reduce HIV incidence rates.
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Affiliation(s)
| | - Maya L. Petersen
- Division of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | | | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda, Makerere University College of Health Sciences, Kampala, Uganda
| | - Florence Mwangwa
- Infectious Diseases Research Collaboration, Kampala, Uganda, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda, Makerere University College of Health Sciences, Kampala, Uganda
| | - Norton Sang
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Laura B. Balzer
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Joshua D. Schwab
- Division of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Tamara D. Clark
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
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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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Alemu DG, Haile ZT, Iwelunmor J, Qiao S, Messias DKH, Conserve DF. Socioeconomic empowerment and HIV testing among Ethiopian women: results from the 2016 Ethiopian Demographic and Health Survey. AIDS Care 2020; 33:214-218. [PMID: 32408763 DOI: 10.1080/09540121.2020.1761517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV testing is a cornerstone for early HIV diagnoses which can improve quality of life, survival, and reduce forward transmission. This study examined socioeconomic determinants of HIV testing among women in Ethiopia using the 2016 Ethiopian Demographic and Health Survey. The sample was collected using stratified cluster sampling design and was selected in two stages. A total of 15,683 women aged 15-49 completed the survey. For this study, only 8681 participants were included. Kabeer's theoretical framework on women's empowerment was used for variable selection and analysis. Chi-square test and multiple logistic regression modeling were performed. Overall, 52% of the women reported testing for HIV. In the multivariable-adjusted model, education, residence, wealth index, occupation, living arrangement, and healthcare decision making were significantly (P < 0.05) associated with ever being tested for HIV. For instance, women who don't participate in the decision making of their own health care were less likely to have ever been tested (AOR: 0.77 (0.63-0.94) than those who do. This implies that HIV prevention among Ethiopian women presupposes national policies that promote their overall socioeconomic empowerment. Providing more resources to women, especially to those living in rural areas, might increase HIV testing.
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Affiliation(s)
- Dawit G Alemu
- Department of Health PromotionEducation and Behavior, University of South Carolina, Columbia, SC, USA
| | - Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Juliet Iwelunmor
- College of Public Health and Social Justice, Saint Louis University, Saint Louis, USA
| | - Shan Qiao
- Department of Health PromotionEducation and Behavior, University of South Carolina, Columbia, SC, USA
| | - DeAnne K Hilfinger Messias
- College of Nursing and Women's and Gender Studies Program, University of South Carolina, Columbia, SC, USA
| | - Donaldson F Conserve
- Department of Health PromotionEducation and Behavior, University of South Carolina, Columbia, SC, USA
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Ong’wen P, Samba BO, Moghadassi M, Okoko N, Bukusi EA, Cohen CR, Wolf HT. Chain Peer Referral Approach for HIV Testing Among Adolescents in Kisumu County, Kenya. AIDS Behav 2020; 24:484-490. [PMID: 31267295 DOI: 10.1007/s10461-019-02560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
New HIV infections among adolescents continues to be a large public health burden in sub-Saharan Africa, with few adolescents accessing HIV testing and counseling (HTC) services. We evaluated the effect of a peer referral program among adolescents in Kisumu county, Kenya in accessing HTC. Female adolescents aged 15 to 19 years were recruited from three health clinics in Kisumu County. They, in turn, recruited their peers for HTC by handing out referral cards. Referrals would then recruit their peers and this peer-referral repeated for approximately 5 months. The 252 female index seeds showed a relatively higher-risk profile for HIV compared to the 792 referral participants. The referral system yielded an increased proportion of first-time adolescent testers from 13.1% among index seeds to 42.7% among the second wave of referrals. However, the peer referral system ultimately did not increase the absolute number of adolescents Queryaccessing HTC. Future strategies should consider these findings to better target those with undiagnosed HIV infection.
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Factores psicosociales asociados a la realización de la prueba diagnóstica del VIH en estudiantes universitarios colombianos. ACTA COLOMBIANA DE PSICOLOGIA 2020. [DOI: 10.14718/acp.2020.23.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Los objetivos de esta investigación fueron: (a) relacionar el riesgo sexual, los conocimientos y las actitudes hacia la prueba del VIH con su realización en estudiantes universitarios colombianos; y (b) describir las barreras percibidas en aquellos que no sela habían realizado, identificando las diferencias según el sexo. Se llevó a cabo un estudio transversal en el que particip- aron 1057 estudiantes colombianos, y en el que se utilizó el Cuestionario Confidencial sobre Vida Sexual Activa (CCVSA), el test Barreras Hacia la Prueba del VIH, la Escala de Actitudes hacia el VIH-Sida y un cuestionario ad hoc de conocimien- tos sobre la prueba. Los estudiantes que se realizaron la prueba (n = 214) reportaron una edad inferior de iniciación sexual (p < .01), un número superior de parejas sexuales (p = .01) y un menor uso de condón en la primera (p = .02) y la última (p = .04) relación sexual, así como mayores conocimientos sobre la prueba del VIH (p < .001). Las principales barreras estuvieron relacionadas con la baja percepción del riesgo de la enfermedad (29.8 %), la confianza en las parejas sexuales (29.2 %) y la falta de ofrecimiento de la prueba (25.2 %). En conclusión, la realización de la prueba está relacionada con la exposición a conductas sexuales de riesgo y con los conocimientos, mas no con las actitudes hacia la prueba. La identi- ficación de los factores psicosociales vinculados podría contribuir al diseño de intervenciones orientadas a la prevención y al tratamiento oportuno de la enfermedad.
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Nungu SI, Mghamba JM, Rumisha SF, Semali IA. Uptake and determinants for HIV postpartum re-testing among mothers with prenatal negative status in Njombe region, Tanzania. BMC Infect Dis 2019; 19:398. [PMID: 31072332 PMCID: PMC6506942 DOI: 10.1186/s12879-019-4062-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/01/2019] [Indexed: 11/16/2022] Open
Abstract
Background Uptake of Human Immunodeficiency Virus (HIV) re-testing among postnatal mothers who had previously tested HIV-negative is crucial for the detection of recent seroconverters who are likely to have high plasma viral loads and an increased risk of mother-to-child HIV transmission. Tanzania set a target of 90% re-testing of pregnant mothers who had tested negative during the first test. However, there is no statistics on the implementation, coverage and the factors determining re-testing among pregnant women in Tanzania. This study determined the proportion of newly-delivered, previously HIV-negative mothers who returned for HIV re-testing, and assessed the determinants of re-testing in Njombe Region in Tanzania. Methods A cross-sectional study was conducted in four health facilities in Njombe and Wanging’ombe districts during December 2015–June 2016. All newly-delivered mothers (≤7 days from delivery) presenting at health facilities and who had previously tested HIV-negative during pregnancy were included. A structured questionnaire was used to collect data on the determinants for re-testing. Records on the previous HIV testing was verified using antenatal clinic card. A multiple logistic regression model was used to calculate the adjusted odds ratio (AOR) with their 95% confidence intervals (CI) to quantify the association. Results Of 668 mothers (median age = 25 years) enrolled, 203 (30.4%) were re-tested for their HIV status. Among these, 27 (13.3%) tested positive. Significant predictors for HIV re-testing were socio-demographic factors including having at least a secondary education [AOR = 1.9, 95% CI: 1.25–3.02] and being employed [AOR = 2.1, 95% CI: 1.06–4.34]; personal and behavioural factors, reporting symptoms of sexually transmitted infections [AOR = 4.9, 95% CI: 2.15–6.14] and use of condoms during intercourse [AOR = 1.7, 95% CI: 1.13–2.71]. Significant health system factors were having ≥4 ANC visits [AOR = 1.8, 95% CI: 1.21–2.69] and perceiving good quality of HIV counselling and testing service at the first ANC visit [AOR = 2.14, 95% CI: 1.53–3.04]. Conclusion Uptake of the HIV re-testing was lower than the national target. Education level, employment status, having ≥4 ANC visits, reporting sexually-transmitted infections, condom use, and good perception of HIV tests were significant factors increased uptake for re-testing. Identified factors should be incorporated in the Prevention of the Mother-to-Child Transmission (PMTCT) programme strategies to prevent HIV infection in new-borns.
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Affiliation(s)
- Saumu Iddy Nungu
- Tanzania Field Epidemiology and Laboratory Training Program, P. O. Box 9083, Dar es Salaam, Tanzania. .,Ministry of Health, Community Development, Gender, Elderly, and Children, P. O. Box 743, Dodoma, Tanzania.
| | - Janneth Maridadi Mghamba
- Tanzania Field Epidemiology and Laboratory Training Program, P. O. Box 9083, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, P. O. Box 743, Dodoma, Tanzania
| | - Susan Fred Rumisha
- Tanzania Field Epidemiology and Laboratory Training Program, P. O. Box 9083, Dar es Salaam, Tanzania.,National Institute for Medical Research, 3 Barack Obama Drive, P. O. Box 9653, Dar es Salaam, Tanzania
| | - Innocent Antony Semali
- Tanzania Field Epidemiology and Laboratory Training Program, P. O. Box 9083, Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
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9
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Correlates of Undiagnosed HIV Infection and Retesting Among Voluntary HIV Testing Clients at Mildmay Clinic, Uganda. AIDS Behav 2019; 23:820-834. [PMID: 30255386 DOI: 10.1007/s10461-018-2274-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increasing HIV diagnosis is important for combatting HIV. We invited individuals aged ≥ 13 years seeking voluntary HIV testing at Mildmay Clinic in Uganda to undertake a computer or audio-computer-assisted self-interview to facilitate post-test counseling. We evaluated first-visit data from 12,233 consenting individuals between January 2011 and October 2013. HIV prevalence was 39.0%. Of those with HIV, 37.2% already knew they were infected. Undiagnosed infection was associated with not being single, screening positive for depression (aOR 1.16, 95% CI 1.04-1.28), and screening for harmful drinking behavior (aOR 1.23, 95% CI 1.10-1.39). The odds of retesting subsequent to HIV diagnosis were lower for males (aOR 0.80, 95% CI 0.70-0.92) and those screening positive for harmful drinking behavior (aOR 0.77, 95% CI 0.66-0.88). Retesting was also associated with higher education and perceived social status below 'better off'. Our findings reiterate the value of population-based HIV surveys to provide estimates of testing coverage.
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10
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Perkins JM, Nyakato VN, Kakuhikire B, Mbabazi PK, Perkins HW, Tsai AC, Subramanian SV, Christakis NA, Bangsberg DR. Actual Versus Perceived HIV Testing Norms, and Personal HIV Testing Uptake: A Cross-Sectional, Population-Based Study in Rural Uganda. AIDS Behav 2018; 22:616-628. [PMID: 28233075 PMCID: PMC5568980 DOI: 10.1007/s10461-017-1691-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HIV testing is an essential part of treatment and prevention. Using population-based data from 1664 adults across eight villages in rural Uganda, we assessed individuals' perception of the norm for HIV testing uptake in their village and compared it to the actual uptake norm. In addition, we examined how perception of the norm was associated with personal testing while adjusting for other factors. Although the majority of people had been tested for HIV across all villages, slightly more than half of men and women erroneously thought that the majority in their village had never been tested. They underestimated the prevalence of HIV testing uptake by 42 percentage points (s.d. = 17 percentage points), on average. Among men, perceiving that HIV testing was not normative was associated with never testing for HIV (AOR = 2.6; 95% CI 1.7-4.0, p < 0.001). Results suggest an opportunity for interventions to emphasize the commonness of HIV testing uptake.
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Affiliation(s)
- Jessica M Perkins
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Center for Population and Development Studies, Cambridge, MA, USA.
| | - Viola N Nyakato
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Pamela K Mbabazi
- Uganda National Council for Science & Technology, Kampala, Uganda
| | | | - Alexander C Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
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11
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Fuster-RuizdeApodaca MJ, Laguia A, Molero F, Toledo J, Arrillaga A, Jaen A. Psychosocial determinants of HIV testing across stages of change in Spanish population: a cross-sectional national survey. BMC Public Health 2017; 17:234. [PMID: 28270139 PMCID: PMC5341365 DOI: 10.1186/s12889-017-4148-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background The goal of this research is to study the psychosocial determinants of HIV-testing as a function of the decision or change stage concerning this health behavior. The determinants considered in the major ongoing health models and the stages contemplated in the Precaution Adoption Process Model are analysed. Methods A cross-sectional survey was administered to 1,554 people over 16 years of age living in Spain by a computer-assisted telephone interview (CATI). The sample design was randomised, with quotas of sex and age. The survey measured various psychosocial determinants of health behaviors considered in the main cognitive theories, the interviewees' stage of change concerning HIV-testing (lack of awareness, decision not to act, decision to act, action, maintenance, and abandonment), and the signal for the action of getting tested or the perceived barriers to being tested. Results Approximately two thirds of the population had not ever had the HIV test. The predominant stage was lack of awareness. The most frequently perceived barriers to testing were related to the health system and to the stigma. We also found that the psychosocial determinants studied differed depending on the respondents' stage of change. Perception of risk, perceived self-efficacy, proximity to people who had been tested, perceived benefits of knowing the diagnosis, and a positive instrumental and emotional attitude were positively associated with the decision and maintenance of testing behavior. However, unrealistic underestimation of the risk of HIV infection, stereotypes about the infection, and the perceived severity of HIV were associated with the decision not to be tested. Conclusions There are various sociocognitive and motivational profiles depending on people’s decision stage concerning HIV-testing. Knowing this profile may allow us to design interventions to influence the psychosocial determinants that characterise each stage of change. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4148-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Jose Fuster-RuizdeApodaca
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), C/Doctor Fleming 3, 28036, Madrid, Spain. .,Universidad Nacional de Educación a Distancia (UNED), Facultad de Psicología, C/Juan del Rosal, 28040, Madrid, Spain.
| | - Ana Laguia
- Universidad Nacional de Educación a Distancia (UNED), Facultad de Psicología, C/Juan del Rosal, 28040, Madrid, Spain
| | - Fernando Molero
- Universidad Nacional de Educación a Distancia (UNED), Facultad de Psicología, C/Juan del Rosal, 28040, Madrid, Spain
| | - Javier Toledo
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), C/Doctor Fleming 3, 28036, Madrid, Spain.,Plan de VIH/Sida Dirección General de Salud Pública, Gobierno de Aragón. Vía Universitas 36, 5a Planta, 50017, Zaragoza, Spain
| | - Arantxa Arrillaga
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), C/Doctor Fleming 3, 28036, Madrid, Spain.,Plan del Sida e Infecciones de Transmisión Sexual (AIDS Strategy), Osakidetza-Servicio vasco de salud, Avda. Navarra, 14, 20013, San Sebastián, Spain
| | - Angeles Jaen
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), C/Doctor Fleming 3, 28036, Madrid, Spain.,Fundació Docència i Recerca Mútua Terrassa, C/Sant Antoni n° 19, 08221, Terrassa, Barcelona, Spain
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12
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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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13
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Lau JTF, Li D, Wang Z, Lai CHY. Repeated HIV Voluntary Counseling and Testing Increased Risk Behaviors Among Men Who Have Sex with Men in China: A Prospective Cohort Study. AIDS Behav 2015; 19:1966-77. [PMID: 25863465 DOI: 10.1007/s10461-015-1034-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
High risk MSM are recommended to take up HIV voluntary counseling and testing (VCT) once every 6 months. 809 HIV-negative MSM in Beijing, China entered the 18-month prospective cohort study; 228 joined an extended study at month 21. The majority (92.5 %) of the participants had taken up four rounds of VCT over the study period. HIV prevalence at months 0, 6, 12, 18 and 21 ranged from 2.5 to 6.3 %; HIV incidences for the four intervals between the five visits ranged from 5.00 to 14.28 per 100-person year. Despite experiencing repeated VCT, high levels of risk behaviors were reported at month 21. 18 % of the participants interviewed at month 21 self-reported increased in UAI and other risk behaviors, comparing recent and pre-baseline experiences. HIV transmission and risk behaviors had not been reduced by multiple rounds of VCT. Reasons behind apparent ineffectiveness and tailored repeated testing strategies need to be investigated.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
- CUHK Shenzhen Research Institute (SZRI), Shenzhen, China.
- Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China.
| | - Dongliang Li
- Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Shenzhen Research Institute (SZRI), Shenzhen, China
| | - Coco H Y Lai
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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14
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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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15
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Conroy AA. The influence of relationship power dynamics on HIV testing in rural Malawi. JOURNAL OF SEX RESEARCH 2015; 52:347-59. [PMID: 24670263 PMCID: PMC4177026 DOI: 10.1080/00224499.2014.883590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Using the theory of gender and power (TGP) and data from the Tsogolo la Thanzi (TLT) study, we examined how relationship power shapes young people's decisions to test for HIV in rural Malawi (N=932), a high-HIV prevalence setting undergoing rapid expansions in testing services. We used generalized estimating equations (GEE) to examine associations among five constructs of relationship power (socioeconomic inequalities, relationship dominance, relationship violence, relationship unity, and mistrust), perceived risk, and receiving an HIV test over a 16-month period. The results indicate that young Malawians are testing for HIV at relatively high rates, repeatedly, and not just during pregnancy. Over the study period, 47.3% of respondents received at least one HIV test outside of TLT (range: 0-4). The GEE analysis revealed that men and women with higher levels of relationship unity were less likely to test for HIV. For men, being a victim of sexual coercion was an additional barrier to testing. Women's testing decisions were more strongly influenced by perceptions of a partner's risk for HIV than their own, whereas men relied more on self-assessments. The results highlight that testing decisions are deeply embedded within the relationship context, which should be considered in future HIV testing interventions.
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Affiliation(s)
- Amy A Conroy
- a Center for AIDS Prevention Studies , University of California , San Francisco
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16
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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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17
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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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18
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Regan S, Losina E, Chetty S, Giddy J, Walensky RP, Ross D, Holst H, Katz JN, Freedberg KA, Bassett IV. Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa. PLoS One 2013; 8:e62362. [PMID: 23626808 PMCID: PMC3633858 DOI: 10.1371/journal.pone.0062362] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 03/20/2013] [Indexed: 11/19/2022] Open
Abstract
Background Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country. Methods We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR’s) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model. Results Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33–1.68), women (ARR: 1.24, 95% CI: 1.11–1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12–1.45). Conclusions In this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis.
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Affiliation(s)
- Susan Regan
- Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
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19
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Oluoch T, Mohammed I, Bunnell R, Kaiser R, Kim AA, Gichangi A, Mwangi M, Dadabhai S, Marum L, Orago A, Mermin J. Correlates of HIV Infection Among Sexually Active Adults in Kenya: A National Population-Based Survey. Open AIDS J 2011; 5:125-34. [PMID: 22253668 PMCID: PMC3257551 DOI: 10.2174/1874613601105010125] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/25/2011] [Accepted: 09/26/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify factors associated with prevalent HIV in a national HIV survey in Kenya. METHODS The Kenya AIDS Indicator Survey was a nationally representative population-based sero-survey that examined demographic and behavioral factors and serologic testing for HIV, HSV-2 and syphilis in adults aged 15-64 years. We analyzed questionnaire and blood testing data to identify significant correlates of HIV infection among sexually active adults. RESULTS Of 10,957 eligible women and 8,883 men, we interviewed 10,239 (93%) women and 7,731 (87%) men. We collected blood specimens from 9,049 women and 6,804 men of which 6,447 women and 5,112 men were sexually active during the 12 months prior to the survey. HIV prevalence among sexually active adults was 7.4%. Factors independently associated with HIV among women were region (Nyanza vs Nairobi: adjusted OR [AOR] 1.6, 95%CI 1.1-2.3), number of lifetime sex partners (6-9 vs 0-1 partners: AOR 3.0, 95%CI 1.6-5.9), HSV-2 (AOR 6.5, 95%CI 4.9-8.8), marital status (widowed vs never married: AOR 2.7, 95%CI 1.5-4.8) and consistent condom use with last sex partner (AOR 2.3, 95%CI 1.6-3.4). Among men, correlates of HIV infection were 30-to-39-year-old age group (AOR 5.2, 95%CI 2.6-10.5), number of lifetime sex partners (10+ vs 0-1 partners, AOR 3.5, 95%CI 1.4-9.0), HSV-2 (AOR 4.7, 95%CI 3.2-6.8), syphilis (AOR 2.4, 95%CI 1.4-4.0), consistent condom use with last sex partner (AOR 2.1, 95% CI 1.5-3.1) and lack of circumcision (AOR 4.0, 95%CI 2.8 - 5.5). CONCLUSION Kenya's heterogeneous epidemic will require regional and gender-specific prevention approaches.
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Affiliation(s)
- Tom Oluoch
- US Centers for Disease Control and Prevention - Division of Global HIV/AIDS, Nairobi, Kenya
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20
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Waters RC, Ostermann J, Reeves TD, Masnick MF, Thielman NM, Bartlett JA, Crump JA. A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa. J Acquir Immune Defic Syndr 2011; 56:443-52. [PMID: 21297484 PMCID: PMC3143215 DOI: 10.1097/qai.0b013e3182118f8c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines in sub-Saharan Africa on when HIV-seronegative persons should retest range from never to annually for lower-risk populations and from annually to every 3 months for high-risk populations. METHODS We designed a mathematical model to compare the cost-effectiveness of alternative HIV retesting frequencies. Cost of HIV counseling and testing, linkage to care, treatment costs, disease progression, and mortality, and HIV transmission are modeled for three hypothetical cohorts with posited annual HIV incidence of 0.8%, 1.3%, and 4.0%, respectively. The model compared costs, quality-adjusted life-years gained, and secondary infections averted from testing intervals ranging from 3 months to 30 years. Input parameters from sub-Saharan Africa were used and explored in sensitivity analyses. RESULTS Accounting for secondary infections averted, the most cost-effective testing frequency was every 7.5 years for 0.8% incidence, every 5 years for 1.3% incidence, and every 2 years for 4.0% incidence. Optimal testing strategies and their relative cost-effectiveness were most sensitive to assumptions about HIV counseling and testing and treatment costs, rates of CD4 decline, rates of HIV transmission, and whether tertiary infections averted were taken into account. CONCLUSIONS While higher risk populations merit more frequent HIV testing than low risk populations, regular retesting is beneficial even in low-risk populations. Our data demonstrate benefits of tailoring testing intervals to resource constraints and local HIV incidence rates.
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Affiliation(s)
- Richard C. Waters
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Jan Ostermann
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
| | - Travis D. Reeves
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Max F. Masnick
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
| | - Nathan M. Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - John A. Bartlett
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
| | - John A. Crump
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
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