1
|
Kinnman E, Herder T, Björkman P, Månsson F, Agardh A. HIV self-testing for men who have sex with men in Sweden. A cross-sectional study concerning interest to use HIV self-tests. Glob Health Action 2022; 15:2021631. [PMID: 35289717 PMCID: PMC8928837 DOI: 10.1080/16549716.2021.2021631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background HIV self-testing (HIVST) has been found to have high acceptability among men who have sex with men (MSM) internationally and might contribute to increase testing frequencies, but many countries, including Sweden, lack policies for using HIVST. Objective To examine interest to use and willingness to pay for HIVST, and associated factors, among MSM attending HIV testing venues in Sweden. Method This cross-sectional study analyzed data from a self-administered survey, consisting of 33 questions, collected at six HIV testing venues in Sweden in 2018. The sample consisted of sexually active men who have sex with men, aged ≥ 18 years, and not diagnosed with HIV. Data were analyzed descriptively and by univariable and multivariable logistic regression. Result Among 663 participants (median age 33 years), 436 respondents (65.8%) expressed interest to use HIVST. Among those interested, less than half, 205 (47.0%), were willing to pay for HIVST. Being interested in HIVST was found to be negatively associated with being in the 55 years or older age group (AOR 0.31, CI 0.14–0.71), and having had syphilis, rectal chlamydia, or rectal gonorrhea in the preceding 12 months (AOR 0.56, CI 0.32–0.99). In the sample of MSM interested in HIVST, willingness to pay was positively associated with being in the age groups 35–44 years (AOR 2.94, CI 1.40–6.21), 45–54 years (AOR 2.82, CI 1.16–6.90), and 55 years or above (AOR 3.90, CI 1.19–12.81), and negatively associated with being single (AOR 0.56, CI 0.36–0.88). Conclusion This study found high interest for HIVST in a sample of MSM in Sweden. However, HIVST offered at a cost is likely to negatively affect uptake among MSM broadly, compared with free availability.
Collapse
Affiliation(s)
- Elin Kinnman
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Tobias Herder
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fredrik Månsson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
2
|
Distribution of HIV Self-tests by Men Who have Sex with Men (MSM) to Social Network Associates. AIDS Behav 2022; 27:1716-1725. [PMID: 36318431 PMCID: PMC9628448 DOI: 10.1007/s10461-022-03903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
Internet-recruited gay, bisexual, and other men who have sex with men (MSM) were offered HIV self-tests (HIVSTs) after completing baseline, 3-, 6-, and 9-month follow-up surveys. The surveys asked about the use and distribution of these HIVSTs. Among 995 who reported on their distribution of HIVSTs, 667 (67.0%) distributed HIVSTs to their social network associates (SNAs), which resulted in 34 newly identified HIV infections among 2301 SNAs (1.5%). The main reasons participants reported not distributing HIVSTs included: wanting to use the HIVSTs themselves (74.9%); thinking that their SNAs would get angry or upset if offered HIVSTs (12.5%); or not knowing that they could give the HIVSTs away (11.3%). Self-testing programs can provide multiple HIVSTs and encourage the distribution of HIVST by MSM to their SNAs to increase awareness of HIV status among persons disproportionately affected by HIV.
Collapse
|
3
|
Babatunde AO, Agboola P, Babatunde Y, Ilesanmi EB, Ayodele H, Ezechi OC. Assessment of knowledge and acceptability of HIV self-testing among students of selected universities in southwest Nigeria: an online cross-sectional study. Pan Afr Med J 2022; 43:94. [PMID: 36660087 PMCID: PMC9816886 DOI: 10.11604/pamj.2022.43.94.31741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction in Nigeria, it was estimated that 1.9 million people were living with HIV of which 130,000 people were newly infected with HIV. HIV self-testing would potentially increase access to HIV testing for people to know their status, get diagnosed, and initiate treatment as soon as possible. Our study aims to assess the knowledge of HIV Self-Testing (HIVST) and the acceptability of this youth-friendly approach among students in southwest Nigeria online. Methods a cross-sectional study was conducted among bona fide undergraduate students (2019/2020 session) of two popular tertiary institutions in southwest Nigeria. An online standardized self-administered questionnaire was administered using Google Forms. Microsoft Excel and IBM SPSS statistics were used for tabulation and statistical data analysis. The Chi-Square test was conducted using a P value of 0.05 to determine the level of significance. Results of the 155 students that participated in the study, 82 (52.9%) were male. Most of the respondents (65.2%) were studying medicine and other health-related courses. The mean knowledge of HIVST among respondents was slightly above average. Respondents studying medical and other health-related courses showed a slightly better level of knowledge than others although not statistically significant (P = 0.222). 76.1% of respondents had never used the HIVST option before and 62.6% are willing to use it sometimes in the future. Conclusion to achieve the UNAIDS 95-95-95 fast-track targets in Nigeria by 2030, there is a need to promote sexual and reproductive health education and increase awareness and accessibility of HIVST to youths.
Collapse
Affiliation(s)
- Abdulhammed Opeyemi Babatunde
- Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria,,Healthy Africans Platform, Ibadan, Nigeria,,Corresponding author: Abdulhammed Opeyemi Babatunde, Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Progress Agboola
- Department of Medicine and Surgery, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Yusuf Babatunde
- Healthy Africans Platform, Ibadan, Nigeria,,Department of Pharmacy, University of Ilorin, Ilorin, Kwara State, Nigeria
| | | | - Habibllah Ayodele
- Department of Mechanical Engineering, Faculty of Technology, University of Ibadan, Ibadan, Nigeria
| | - Oliver Chukwujekwu Ezechi
- Centre for Reproductive and Population Health Studies, Lagos, Nigeria,,Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria,Department of Public Health, Lead City University, Ibadan, Nigeria
| |
Collapse
|
4
|
Budzyńska J, Patryn R, Kozioł I, Leśniewska M, Kopystecka A, Skubel T. Self-Testing as a Hope to Reduce HIV in Transgender Women—Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159331. [PMID: 35954695 PMCID: PMC9368376 DOI: 10.3390/ijerph19159331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
So far, the rate of HIV-positive people who do not know their sero-status is about 14% and the percentage is higher among transgender women (TGW). They represent one of the most vulnerable groups to infection. HIV self-testing (HIVST) may be a way to reduce transmission of the virus. The aim of this analysis and in-depth review was to collect available data on factors that may influence the use and dissemination of HIVST among TGW. This review was conducted in accordance with PRISMA guidelines for systematic reviews and meta-analyses. All data from 48 papers were used. From the available literature, HIVST is a convenient and preferred method of testing due to its high confidentiality and possibility of being performed at home. However, there are barriers that limit its use, including marginalization of transgender people, stigma by medical personnel, lack of acceptance of sexual partners, and even cultural standards. Therefore, there is a need for activities that promote and inform on the possibility of using HIVST as well as enable easier access to it.
Collapse
Affiliation(s)
- Julia Budzyńska
- Students’ Scientific Group on Medical Law, Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland; (I.K.); (M.L.); (A.K.); (T.S.)
- Correspondence:
| | - Rafał Patryn
- Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Ilona Kozioł
- Students’ Scientific Group on Medical Law, Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland; (I.K.); (M.L.); (A.K.); (T.S.)
| | - Magdalena Leśniewska
- Students’ Scientific Group on Medical Law, Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland; (I.K.); (M.L.); (A.K.); (T.S.)
| | - Agnieszka Kopystecka
- Students’ Scientific Group on Medical Law, Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland; (I.K.); (M.L.); (A.K.); (T.S.)
| | - Tomasz Skubel
- Students’ Scientific Group on Medical Law, Department of Humanities and Social Medicine, Medical University of Lublin, 20-059 Lublin, Poland; (I.K.); (M.L.); (A.K.); (T.S.)
| |
Collapse
|
5
|
King K, Balan S, Kanamori M, Shrader CH, Arroyo-Flores J, Johnson A, Whiteside P, Michniewicz M, Doblecki-Lewis S. Feasibility and Acceptability of HIV Self-Test Kit Distribution Through PrEP Clients' Social and Sexual Networks to Increase HIV Testing and PrEP Information. J Acquir Immune Defic Syndr 2022; 90:S105-S113. [PMID: 35703762 PMCID: PMC9204857 DOI: 10.1097/qai.0000000000002970] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the feasibility, acceptability, and implementation of a HIV self-test (HIVST) program through PrEP clients' social and sexual networks. BACKGROUND HIV testing is critical for treatment and prevention engagement. HIVST kits can overcome barriers to testing. A negative result is an opportunity to provide PrEP information. We describe implementation factors associated with engaging current Mobile PrEP (MP) clients to distribute HIVST kits and PrEP information through their networks. SETTING Community venues in Miami-Dade County, Florida. METHODS A baseline survey collected network information and explored distribution plans for offering HIVST kits. A follow-up survey evaluated use and distribution. A logic model describes the process of implementation and evaluation. Up to 4 Ora-Quick HIV ST kits were offered to 81 MP clients. A brief training included resources for posttest engagement. RESULTS Forty-four percent of the kits were reported as distributed. Of 81 MP clients offered kits, 50 (62%) accepted. In a follow-up survey, 77% of MP clients distributed at least 1 kit. Fifty-six (86%) social network members were Latino, and 9 (14%) were Black. Three of 4 MP clients engaged in PrEP discussions (77%) with SN members. Reported reasons for HIVST kit use included convenience, confidentiality, privacy concerns, and discomfort with going to a testing site. MP clients reported that kit distribution was affected by the COVID-19 pandemic. CONCLUSION HIV ST kits allowed PrEP users to engage others in their social and sexual networks for HIV testing and information regarding PrEP. Work to scale-up this intervention is underway.
Collapse
Affiliation(s)
- Katherine King
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Shuba Balan
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Cho-Hee Shrader
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - Ariana Johnson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - Mara Michniewicz
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, HIV Prevention Program, Tallahassee, FL; and
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
6
|
Agot K, Cain M, Medley A, Kimani J, Gichangi P, Kiio C, Mukiri E, Odonde P, Toroitich-Ruto C, Bingham T, Downer M, Chesang K. Formative assessment to identify perceived benefits and barriers of HIV oral self-testing among female sex workers, service providers, outreach workers, and peer educators to inform scale-up in Kenya. AIDS Care 2022; 34:717-724. [PMID: 33657929 PMCID: PMC10962321 DOI: 10.1080/09540121.2021.1894318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
In Kenya, HIV prevalence estimates among female sex workers (FSWs) are almost five times higher than among women in the general population. However, only 68% of infected FSWs are aware of their HIV-positive status. We aimed to identify perceived benefits, opportunities, and barriers of HIV self-testing (HIVST) in improving testing coverage among FSWs. Twenty focus group discussions were conducted with 77 service providers, 42 peer educators (PEs) and outreach workers, and 37 FSWs attending drop-in centers (DiCEs) in four regions of Kenya. An additional 8 FSWs with HIV-negative or unknown status-completed in-depth interviews. Data were analyzed thematically. Acceptability of HIVST was high, with cited benefits including confidentiality, convenience, and ease of use. Barriers included absence of counseling, potential for inaccurate results, fear of partner reaction, possible misuse, and fear that HIVST could lead to further stigmatization. PEs and DiCEs were the preferred models for distributing HIVST kits. FSWs wanted kits made available free or at a nominal cost (100 Kenya Shillings or ∼USD 1). Linkage to confirmatory testing, the efficiency of distributing HIVST kits using peers and DiCEs, and the types and content of effective HIVST messaging require further research.
Collapse
Affiliation(s)
- Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Meagan Cain
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Amy Medley
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Joshua Kimani
- University of Nairobi/University of Manitoba, Nairobi, Kenya
| | - Peter Gichangi
- International Center for Reproductive Health-Kenya, Mombasa, Kenya
| | - Caroline Kiio
- International Center for Reproductive Health-Kenya, Mombasa, Kenya
| | - Elosy Mukiri
- University of Nairobi/University of Manitoba, Nairobi, Kenya
| | | | | | - Trista Bingham
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Marie Downer
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | | |
Collapse
|
7
|
Lentz C, Lopez-Rios J, Dolezal C, Kutner BA, Rael CT, Balán IC. Negotiating Use of a Blood-Based, Dual HIV and Syphilis Test with Potential Sexual Partners Among a Sample of Cisgender Men and Transgender Women Who Have Sex with Men in New York City. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2015-2025. [PMID: 35449365 PMCID: PMC9197957 DOI: 10.1007/s10508-021-02275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 05/03/2023]
Abstract
Cisgender men who have sex with men (cMSM) and transgender women (TGW) are disproportionally burdened by HIV. Among these populations, HIV partner-testing is a highly acceptable harm reduction tool. Particularly, cMSM and TGW report a stronger preference for blood-based tests that include assays for multiple STIs. However, no existing research has explored how these populations negotiate blood-based testing with sexual partners. In the SMARTtest study, 48 sexually active cMSM and TGW took home dual, blood-based HIV/Syphilis kits for self- and partner-testing. After 3 months, they completed a follow-up assessment and in-depth interviews about their experiences initiating testing. Of the 42 responding participants, 27 (64%) reported that it had been "fairly" or "very easy" to raise the idea of testing with partners. Participants predominantly employed partner-conscious communication strategies, including framing the testing proposal as a mandatory, non-personal component of their participation in a research study, gradually incorporating testing mentions into discussions about sexual health, and using the kits to facilitate joint testing. Yet, 21 (44%) participants reported having sex with at least one partner they did not ask to test. Concern regarding partner reactions emerged as a significant barrier to discussing test use; similarly, many partners were averse to taking a blood-based test in the context of a casual sexual encounter. Nonetheless, these findings suggest that dual, blood-based HIV/STI rapid tests may represent acceptable harm reduction tools among similar populations of cMSM and TGW, particularly if future partner-testing research is broadened to consider key couples' dynamics that may impact test usage.
Collapse
Affiliation(s)
- Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Javier Lopez-Rios
- Department of Community Health and Prevention, Dornsife School of Public Health at Drexel University, Philadelphia, PA, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- College of Nursing, Anschutz Medical Campus at Colorado University, Aurora, CO, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA.
- Center for Translational Behavioral Science, Florida State University College of Medicine, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL, 32310, USA.
| |
Collapse
|
8
|
Mujugira A, Nakyanzi A, Nabaggala MS, Muwonge TR, Ssebuliba T, Bagaya M, Nampewo O, Sapiri O, Nyanzi KR, Bambia F, Nsubuga R, Serwadda DM, Ware NC, Baeten JM, Haberer JE. Effect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trial. J Acquir Immune Defic Syndr 2022; 89:381-389. [PMID: 34954718 PMCID: PMC8860206 DOI: 10.1097/qai.0000000000002895] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP) are complementary tools that could empower sex workers to control their HIV protection, but few studies have jointly evaluated PrEP and HIVST in any setting. METHODS The Empower Study was an open-label randomized trial in Uganda. Sex workers were offered F/tenofovir disoproxil fumarate and randomized 1:1 to monthly HIVST and quarterly in-clinic testing (intervention) or quarterly in-clinic HIV testing alone (standard of care) and followed up for 12 months. PrEP adherence was measured using electronic adherence monitoring and tenofovir diphosphate (TFV-DP) levels in dried blood spots. Adherence outcomes and sexual behaviors were compared by arm using generalized estimating equation models. RESULTS We enrolled 110 sex workers: 84 cisgender women, 14 transgender women, 10 men who have sex with men, and 2 transgender men. The median age was 23 years. The 12-month retention was 75%. Nearly all (99.4%) used ≥1 HIVST kit. The proportion with TFV-DP levels ≥700 fmol/punch in the HIVST and standard of care arms at the 3-, 6-, 9-, and 12-month visits was 2.4%, 2.3%, 0%, and 0% and 7.9%, 0%, 0%, and 0%, respectively, with no differences by randomization arm (P > 0.2). Self-reported condomless sex acts with paying partners was similar by arm [adjusted incidence rate ratio 0.70; 95% confidence interval (CI): 0.42 to 1.17; P = 0.18]. One seroconversion occurred (HIV incidence, 0.9/100 person-years); TFV-DP was not detected at any visit. CONCLUSIONS A gender-diverse sample of sex workers in Uganda used HIVST but not daily oral PrEP for HIV protection. Alternate approaches to promote PrEP use, including long-acting formulations, should be considered in this population.
Collapse
Affiliation(s)
- Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Global Health, University of Washington, Seattle, WA
| | - Agnes Nakyanzi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maria S. Nabaggala
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Timothy R. Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Timothy Ssebuliba
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Monica Bagaya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Olivia Nampewo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Oliver Sapiri
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kikulwe R. Nyanzi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bambia
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rogers Nsubuga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David M. Serwadda
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Norma C Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; and
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA
| | | |
Collapse
|
9
|
Pastolero PC, Suss A, Cambridge R, Hammerschlag MR. If We Make It, Will They Take It? Attitudes Toward the Acceptability of Chlamydia Point-of-Care Testing Among Adolescents and Young Adults. Sex Transm Dis 2022; 49:204-207. [PMID: 34561372 DOI: 10.1097/olq.0000000000001563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent women, 15 to 19 years of age, have the highest rate of Chlamydia trachomatis infection in the United States. The objective of this study was to ascertain knowledge and experience of C. trachomatis and acceptance of C. trachomatis point-of-care testing (POCT) if made available over-the-counter (OTC). Currently, there are no tests for C. trachomatis available OTC for purchase. METHODS Patients attending adolescent clinics at University Hospital of Brooklyn and Kings County Hospital received an anonymous 12-item questionnaire. Both clinics serve predominantly African and Caribbean American urban populations. Questions included demographics, sexual orientation, chlamydia knowledge, testing history, prior infection, partner notification, and acceptance of OTC POCT for C. trachomatis. RESULTS Surveys from 151 patients (116 women, 35 men) aged 12 to 21 years (mean age, 17.6 years) were analyzed. Only 34 of the 151 (22.5%) respondents understood C. trachomatis transmission; 31 (20.5%) knew its complications. Sixty-seven (44.4%) would purchase an OTC test but 101 (66.8%) would pay no more than $20. All 151 patients reported that they would follow-up with doctor if positive; 143 (94.7%) would notify partners, although 5 of the 31 (16.1%) women with prior infection did not notify partners. CONCLUSIONS Nearly half (44%) of adolescents in our population would be interested in using a potential OTC test for C. trachomatis. Cost was a major disincentive. Knowledge of infection remains cursory. However, those with a history of C. trachomatis infection and familiar with its complications were more interested in purchasing a home test. Although 100% of the respondents reported that they would follow-up with their physician if they tested positive, past behavior suggests that partner notification might be suboptimal.
Collapse
Affiliation(s)
| | - Amy Suss
- From the Division of Adolescent Medicine
| | | | - Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, NY
| |
Collapse
|
10
|
Johnson MC, Chung R, Leung SYJ, Edelstein Z, Yuan Y, Flavin SM. Combating Stigma Through HIV Self-Testing: New York State's HIV Home Test Giveaway Program for Sexual Minorities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:174-183. [PMID: 32015253 PMCID: PMC8781215 DOI: 10.1097/phh.0000000000001138] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Gay, bisexual, and men who have sex with men (MSM) are disproportionately affected by the HIV/AIDS epidemic more than any other group. In New York State (NYS) outside of New York City (NYC), MSM accounted for 57% of new HIV/AIDS diagnoses in 2017. HIV/AIDS home testing initiatives have been effective at getting priority populations tested for HIV. OBJECTIVES The NYS Department of Health (NYSDOH) administered the HIV Home Test Giveaway (HHTG) program through social media and mobile applications popular among the priority populations to (1) promote HIV screening among gay and bisexual men, MSM, transgender (TG), and gender queer/gender nonconforming (GNC) individuals who have sex with men, and (2) identify individuals with undiagnosed HIV infection. DESIGN/SETTING The NYSDOH recruited participants from NYS (excluding NYC) through social media campaigns between November 2016 and January 2018. Interested individuals were directed to an online eligibility survey. Eligible participants received a coupon via e-mail for a free HIV self-test (HIVST) kit through the manufacturer's Web site. Eligible participants received a $20 to $25 Amazon online gift card if they completed a voluntary online follow-up survey regarding their test results, experiences with the HHTG, and HIV/AIDS risk behaviors. Participants were also able to request assistance from the NYSDOH with further testing and various prevention and supportive services. PARTICIPANTS In total, 6190 individuals participated and 3197 (52%) were eligible and received a coupon. Of the eligible, 2022 (63%) redeemed coupons for HIVST. RESULTS Among eligible participants, 976 (31%) reported having never been tested for HIV. On the follow-up survey, 922 (29%) participants reported having used the HIVST kit for themselves; 203 (22%) were first-time testers; and 7 (0.8%) tested HIV reactive. Of the follow-up survey participants, 761 (59%) requested assistance with various services. CONCLUSIONS Media campaigns were effective in promoting HIV testing among priority populations and reaching individuals who have never been tested for HIV.
Collapse
Affiliation(s)
- Megan C. Johnson
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Rakkoo Chung
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Shu-Yin J. Leung
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Zoe Edelstein
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Yingchao Yuan
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| | - Susan M. Flavin
- New York State Department of Health—AIDS Institute, Albany, New York (Mss Johnson and Flavin, Dr Chung, and Messrs Leung and Yuan); and New York City Department of Health and Mental Hygiene, New York, New York (Dr Edelstein)
| |
Collapse
|
11
|
Pressure to Use HIV Self-Tests Among Men Who Have Sex With Men, United States, 2015-2016. AIDS Behav 2022; 26:623-630. [PMID: 34406551 DOI: 10.1007/s10461-021-03422-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
To assess whether pressuring others to use HIV self-tests is prevalent among US men who have sex with men (MSM), we analyzed data from a randomized controlled trial of HIV self-testing. Among 752 online-recruited MSM who received HIV self-tests and responded to a 12-month survey, 8.5% (60/709) reported pressuring someone to use an HIV self-test: 29 pressured a friend, 28 pressured a sexual partner, and 1 pressured a family member. Conversely, 2.1% (15/715) reported being pressured to self-test: 12 by a sexual partner and 3 by a friend. No physical harm was reported. HIV prevention programs that use HIV self-tests to reach populations at risk for HIV may be reassured by our findings because, despite reports of pressure to use HIV self-tests, no physical abuse was reported between sex partners. These programs should, however, include messages emphasizing the voluntary use of HIV self-tests and be prepared to address concerns of persons who have been pressured to use HIV self-tests. This trial is registered at www.clinicaltrials.gov (NCT02067039) and the date of registration is February 5, 2014.
Collapse
|
12
|
Acceptability and Use of a Dual HIV/Syphilis Rapid Test and Accompanying Smartphone App to Facilitate Self- and Partner-Testing Among Cisgender Men and Transgender Women Who Have Sex with Men. AIDS Behav 2022; 26:35-46. [PMID: 34037931 PMCID: PMC8617080 DOI: 10.1007/s10461-021-03322-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 01/03/2023]
Abstract
At home self- and partner-testing may reduce HIV and syphilis transmission by detecting undiagnosed infections. Forty-eight cisgender men and transgender women who men who have sex with men were given ten INSTI Multiplex kits and downloaded the SMARTtest app to facilitate self- and partner testing over the next three months. Thirty-seven (77%) participants self-tested using the INSTI (mean = 3.7 times, SD = 3.9); 26 (54%) tested partners (mean = 1.6 times, SD = 2.2). Participants liked the test for its ease of use, quick results, and dual HIV/syphilis testing but its blood-based nature hindered use with partners. Participants with reactive syphilis results always attributed them to a past infection and these results presented a challenge to testing with partners and the ability to accurately assess risk of infection. Most participants stated they would use the INSTI for self-testing (100%) and for partner-testing (89%). Acceptability of the SMARTtest app was high for functionality (M = 4.16 of max 5, SD = 0.85) and helpfulness (M = 6.12 of max 7, SD = 1.09). Participants often used the app as needed, eschewing its use if they felt comfortable conducting the test and interpreting its results. Seventy-eight percent would recommend the app to a friend. Availability of the INSTI Multiplex as a self-test with the accompanying SMARTtest app might increase frequency of HIV and syphilis testing, allowing for earlier detection of infection and reduced transmission.
Collapse
|
13
|
Wango GN, Agot K, Ogolla H, Ochillo M, Ohaga S, Thirumurthy H. Adolescent girls' perception about their ability to safely offer HIV self-test kits to sexual partners: a feasibility study in Siaya County, Kenya. Afr Health Sci 2021; 21:1059-1066. [PMID: 35222567 PMCID: PMC8843252 DOI: 10.4314/ahs.v21i3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Adolescent girls (AG) in sub-Saharan Africa are at elevated risk of acquiring HIV, yet few know the HIV status of their sexual partners. Interventions to promote testing among partners are urgently needed. Objectives To explore AG's perceived ability to safely distribute HIV self-tests to their partners, if partners would self-test, and how to minimize partner violence. Methods We recruited HIV-negative AG ages 15–19 years with a partner of unknown HIV status or who tested negative >6 months previously. Using mixed-methods for data collection and regression and inductive thematic analysis for quantitative and qualitative analysis, respectively, we determined factors associated with the study objectives. Results We enrolled 101 AG, median age 17.3 years, sexual debut 15–16 years, and 54.5% reported ≥2 lifetime partners. Most participants (95.0%) would offer self-tests to their partners and 95.1% reported high-to-moderate chance their partner would self-test. No participant attribute was associated with perceived ability to offer self-test or likelihood of partner testing. To avoid violence, AG recommended politeness, indirect approach, voluntariness, and highlighting advantages of self-testing. Conclusions AG believe they can safely distribute self-tests to their partners, and most partners would self-test, expanding utility of HIV self-tests to include partners of AG.
Collapse
Affiliation(s)
- Gift-Noelle Wango
- Nyanza Initiative for Girls Education and Empowerment, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Henry Ogolla
- Impact Research and Development Organization, Kisumu, Kenya
| | | | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
14
|
Kutner BA, Pho AT, López-Rios J, Lentz C, Dolezal C, Balán IC. Attitudes and Perceptions About Disclosing HIV and Syphilis Results Using Smarttest, a Smartphone App Dedicated to Self- and Partner Testing. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:234-248. [PMID: 34014111 PMCID: PMC8209687 DOI: 10.1521/aeap.2021.33.3.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.
Collapse
Affiliation(s)
- Bryan A. Kutner
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Anthony T. Pho
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, MC5376, Palo Alto, CA 94304, USA
| | - Javier López-Rios
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Cody Lentz
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Curtis Dolezal
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Iván C. Balán
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| |
Collapse
|
15
|
Agot K, Wango GN, Obonyo B, Thirumurthy H. HIV Self-Testing Can Be Liberating to HIV-Positive Women and Their Sexual Partners: A Qualitative Study in Kisumu, Western Kenya. J Int Assoc Provid AIDS Care 2021; 19:2325958220919230. [PMID: 32347143 PMCID: PMC7236088 DOI: 10.1177/2325958220919230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Nearly half of Kenyan men with HIV-positive partners do not know their partner’s
status. We carried out a qualitative substudy to explore the experiences of a sample of
HIV-positive women when distributing HIV self-tests (HIVST) to their sexual
partners. Methods: HIV-positive women were invited for in-depth interviews to share their experiences in
offering HIVST to their partners and how self-testing impacted their relationships. Results: Two hundred ninety-seven women were randomized to HIVST, 12 of whom self-reported being
HIV positive and 11 participated in the interview. Self-testing procedures and
interpretation of results were well understood. Participants were strategic in
approaching their partners, thus avoided partner violence. Couple testing was high,
which strengthened relationships, improved condom use, and empowered women to make joint
decisions concerning their health. Conclusions: Giving HIV-positive women HIVST kits to distribute to their male partners is feasible
and safe. Providers who have challenges reaching male partners with testing should
consider HIVST.
Collapse
Affiliation(s)
- Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Gift-Noelle Wango
- Nyanza Initiative for Girls Education and Empowerment, Kisumu, Kenya
| | | | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
16
|
Wachinger J, Kibuuka Musoke D, Oldenburg CE, Bärnighausen T, Ortblad KF, McMahon SA. "But I Gathered My Courage": HIV Self-Testing as a Pathway of Empowerment Among Ugandan Female Sex Workers. QUALITATIVE HEALTH RESEARCH 2021; 31:443-457. [PMID: 33427073 PMCID: PMC7887607 DOI: 10.1177/1049732320978392] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
HIV self-testing (HIVST) increases HIV testing in diverse populations, but little is known about the experiences of individuals who self-test. We used a five-step framework approach to analyze 62 qualitative interviews with 33 female sex workers (FSWs) participating in an HIVST trial in urban Uganda. Notions of empowerment emerged from the data, and findings were interpreted based on Kabeer's empowerment framework of resources, agency, and achievements. We found that access to HIVST bolstered empowerment because it increased participant's time and money (resources), control of testing circumstances and status disclosure (agency), and sense of competency (achievements). In addition, we found that knowledge of HIV status empowered participants to better control HIV-related behaviors (agency) and recognize a new sense of self (achievements). This suggests that the availability of HIVST can facilitate feelings of empowerment, meriting a higher awareness for benefits outside of linkage to HIV treatment and prevention services.
Collapse
Affiliation(s)
- Jonas Wachinger
- Heidelberg University, Heidelberg, Germany
- Jonas Wachinger, Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | | | | | - Till Bärnighausen
- Heidelberg University, Heidelberg, Germany
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, Durban, South Africa
| | | | - Shannon A. McMahon
- Heidelberg University, Heidelberg, Germany
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
17
|
Broaching the Topic of HIV Self-testing with Potential Sexual Partners Among Men and Transgender Women Who Have Sex with Men in New York and Puerto Rico. AIDS Behav 2020; 24:3033-3043. [PMID: 32239360 DOI: 10.1007/s10461-020-02851-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Men who have sex with men (MSM) and transgender women (TGW) are highly affected by HIV and need novel prevention strategies. Using HIV self-testing (HIVST) kits to screen sexual partners may represent a viable risk-reduction alternative; however, more research is needed on effective strategies for broaching HIVST with partners. In the ISUM study, 136 MSM and TGW were given ten HIVST kits for self- and partner-testing. After 3 months, they returned for a follow-up assessment; thirty participants were also selected for in-depth interviews about their experiences initiating HIVST with partners. Most found proposing HIVST to a diverse array of partners relatively easy. They employed strategies such as joint testing and integrating HIVST into larger discussions about protection and sexual health, with moderate success. Nonetheless, real or anticipated negative partner reactions were a significant barrier. Future research can inform best practices for safely and successfully broaching HIVST with sexual partners.
Collapse
|
18
|
Chen YH, Gilmore HJ, Maleke K, Lane T, Zuma N, Radebe O, Manyuchi AE, McIntyre JA, Lippman SA. Increases in HIV status disclosure and sexual communication between South African men who have sex with men and their partners following use of HIV self-testing kits. AIDS Care 2020; 33:1262-1269. [PMID: 33021097 DOI: 10.1080/09540121.2020.1828564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Availability of HIV self-testing may increase HIV testing frequency among men who have sex with men (MSM). It is unclear, however, if self-testing may impact HIV-related sexual behaviors among MSM, including HIV status disclosure and condom use. We conducted a mixed methods analysis of changes in HIV-related behaviors after HIV self-testing introduction, using data from 110 MSM participating in a feasibility and acceptability study of HIV self-testing in Mpumalanga Province, South Africa. We found increased HIV status disclosure from study participants to sexual partners after HIV self-testing introduction, from 61.8% at baseline to 75.5% at 6-month follow-up (p = 0.04), but decreased condom use with female partners (p = 0.03). Qualitative interviews reveal that some participants used test results to inform condom use. Distribution of self-testing kits can improve mutual disclosure, but should be accompanied by information stressing that the tests may not detect early HIV infections or other sexually transmitted infections.
Collapse
Affiliation(s)
- Yea-Hung Chen
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Timothy Lane
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Equal International, Horsham, UK
| | | | - Oscar Radebe
- Anova Health Institute, Johannesburg, South Africa
| | | | - James A McIntyre
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
19
|
Balán IC, Lopez-Rios J, Dolezal C, Rael CT, Lentz C. Low sexually transmissible infection knowledge, risk perception and concern about infection among men who have sex with men and transgender women at high risk of infection. Sex Health 2020; 16:580-586. [PMID: 31699208 DOI: 10.1071/sh18238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/06/2019] [Indexed: 11/23/2022]
Abstract
Background Amidst an increase in STI rates among men who have sex with men (MSM) and transgender women (TGW), there is little research on STI knowledge, risk perception and concern about infection in these populations. METHODS This mixed-methods study explored these constructs among 60 racially and ethnically diverse MSM and TGW who regularly engage in condomless anal intercourse with multiple partners. RESULTS Participants had a mean age of 40.63 years. Most (95%) identified as a man and as gay or homosexual (73%); 55% were college graduates. Almost half the respondents reported a prior STI. Participants correctly answered a mean of 55.36% and 76.90% STI and HIV knowledge items respectively. STI knowledge was positively correlated with education and prior HIV tests, and was higher among those with a prior STI. During in-depth interviews, some participants expressed concerns about limited knowledge of STIs and syphilis. Half reported low concern about syphilis infection, due to prior treatment that was perceived as relatively simple, lack of STI infection in the past, erroneous information about transmission routes or simply not thinking about it. CONCLUSIONS Among this high-risk sample who perceived themselves to be at low risk of infection, knowledge was primarily gained through being diagnosed and treated for an STI rather than from acquiring knowledge to prevent STI infection. Participants expressed interest in increasing their STI knowledge and recognised the importance of regular STI testing. Dissemination of targeted information about STI prevention, routinising of STI testing and STI self-testing might contribute to decreasing STI infection rates among this population.
Collapse
Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA; and Corresponding author.
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA
| |
Collapse
|
20
|
Shrestha R, Galka JM, Azwa I, Lim SH, Guadamuz TE, Altice FL, Wickersham JA. Willingness to Use HIV Self-Testing and Associated Factors Among Transgender Women in Malaysia. Transgend Health 2020; 5:182-190. [PMID: 32923668 DOI: 10.1089/trgh.2019.0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: While global research on the implementation of HIV self-testing (HIVST) has increased exponentially, few studies have assessed information on HIVST uptake factors (i.e., willingness, preferences) in transgender women (TW) and none in the Malaysian context. We therefore sought to assess willingness to use HIVST among this understudied key population. Methods: A cross-sectional survey was conducted among 361 HIV-negative Malaysian TW in 2017. Participants were recruited using flyers, announcements through social media, and direct referral from staff members of the community-based organizations serving the TW communities. Multivariable logistic regression was used to identify correlates of willingness to use HIVST. Results: Nearly half of the participants (47.6%) reported that they would be willing to use HIVST. Multivariable analysis showed that willingness to use HIVST was positively associated with having experienced sexual assault in childhood (adjusted odds ratio [aOR]=3.239, p<0.001), having ever used mobile phone or apps to find sex work clients (aOR=1.677, p=0.040), and having engaged in condomless sex in the past 6 months (aOR=1.886, p=0.018). In contrast, living in Kuala Lumpur (aOR=0.559, p=0.032), having higher number of sex work clients per day (aOR=0.927, p=0.004), and current depressive symptoms (aOR=0.576, p=0.026) were negatively associated with willingness to use HIVST. Conclusions: Findings in this study suggest that TW in our sample were moderately willing to use HIVST. Especially important here is the increased interest in HIVST among TW who are at higher risk for HIV infection. Overall, our findings underscore the need for additional research on how to most effectively implement HIVST for key populations, including TW, such that uptake and retention in regular HIV screening is sustained.
Collapse
Affiliation(s)
- Roman Shrestha
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Jonathan M Galka
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Iskandar Azwa
- Department of Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine, Infectious Disease Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sin How Lim
- Department of Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thomas E Guadamuz
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand.,Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jeffrey A Wickersham
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Medicine, Infectious Disease Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
21
|
Rael CT, Giguere R, Lopez-Rios J, Lentz C, Balán IC, Sheinfil A, Dolezal C, Brown W, Frasca T, Torres CC, Crespo R, Iribarren S, Leu CS, Febo I, Carballo-Diéguez A. Transgender Women's Experiences Using a Home HIV-Testing Kit for Partner-Testing. AIDS Behav 2020; 24:2732-2741. [PMID: 32193729 DOI: 10.1007/s10461-020-02829-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HIV partner-testing (PT) may represent a unique and empowering HIV prevention strategy for groups that face structural and institutional barriers to HIV testing and care, including transgender women. We report on in-depth interviews (IDIs) with N = 10 transgender women who used HIV self-test kits for three months to screen potential sexual partners in a randomized controlled trial (iSUM; "I'll Show You Mine") that took place in New York City and San Juan, Puerto Rico. Participants were assigned to intervention (supplied with 10 self-test kits immediately) or control groups (received 6 test kits after 3 months). We conducted IDIs with the first N = 10 transgender women to enroll in the intervention group after three months in the study (after participants used kits with partners) to understand their experiences. Themes discussed in IDIs included: partners' reaction to HIV testing, participants' reactions to partners' test results or refusal to test, partners' own reaction to their test results, and decision-making around test use. Data were independently analyzed by two coders. Overwhelmingly, participants' experiences with PT was positive. Participants reported kits were convenient and acceptable to most partners. Transgender women felt that PT could pose additional risk for them; one woman experienced violence related to kit use. Furthermore, the availability of kits appeared to encourage participants and their partners to think about their HIV status and, in some cases, modify sexual behavior. Work suggests that HIV PT could be a viable risk-reduction strategy for transgender women.
Collapse
Affiliation(s)
- Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA.
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - William Brown
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
- Baker Computational Health Science Institute, University of California San Francisco, San Francisco, CA, USA
| | - Timothy Frasca
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Raynier Crespo
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Sarah Iribarren
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| |
Collapse
|
22
|
Balán IC, Lopez-Rios J, Giguere R, Lentz C, Dolezal C, Cruz Torres C, Brown W, Crespo R, Sheinfil A, Tagliaferri Rael C, Febo I, Carballo-Diéguez A. Then We Looked at His Results: Men Who Have Sex With Men from New York City and Puerto Rico Report Their Sexual Partner's Reactions to Receiving Reactive HIV Self-Test Results. AIDS Behav 2020; 24:2597-2605. [PMID: 32078078 DOI: 10.1007/s10461-020-02816-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Secondary distribution of HIV self-tests to sexual partners is acceptable but concerns remain about reactions if a partner tests HIV-positive. We report on 14 participants whose sexual partners tested HIV-positive during the "I'll Show You Mine" Study, a randomized controlled trial (N = 272) of HIV self- and partner-testing among men who have sex with men (MSM) and transgender women (TGW). All 14 were MSM and racial/ethnic minorities, mean age was 36.6 years; 86% were gay-identified. Twenty-four partners tested positive; about half were new partners. Six participants had multiple partners test positive. During in-depth interviews with 10 of these participants, they reported their partners' reactions ranged from tearful and worried among those whose result was unexpected, to resignation among those who suspected a positive result, to nonchalance among partners who participants concluded knew of their HIV infection. After testing, some HIV-positive partners disclosed prior knowledge of their status. No partner reacted violently. Participants typically comforted their partners and encouraged confirmatory testing. Four participants had anal intercourse with partners who tested positive. Participants and partners were able to effectively handle situations in which the partner tested HIV-positive.
Collapse
|
23
|
John SA, López-Rios J, Starks TJ, Rendina HJ, Grov C. Willingness to Distribute HIV Self-Testing Kits to Recent Sex Partners Among HIV-Negative Gay and Bisexual Men and an Examination of Free-Response Data from Young Men Participating in the Nationwide Cohort. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2081-2089. [PMID: 32495242 PMCID: PMC7366497 DOI: 10.1007/s10508-020-01752-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
Sexual minority men (SMM)-and young SMM in particular-are disproportionately affected by HIV. Secondary distribution of HIV self-testing (HIVST) kits-wherein patients deliver kits to partners-is a novel strategy to increase HIV testing access. Using quantitative data, we assessed willingness to distribute HIVST kits to recent sex partners among a U.S. national sample of HIV-negative SMM (n = 786). A thematic analysis was then conducted to identify barriers and facilitators of kit distribution to partners among young SMM (M age = 25.75 years; range: 20-29; n = 165). Overall, 93.5% of SMM (and 97.0% of young SMM) were willing to deliver HIVST kits to recent sex partners. Among young SMM, main barriers and facilitators included concerns about their partners' reaction, availability and cost, protection beliefs for others, HIV stigma and perceived infidelity, packaging and support, communication skill needs, inability to contact partners, requests for anonymity, and dyadic self-testing with their partners. The findings highlight the need for supportive intervention strategies such as informational content for HIVST, using motivational interviewing when providing the testing kits to index clients and providing skills-based training through role-playing exercises. Secondary distribution of HIVST kits through index patients is a potentially acceptable approach that could be used to expand access to HIV testing and aid in efforts to end the HIV epidemic in the U.S.
Collapse
Affiliation(s)
- Steven A John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Javier López-Rios
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, 55 West 125th Street, New York, NY, 10027, USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, 55 West 125th Street, New York, NY, 10027, USA.
| |
Collapse
|
24
|
Carballo-Diéguez A, Giguere R, Balán IC, Dolezal C, Brown W, Lopez-Rios J, Sheinfil A, Frasca T, Rael C, Lentz C, Crespo R, Cruz Torres C, Leu CS, Febo I. Few Aggressive or Violent Incidents are Associated with the Use of HIV Self-tests to Screen Sexual Partners Among Key Populations. AIDS Behav 2020; 24:2220-2226. [PMID: 32030526 DOI: 10.1007/s10461-020-02809-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Men who have sex with men and transgender women who had multiple sexual partners in the prior 3 months participated in ISUM, a randomized, controlled trial of self- and partner-testing in New York City and San Juan, PR. Only 2% of screened participants were ineligible to enroll due to anticipating they would find it very hard to avoid or handle violence. The intervention group received free rapid HIV self-test kits. During the trial, 114 (88%) of intervention participants who were assessed at follow-up used self-tests with at least one potential partner. Only 6% of participants who asked a partner in person to test reported that at least one of their partners got physically violent, some in the context of sex work. In total, 16 (2%) partners reacted violently. Post-trial, only one participant reported finding it very hard to handle violence, and none found it very hard to avoid potential violence.
Collapse
Affiliation(s)
- Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - William Brown
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, USA
- Center for Vulnerable Populations At Zuckerberg San Francisco General Hospital and Trauma Center, Department of Medicine, University of California San Francisco, San Francisco, USA
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse, USA
| | - Timothy Frasca
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Christine Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Raynier Crespo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| |
Collapse
|
25
|
Carballo-Diéguez A, Giguere R, Balán IC, Brown W, Dolezal C, Leu CS, Lopez Rios J, Sheinfil AZ, Frasca T, Rael CT, Lentz C, Crespo R, Iribarren S, Cruz Torres C, Febo I. Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study. AIDS Behav 2020; 24:1929-1941. [PMID: 31853772 PMCID: PMC7771229 DOI: 10.1007/s10461-019-02763-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ISUM ("I'll show you mine") was a randomized controlled trial in which 272 transgender women and men who have sex with men in New York, NY (NYC) and San Juan, Puerto Rico (SJU) were assigned to an intervention group (n = 136), in which they had access to free HIV self-testing (ST) kits, or to a control group (n = 136). The trial aimed to determine whether the intervention group would use ST to screen sexual partners and have fewer condomless anal intercourse (CAI) occasions with serodiscordant or unknown status partners than the control group. The intervention group had on average 10 (32%) fewer CAI occasions; though clinically relevant, this difference fell short of statistical significance (p = .08). In NYC (n = 166) intervention participants had significantly fewer CAI occasions, whereas in SJU (n = 106) they reported non-significantly more CAI occasions. Two devastating hurricanes hit SJU during the study and may have impacted results in unmeasured ways.
Collapse
Affiliation(s)
- Alex Carballo-Diéguez
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Rebecca Giguere
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Iván C Balán
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - William Brown
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Curtis Dolezal
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cheng-Shiun Leu
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Biostatistics (in Psychiatry), Columbia University Medical Center, New York, NY, USA
| | - Javier Lopez Rios
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Timothy Frasca
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Christine Tagliaferri Rael
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Raynier Crespo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Sarah Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| |
Collapse
|
26
|
SMARTtest: A Smartphone App to Facilitate HIV and Syphilis Self- and Partner-Testing, Interpretation of Results, and Linkage to Care. AIDS Behav 2020; 24:1560-1573. [PMID: 31679075 DOI: 10.1007/s10461-019-02718-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Acceptability of rapid HIV self-testing is high but potential users remain concerned about correct use, interpretation of test results, and linkage to care. This article describes user preferences for a smartphone app to mitigate these challenges and how these were integrated into the SMARTtest app to support self- and partner-testing using the INSTI Multiplex®. Sixty men and transgender women who have sex with men self-tested for HIV and syphilis while guided by a prototype app that provided a video, pictorial step-by-step instructions, and sample test results presented textually ("positive," "negative"). Subsequently, participants provided feedback on revisions and additional app content. Participants recommended offering different user modes (self, partner, both), and retaining the video, step-by-step instructions, and textual test results. They strongly favored the ability to save and send test results to sexual partners or providers. These features were integrated into the SMARTtest app to facilitate HIV/syphilis self- and partner-testing, HIV/syphilis status awareness and disclosure, and linkage to care.
Collapse
|
27
|
Hidayat R, Marguari D, Hairunisa N, Suparno H, Magnani R. Community HIV Screening Among MSM in Three Indonesian Cities. Curr HIV Res 2020; 17:65-71. [PMID: 30907323 DOI: 10.2174/1570162x17666190321115419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Indonesia lags behind its peers with regard to ART coverage of PLHIV. Insufficient HIV testing among MSM and other key affected populations remains a barrier to increasing ART coverage. OBJECTIVE This report presents the results of the first government-endorsed implementation research study of a community screening approach to increasing the rate of HIV testing among MSM in three cities. METHODS All new MSM outreach contacts meeting eligibility criteria during March-June 2017 were included in the study. HIV testing at a government health facility, which is required to qualify for government-supported ART, was advised for all new contacts. Men refusing formal testing were offered an HIV screening test in a community setting using a saliva-based rapid test and advised to get a confirmatory test at a health facility. All outreach contacts and testing activities were recorded on individual client records. RESULTS Of 1,149 eligible MSM, 27% were willing to be referred to receive HIV testing at a health facility, among which 83% were confirmed to have been tested. Of the 838 study subjects refusing health facility testing, 38% accepted community screening. The screening positivity rate was 14.8%. Only 38% of men with reactive screening tests received a confirmatory test at a health facility, along with 8% of those with non-reactive tests. CONCLUSION While community screening resulted in more MSM knowing their HIV status, reluctance to avail government health facility-based services, or indeed to be tested at all, must be addressed if community screening is to accelerate progress in getting HIV-positive MSM onto treatment.
Collapse
Affiliation(s)
| | | | - Nany Hairunisa
- Yayasan Spiritia, Jakarta, Indonesia.,Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Heru Suparno
- Health Research Center, University of Indonesia, Jakarta, Indonesia
| | - Robert Magnani
- AIDS Research Center, Atma Jaya Catholic University, Jakarta, Indonesia
| |
Collapse
|
28
|
Fan S, Liu Z, Luo Z, Yu M, Ouyang L, Gong H, Ding Y, Li P, Yuan T, Zhou Y, Wu G, Zou H. Effect of availability of HIV self-testing on HIV testing frequency among men who have sex with men attending university in China (UniTest): protocol of a stepped-wedge randomized controlled trial. BMC Infect Dis 2020; 20:149. [PMID: 32070297 PMCID: PMC7029612 DOI: 10.1186/s12879-020-4807-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background HIV testing plays a central role in the combat against HIV. We aimed to determine if the availability of HIV self-testing (HIVST) would increase the frequency of testing among men who have sex with men (MSM) attending university in China. Methods A stepped wedge randomized controlled trial will be conducted in 4 provinces in China: Chongqing, Guangdong, Shandong, and Tianjin. Eligibility assessment will include (1) male, aged 16 years or older, (2) university student (technical diploma and undergraduate students), (3) MSM (sexual behaviors including mutual masturbation, oral sex, and anal sex), (4) HIV negative, and (5) willing to provide informed consent. Participants will be randomly allocated to HIV self-testing intervention with free HIVST kits in every 30 days according to the intervention waiting lists with a computer-generated randomized sequence. All participants will complete a self-administrated online questionnaire onsite at baseline and 12-month follow-up and complete an online questionnaire at 4- and 8-month. The primary outcome is the effect of HIVST on HIV testing frequency. Secondary outcomes include the change in sexual behaviors and HIV incidence. Discussion No previous study had measured the effect of social media based HIVST intervention on the change in HIV testing behaviors, sexual behaviors and incident HIV infection among MSM attending university in China. Findings from this study will provide evidence for further interventional practice promotions and prevention strategies scale-up, including HIV testing, pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), and sexual partner serosorting. Trial registration Chinese Clinical Trial Registry: ChiCTR1900020645. Registered 11 January 2019.
Collapse
Affiliation(s)
- Song Fan
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,School of Public Health, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhongquan Liu
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhenzhou Luo
- Nanshan District Center for Chronic Disease Control, Shenzhen, 518000, China
| | - Maohe Yu
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, 300011, China
| | - Lin Ouyang
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Hui Gong
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, 300011, China
| | - Yi Ding
- Nanshan District Center for Chronic Disease Control, Shenzhen, 518000, China
| | - Peiyang Li
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 510006, Guangdong, China
| | - Yepeng Zhou
- Foshan Pengyou AIDS Prevention Care Center, Foshan, 528000, Guangdong, China
| | - Guohui Wu
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 510006, Guangdong, China. .,Kirby Institute, University of New South Wales, Sydney, Australia. .,School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| |
Collapse
|
29
|
Giguere R, Lopez-Rios J, Frasca T, Lentz C, Balán IC, Dolezal C, Rael CT, Brown W, Sheinfil AZ, Cruz Torres C, Crespo R, Febo I, Carballo-Diéguez A. Use of HIV Self-Testing Kits to Screen Clients Among Transgender Female Sex Workers in New York and Puerto Rico. AIDS Behav 2020; 24:506-515. [PMID: 31865516 DOI: 10.1007/s10461-019-02730-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transgender female sex workers (TFSW) are highly affected by HIV, with a global prevalence of 27%. HIV self-testing (HIVST) to screen sexual partners has helped men who have sex with men and female sex workers make informed sexual decisions and avoid HIV exposure. This is the first report on TFSW's experiences screening clients using HIVST. Ten TFSW were each given ten HIVST kits and returned after 3 months to complete an online questionnaire and undergo an interview. Eight of them reported using HIVST with potential partners. Among fifty potential partners who were asked in person to test, 42 (84%) were clients. Thirty-four out of fifty (68%) accepted and 16 (32%) refused. Very few violent incidents occurred, and participants felt empowered by offering HIVST to others. Nevertheless, HIVST market cost was prohibitive for future use. HIVST use with clients could be feasible for TFSW if the cost were lowered or subsidized.
Collapse
|
30
|
Gohil J, Baja ES, Sy TR, Guevara EG, Hemingway C, Medina PMB, Coppens L, Dalmacion GV, Taegtmeyer M. Is the Philippines ready for HIV self-testing? BMC Public Health 2020; 20:34. [PMID: 31918706 PMCID: PMC6953179 DOI: 10.1186/s12889-019-8063-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Philippines is facing a rapidly rising HIV epidemic among young men who have sex with men (MSM). Testing rates among young populations is poor. HIV self-testing (HIVST) is a promising strategy to address this testing gap. The study's purpose was to explore the perceived acceptability, feasibility and programmatic challenges of HIVST among key informants and target users. METHOD A qualitative study involving semi-structured interviews and focus group discussions (FGD). We interviewed 15 key informants involved with HIV testing programs or policies and 42 target users in six FGD in Metro Manila. We held separate discussions with high socio-economic MSM (n = 12), urban poor MSM (n = 15) and transgender women (TGW) (n = 15). Results were analysed using a thematic framework approach. RESULTS MSM and TGW welcomed the convenience and privacy HIVST could provide. They preferred an inexpensive accurate blood-based kit attained from reputable sites. Key informants at national and local level equally welcomed HIVST but identified a number of policy and regulatory issues. Both groups articulated the challenge of enrolling those who test reactive using HIVST to further testing and treatment in an environment characterised by acute stigma around HIV. CONCLUSIONS HIVST was found to be highly acceptable to target users and was welcomed as an additional testing approach at national level. Strategic alliances are now needed between stakeholders to proactively deliver a patient-centred HIVST program that could provide an effective, safe means of increasing testing coverage in this escalating context.
Collapse
Affiliation(s)
- Jesal Gohil
- Department of Medicine, The Royal London Hospital, London, UK
| | - Emmanuel S Baja
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - Tyrone Reden Sy
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - Ernest Genesis Guevara
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines
| | - Charlotte Hemingway
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool, L3 5QA, UK
| | - Paul Mark B Medina
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - Leila Coppens
- World Health Organization (WHO) Philippines, Manila, Philippines
| | - Godofreda V Dalmacion
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines-Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines-Manila, Manila, Philippines.,Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool, L3 5QA, UK.
| |
Collapse
|
31
|
MacGowan RJ, Chavez PR, Borkowf CB, Owen SM, Purcell DW, Mermin JH, Sullivan PS. Effect of Internet-Distributed HIV Self-tests on HIV Diagnosis and Behavioral Outcomes in Men Who Have Sex With Men: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:117-125. [PMID: 31738378 PMCID: PMC6865312 DOI: 10.1001/jamainternmed.2019.5222] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Undiagnosed HIV infection results in delayed access to treatment and increased transmission. Self-tests for HIV may increase awareness of infection among men who have sex with men (MSM). OBJECTIVE To evaluate the effect of providing HIV self-tests on frequency of testing, diagnoses of HIV infection, and sexual risk behaviors. DESIGN, SETTING, AND PARTICIPANTS This 12-month longitudinal, 2-group randomized clinical trial recruited MSM through online banner advertisements from March through August 2015. Those recruited were at least 18 years of age, reported engaging in anal sex with men in the past year, never tested positive for HIV, and were US residents with mailing addresses. Participants completed quarterly online surveys. Telephone call notes and laboratory test results were included in the analysis, which was completed from August 2017 through December 2018. INTERVENTIONS All participants had access to online web-based HIV testing resources and telephone counseling on request. Participants were randomized in a 1:1 ratio to the control group or a self-testing (ST) group, which received 4 HIV self-tests after completing the baseline survey with the option to replenish self-tests after completing quarterly surveys. At study completion, all participants were offered 2 self-tests and 1 dried blood spot collection kit. MAIN OUTCOMES AND MEASURES Primary outcomes were HIV testing frequency (tested ≥3 times during the trial) and number of newly identified HIV infections among participants in both groups and social network members who used the study HIV self-tests. Secondary outcomes included sex behaviors (eg, anal sex, serosorting). RESULTS Of 2665 participants, the mean (SD) age was 30 (9.6) years, 1540 (57.8%) were white, and 443 (16.6%) had never tested for HIV before enrollment. Retention rates at each time point were more than 54%, and 1991 (74.7%) participants initiated 1 or more follow-up surveys. More ST participants reported testing 3 or more times during the trial than control participants (777 of 1014 [76.6%] vs 215 of 977 [22.0%]; P < .01). The cumulative number of newly identified infections during the trial was twice as high in the ST participants as the control participants (25 of 1325 [1.9%] vs 11 of 1340 [0.8%]; P = .02), with the largest difference in HIV infections identified in the first 3 months (12 of 1325 [0.9%] vs 2 of 1340 [0.1%]; P < .01). The ST participants reported 34 newly identified infections among social network members who used the self-tests. CONCLUSIONS AND RELEVANCE Distribution of HIV self-tests provides a worthwhile mechanism to increase awareness of HIV infection and prevent transmission among MSM. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02067039.
Collapse
Affiliation(s)
| | | | - Craig B Borkowf
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Michele Owen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David W Purcell
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | |
Collapse
|
32
|
Korte JE, Strauss M, Ba A, Buregyeya E, Matovu JKB, Kisa R, Musoke W, Chemusto H, Vrana-Diaz CJ, Malek AM, Wanyenze RK, George G. HIV testing preferences among pregnant women attending antenatal care and their male partners: a discrete choice experiment in Uganda. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2019; 18:332-340. [PMID: 31779576 PMCID: PMC6890225 DOI: 10.2989/16085906.2019.1686032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
HIV testing rates remain stubbornly low among men - a crucial target population for reaching the ambitious global and regional goals of the HIV programme. In an era of declining donor funding, identifying cost-effective strategies to increase testing rates amongst men remains paramount. Antenatal care is an effective entry-point for the delivery of HIV testing services for women, and partner testing presents an important opportunity to reach their male partners. We present the results of a discrete choice experiment in Uganda, examining preferences among 824 pregnant women and 896 male partners regarding service delivery characteristics of HIV testing. Both men and women preferred nurse administered testing to self-testing (OR = 0.835; p < 0.001), oral testing over a finger-prick test (OR = 1.176; p < 0.001) and testing with a partner over testing alone (OR = 1.230; p < 0.001). Men had a preference for testing at home compared to testing at a clinic (OR = 1.099; p = 0.024), but women were indifferent regarding the testing location. The cost of testing had the biggest effect on preferences. Free testing was preferred over a cost of US$2.90 (OR = 0.781; p < 0.001) or US$2.00 (OR = 0.670; p < 0.001). Offering an incentive of US$3.40 increased men's preferences compared to a free test (OR = 1.168; p < 0.001), although this did not affect women's preferences. Partner testing linked to antenatal care is a potential strategy to increase testing coverage among men, particularly given the preference for partner testing - provided costs to clients remain low. Future cost-effectiveness evaluations should investigate the economic impact of reaching men using these strategies.
Collapse
Affiliation(s)
- Jeffrey E. Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Aissatou Ba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | | | | | - Rose Kisa
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Caroline J. Vrana-Diaz
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | | | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
33
|
Using a Social Network Strategy to Distribute HIV Self-Test Kits to African American and Latino MSM. J Acquir Immune Defic Syndr 2019; 79:38-45. [PMID: 29771792 DOI: 10.1097/qai.0000000000001726] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) continue to be disproportionately impacted globally by the HIV epidemic. Studies suggest that HIV self-testing (HIVST) is highly acceptable among MSM. Social network strategies to increase testing are effective in reaching MSM, particularly MSM of color, who may not otherwise test. We tested a social network-based strategy to distribute HIVST kits to African American MSM (AAMSM) and Latino MSM (LMSM). SETTING This study was conducted in Alameda County, California, a large, urban/suburban county with an HIV epidemic mirroring the national HIV epidemic. METHODS From January 2016 to March 2017, 30 AAMSM, LMSM, and transgender women were trained as peer recruiters and asked to distribute 5 self-test kits to MSM social network members and support those who test positive in linking to care. Testers completed an online survey after their test. We compared peer-distributed HIVST testing outcomes to outcomes from Alameda County's targeted, community-based HIV testing programs using χ tests. RESULTS Peer-distributed HIVST to 143 social and sexual network members, of whom 110 completed the online survey. Compared with MSM who used the County's sponsored testing programs, individuals reached through the peer-based self-testing strategy were significantly more likely to have never tested for HIV (3.51% vs. 0.41%, P < 0.01) and to report a positive test result (6.14% vs. 1.49%, P < 0.01). CONCLUSION Findings suggest that a network-based strategy for self-test distribution is a promising intervention to increase testing uptake and reduce undiagnosed infections among AAMSM and LMSM.
Collapse
|
34
|
HIV Self-Testing Increases HIV Testing Frequency in High-Risk Men Who Have Sex With Men: A Randomized Controlled Trial. J Acquir Immune Defic Syndr 2019; 78:505-512. [PMID: 29697595 DOI: 10.1097/qai.0000000000001709] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Self-testing may increase HIV testing and decrease the time people with HIV are unaware of their status, but there is concern that absence of counseling may result in increased HIV risk. SETTING Seattle, Washington. METHODS We randomly assigned 230 high-risk HIV-negative men who have sex with men to have access to oral fluid HIV self-tests at no cost versus testing as usual for 15 months. The primary outcome was self-reported number of HIV tests during follow-up. To evaluate self-testing's impact on sexual behavior, we compared the following between arms: non-HIV-concordant condomless anal intercourse and number of male condomless anal intercourse partners in the last 3 months (measured at 9 and 15 months) and diagnosis with a bacterial sexually transmitted infection (STI: early syphilis, gonorrhea, and chlamydial infection) at the final study visit (15 months). A post hoc analysis compared the number of STI tests reported during follow-up. RESULTS Men randomized to self-testing reported significantly more HIV tests during follow-up (mean = 5.3, 95% confidence interval = 4.7 to 6.0) than those randomized to testing as usual (3.6, 3.2 to 4.0; P < 0.0001), representing an average increase of 1.7 tests per participant over 15 months. Men randomized to self-testing reported using an average of 3.9 self-tests. Self-testing was noninferior with respect to all markers of HIV risk. Men in the self-testing arm reported significantly fewer STI tests during follow-up (mean = 2.3, 95% confidence interval = 1.9 to 2.7) than men in the control arm (3.2, 2.8 to 3.6; P = 0.0038). CONCLUSIONS Access to free HIV self-testing increased testing frequency among high-risk men who have sex with men and did not impact sexual behavior or STI acquisition.
Collapse
|
35
|
Can Women Safely Distribute HIV Oral Self-test Kits to Their Sexual Partners? Results From a Pilot Study in Kenya. J Acquir Immune Defic Syndr 2019; 78:e39-e41. [PMID: 29683990 DOI: 10.1097/qai.0000000000001708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
36
|
Tang W, Huang W, Lu H, Cao B, Wu D, Ong J, Fu H, Zhang Y, Yang B, Wang C, Ma W, Wei C, Tucker JD. What happens after HIV self-testing? Results from a longitudinal cohort of Chinese men who have sex with men. BMC Infect Dis 2019; 19:807. [PMID: 31521123 PMCID: PMC6744670 DOI: 10.1186/s12879-019-4455-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) is a promising approach to expand HIV testing. HIVST is a process in which a person performs an HIV test and interprets the result. Negative HIVST results may encourage men who have sex with men (MSM) to use HIV prevention services. The objective of this study was to examine behaviors (e.g., facility-based HIV testing, condom use) after a negative HIVST test result among Chinese MSM. METHODS We collected data from MSM in eight Chinese cities over a 12-month period. This is a secondary analysis of longitudinal cohort data collected as part of an intervention trial to increase HIV testing. Men completed a survey that described sociodemographic information, sexual behaviors, HIV self-testing, and facility-based HIV testing. Men who completed at least one follow-up survey were included in this analysis. Generalized linear mixed models were used to evaluate whether HIVST increased subsequent facility-based HIV testing and consistent condom use. RESULTS We included 1219 men. Most men (78.7%) were under 30 years old and had never been married (87.0%). 755 (61.9%) men tested for HIV and 593 (49.3%) men self-tested during the study period. At baseline, among men who had never been tested for HIV, 44.9% (314/699) initiated HIVST during the study period. HIVST was associated with subsequent facility-based testing (aOR of 1.87, 95% CI: 1.47-2.37). HIVST was also associated with subsequent consistent condom use (aOR = 1.53, 95% CI: 1.13-2.06). CONCLUSION HIVST was associated with subsequent facility-based HIV testing and consistent condom use. HIVST may enhance uptake of related HIV prevention services at facilities, suggesting the need for more implementation research.
Collapse
Affiliation(s)
- Weiming Tang
- Dermatology Hospital, Southern Medical University Guangzhou, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
| | - Wenting Huang
- Dermatology Hospital, Southern Medical University Guangzhou, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
- SESH Study Group, Guangzhou, China
| | - Haidong Lu
- SESH Study Group, Guangzhou, China
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bolin Cao
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
- SESH Study Group, Guangzhou, China
- College of Mass Communication, Shenzhen University, Shenzhen, China
| | - Dan Wu
- Dermatology Hospital, Southern Medical University Guangzhou, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
- SESH Study Group, Guangzhou, China
| | - Jason Ong
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
- SESH Study Group, Guangzhou, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Ye Zhang
- Dermatology Hospital, Southern Medical University Guangzhou, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University Guangzhou, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University Guangzhou, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | | | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095 China
- SESH Study Group, Guangzhou, China
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
37
|
John SA, Cain D, Bradford-Rogers J, Rendina HJ, Grov C. Gay and bisexual men's experiences using self-testing kits for HIV and rectal and urethral bacterial sexually transmitted infections: Lessons learned from a study with home-based testing. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2019; 31:308-318. [PMID: 32983310 PMCID: PMC7518382 DOI: 10.1080/19317611.2019.1645075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 06/11/2023]
Abstract
This study investigated the experiences of gay, bisexual, and other men who have sex with men (GBM) conducting HIV and sexually transmitted infection (STI) self-testing procedures. We analyzed mixed-methods data from 11 GBM who self-tested HIV-positive and 1,070 HIV-negative GBM who completed the HIV self-testing and STI self-sampling procedures. Nearly all (99%) reported ease in urine-based STI self-sampling and most (90%) found rectal swab self-collection easy. Most (94%) checked their rapid-HIV self-testing results during the correct window (20-40 minutes), and nearly all (99%) trusted their HIV results. Recommendations for future self-testing procedures are provided based on findings from free-response data.
Collapse
Affiliation(s)
- Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Demetria Cain
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Jesse Bradford-Rogers
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - H. Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy; The CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| |
Collapse
|
38
|
Nayak S, Guo T, Lopez-Rios J, Lentz C, Arumugam S, Hughes J, Dolezal C, Linder V, Carballo-Diéguez A, Balán IC, Sia SK. Integrating user behavior with engineering design of point-of-care diagnostic devices: theoretical framework and empirical findings. LAB ON A CHIP 2019; 19:2241-2255. [PMID: 31168548 PMCID: PMC6592761 DOI: 10.1039/c9lc00188c] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
With point-of-care (POC) diagnostic devices becoming increasingly available to untrained users, it will be critical to understand how real-world user behavior can best inform and guide the engineering design process. Social sciences present frameworks for analyzing user behavior, but they have not yet been applied to POC diagnostics in a methodical manner. Here, we develop a framework that synthesizes two models that can collectively account for user behavior and experience with POC diagnostic devices: a social psychological information-motivation-behavior (IMB) model (first described by Fisher and Fisher) for identifying determinants for health-related behavior, and user experience (UX) elements for studying interactions between users and products. Based on studies of 40 naïve users of our smartphone-enabled microfluidics device that can be used for HIV home-testing, we found that untrained participants could perform 90% of steps correctly, with engineering design elements that provided feedback that was either direct (e.g., a light or click) or binary (e.g., a switch) enhancing usability. Interestingly, of the steps performed incorrectly, over 70% were due not to errors in the device or user operation, but user-to-user variability (e.g. time in collecting fingerstick and force applied to initiate vacuum), which could be addressed by further modifications to the device. Overall, this study suggests that microfluidic POC HIV home-testing is likely to benefit from smartphone integration, and that engineering design of POC diagnostic devices can benefit from a structured evaluation of user behavior and experience, as guided by a social-psychological framework, which emphasizes user credibility, accessibility, acceptability, usability, and value.
Collapse
Affiliation(s)
- Samiksha Nayak
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Tiffany Guo
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Siddarth Arumugam
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Joshua Hughes
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Vincent Linder
- OPKO Diagnostics, LLC, 4 Constitution Way, Suite E, Woburn, MA, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Iván C. Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Samuel K. Sia
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| |
Collapse
|
39
|
Recruiting vulnerable populations to participate in HIV prevention research: findings from the Together 5000 cohort study. Ann Epidemiol 2019; 35:4-11. [PMID: 31182379 DOI: 10.1016/j.annepidem.2019.05.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/12/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the article was to examine factors associated with completing enrollment milestones in the Together 5000 cohort of at-risk men (n = 8661), transmen (n = 53), and transwomen (n = 63) who have sex with men. METHODS Between 2017 and 2018, participants completed an online enrollment survey and were offered opportunities to complete an incentivized secondary online survey as well as self-administered at-home HIV testing (OraSure). We explored factors associated with completing each study component. RESULTS In total, 8777 individuals completed our enrollment survey, 6166 (70.3%) completed the secondary survey, and 5010 returned the at-home HIV test kit that was mailed to them (81.3% of those mailed a kit). In our multivariable models, those who were White, with more years of education, were more likely to complete study components, although the magnitude of these associations was small. For example, 50.9% of those enrolled, 47.9% of those completing the secondary survey, and 46.8% of those completing HIV testing were persons of color-a statistically significant, but meaningfully insignificant decline. CONCLUSIONS These findings highlight the need for researchers to identify barriers that may prevent persons of color and younger individuals from participating in research studies.
Collapse
|
40
|
Wulandari LPL, Ruddick A, Guy R, Kaldor J. "Self-testing sounds more private, rather than going to the clinic and everybody will find out": Facilitators and barriers regarding HIV testing among men who purchase sex in Bali, Indonesia. PLoS One 2019; 14:e0214987. [PMID: 30958845 PMCID: PMC6453456 DOI: 10.1371/journal.pone.0214987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/25/2019] [Indexed: 12/29/2022] Open
Abstract
In many Asian countries, men who purchase sex account for the largest single network of people which often face elevated HIV risk in relation to the general population. However, high proportions of these men have never undertaken HIV testing. We assessed barriers to and facilitators of HIV testing among men who purchase sex in Indonesia, including the acceptability of HIV self-testing. A qualitative study was conducted during December 2016-January 2017 at fourteen sex-work venues and one voluntary HIV counselling and testing (VCT) clinic in Bali. Interviews were conducted with men who purchase sex exploring the men's views on HIV testing. Data were examined using thematic analysis. Twenty-nine men participated in the study. The themes that emerged regarding the barriers to HIV testing included fear of potential shame, embarrassment, and confidentiality breach in accessing HIV testing; fear of social exclusion if the test result was positive; self-treatment and prevention; the distance to a clinic; time constraints; and fear of an invasive testing method. Factors that were seen as facilitating a test were the convenience of time and place; the provision of speedy results; and privacy. Participants expressed interest in HIV self-testing and preferred it to clinic-based testing due to the privacy and confidentiality of the results. The findings support the introduction of an HIV self-testing strategy among this group to improve access to HIV testing.
Collapse
Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
- * E-mail: ,
| | - Abby Ruddick
- Independent Consultant, Denpasar, Bali, Indonesia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
41
|
Otiashvili D, Kirtadze I, Vardanashvili I, Tabatadze M, Ober AJ. Perceived acceptability of and willingness to use syringe vending machines: results of a cross-sectional survey of out-of-service people who inject drugs in Tbilisi, Georgia. Harm Reduct J 2019; 16:21. [PMID: 30898120 PMCID: PMC6429706 DOI: 10.1186/s12954-019-0292-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background The growing HIV epidemic in Eastern Europe and Central Asia has been driven by high rates of injection drug use. The Republic of Georgia has among the highest injection drug use rates globally, with a prevalence of 2.24%. The reach of evidence-based HIV prevention interventions like needle and syringe programs (NSP) among people who inject drugs (PWID) has remained below rates that could significantly impact the epidemic. Syringe vending machines (SVM) are an effective and cost-effective supplement to standard NSP; if acceptable to PWID, SVM could reach hard-to-reach PWID and cover geographic areas where fixed or mobile NSPs do not operate. The aim of this study was to assess the perceived acceptability of SVM among out-of-service (harm reduction or substance use treatment) PWID in Tbilisi, Georgia. Methodology Participants were recruited using respondent-driven sampling (RDS) to participate in cross-sectional, face-to-face interviews. We conducted individual interviews using a structured questionnaire that covered participants’ socio-demographics, drug use practices, and perceived acceptability of SVM. Uni-variate analyses were employed for data analysis. Results The final sample (n = 149) was almost exclusively male with a mean age of 42.2 years and mean years of injection drug use of 14.4 years. Heroin, buprenorphine, and stimulants were the main drugs injected. Eighty-five percent of the sample had never received any harm reduction services, and 30% had never been tested for HIV. Fifteen percent of the sample reported sharing injection equipment with others during last month. All but one participant agreed that PWID would benefit from SVM and 145 (97%) said they would personally use SVM. Ninety percent of those sampled stated that they would use HIV self-tests if available from vending machines. The most highly endorsed features of SVM were provision of free injection equipment, no need to deal with pharmacies, uninterrupted 24/7 access, and availability of HIV self-testing kits. Discussion Perceived acceptability of syringe vending machines was extremely high among PWID not currently receiving any harm reduction or treatment services, with strong support indicated for uninterrupted free access to sterile injection equipment, privacy, and anonymity. Introducing SVM in Georgia holds the potential to deliver significant public health benefits by attracting hard-to-reach PWID, reducing unsafe injection behavior, and contributing to HIV testing uptake and linkage to care.
Collapse
Affiliation(s)
- David Otiashvili
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177, Tbilisi, Georgia.
| | - Irma Kirtadze
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177, Tbilisi, Georgia.,School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162, Tbilisi, Georgia
| | - Irina Vardanashvili
- School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162, Tbilisi, Georgia
| | - Mzia Tabatadze
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177, Tbilisi, Georgia.,School of Business, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162, Tbilisi, Georgia
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| |
Collapse
|
42
|
Hill AO, Bavinton BR, Armstrong G. Prevalence and correlates of lifetime and recent HIV testing among men who have sex with men (MSM) who use mobile geo-social networking applications in Greater Tokyo. PLoS One 2019; 14:e0209933. [PMID: 30673729 PMCID: PMC6343926 DOI: 10.1371/journal.pone.0209933] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 12/18/2022] Open
Abstract
Men who have sex with men (MSM) are disproportionately burdened by the human immunodeficiency virus (HIV), accounting for 78% of all Japanese male HIV cases in 2016. Over 30% of newly identified HIV infections in Japan are diagnosed as AIDS annually, suggesting a large proportion of people living with HIV were unaware of their own infection status. An estimated two-thirds of Japanese men who have sex with men (MSM) are not attached to the gay community, and previous studies have largely sampled gay venues, thus, previous studies have likely failed to reach many men in this population. This study therefore examined HIV testing prevalence and correlates among MSM in Greater Tokyo who use gay mobile geo-social networking applications (gay mobile apps), which have been found to increase access to MSM not traditionally accessible through venue-based surveys. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, the prevalence of lifetime and six-monthly HIV testing was 72.8% and 29.7% respectively. In multiple regression analysis, higher lifetime HIV testing was associated with older age, education, HIV knowledge, anal intercourse with regular and casual male partners, and gay venue attendance. Testing was negatively associated with regular male partner condom use, marriage, residing outside central Tokyo and having both male and female partners. These results indicated that MSM who use gay mobile apps in Greater Tokyo do not meet the CDC yearly testing recommendations for high risk populations. Considering limited HIV prevention funding in Japan for MSM, moderate lifetime and recent testing, and the large number of gay mobile app users, utilization of popular gay mobile apps to promote nearby HIV testing facilities may be an effective prevention policy to target non-community attached MSM, particularly at-risk youth and individuals at risk of sudden-onset AIDS.
Collapse
Affiliation(s)
- Adam O. Hill
- Faculty of Arts, School of Social and Political Sciences, University of Melbourne, Parkville, VIC, Australia
| | | | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
43
|
Lippman SA, Gilmore HJ, Lane T, Radebe O, Chen YH, Mlotshwa N, Maleke K, Manyuchi AE, McIntyre J. Ability to use oral fluid and fingerstick HIV self-testing (HIVST) among South African MSM. PLoS One 2018; 13:e0206849. [PMID: 30408055 PMCID: PMC6224086 DOI: 10.1371/journal.pone.0206849] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/19/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND HIV self-testing (HIVST) may increase HIV testing uptake, facilitating earlier treatment for key populations like MSM who experience barriers accessing clinic-based HIV testing. HIVST usability among African MSM has not been explored. METHODS We assessed usability of oral fluid (OF) and fingerstick (FS; blood) HIVST kits during three phases among MSM with differing degrees of HIVST familiarity in Mpumalanga, South Africa. In 2015, 24 HIVST-naïve MSM conducted counselor-observed OF and FS HIVST after brief demonstration. In 2016 and 2017, 45 and 64 MSM with experience using HIVST in a pilot study chose one HIVST to conduct with a counselor-observer present. In addition to written, the latter group had access to video instructions. We assessed frequency of user errors and reported test use ease, changes in error frequency by phase, and covariates associated with correct usage using log-Poisson and Gaussian generalized estimating equations. RESULTS Among OF users (n = 57), 15-30% committed errors in each phase; however, observers consistently rated participants as able to test alone. Among FS users (n = 100), observers noted frequent errors, most commonly related to blood collection and delivery. We found suggestive evidence (not reaching statistical significance) that user errors decreased, with 37.5%, to 28.1%, and 18.2% committing errors in phases I, II, and III, respectively (p-value:0.08), however observer concerns remained constant. Ease and confidence using HIVST increased with HIV testing experience. Participants using three HIVST were more likely (RR:1.92, 95% CI:1.32, 2.80) to report ease compared to those without prior HIVST experience. Never testers (RR:0.66, 95% CI:0.44-0.99) reported less ease performing HIVST compared to participants testing in the past six months. CONCLUSIONS MSM were able to perform the OF test. Fingerstick test performance was less consistent; however preference for fingerstick was strong and performance may improve with exposure and instructional resources. Continued efforts to provide accessible instructions are paramount.
Collapse
Affiliation(s)
- Sheri A. Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Hailey J. Gilmore
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Tim Lane
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Oscar Radebe
- Anova Health Institute, Johannesburg, South Africa
| | - Yea-Hung Chen
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | | | | | | | - James McIntyre
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
44
|
Zhao Y, Zhu X, Pérez AE, Zhang W, Shi A, Zhang Z, Gao P, Wang J, Yang C, Zaller N, Sun Y, Operario D, Zhang H. MHealth approach to promote Oral HIV self-testing among men who have sex with men in China: a qualitative description. BMC Public Health 2018; 18:1146. [PMID: 30261856 PMCID: PMC6161330 DOI: 10.1186/s12889-018-6046-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 09/19/2018] [Indexed: 12/25/2022] Open
Abstract
Background HIV self-testing (HIVST) has demonstrated potential to expand HIV testing among key populations, including men who have sex with men (MSM) in China who have low testing rates. However, due to the autonomous nature of self-testing, people who undergo HIVST may lack access to relevant information and counseling support typically provided by in-person HIV testing counselors. WeChat, a popular smartphone application in China, offers a potential source of mobile health (mHealth) information and support for individuals using HIVST. This paper aimed to explore the opinions of MSM in China about the feasibility and potential concerns of using WeChat to support HIVST and reduce risk for HIV infection. Methods We conducted in-depth interviews with 36 MSM about their mobile smartphone usage and the use of WeChat for helping MSM self-administer HIVST kits in Hefei, China. Each interview was digitally recorded and transcribed. Transcripts were analyzed used content analysis method according to Elo and Kyngas. Results MSM described their use of WeChat and expressed cautious endorsement about using this platform to promote HIVST and disseminate HIV-related information. They described their preferences about the implementation features of an mHealth intervention to promote HIVST, including the delivery source of intervention messages, as well as message timing, frequency, form, tone, and content. Participants also described privacy-related concerns about receiving messages via WeChat and offered potential solutions. Conclusions Findings from this study show the potential utility of WeChat app-based messaging for engaging MSM in HIV self-testing and prevention. Future research is needed to integrate the concerns expressed in this analysis and evaluate a WeChat-based intervention to promote oral HIV self-testing, risk reduction, and health promotion among MSM in China.
Collapse
Affiliation(s)
- Yue Zhao
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Xiaofang Zhu
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Ashley E Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Wenhan Zhang
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Anxia Shi
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Zhihua Zhang
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Pan Gao
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Jun Wang
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nickolas Zaller
- Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yehuan Sun
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China
| | - Don Operario
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Hongbo Zhang
- School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China.
| |
Collapse
|
45
|
Hahn A, Schwarz NG, Meyer T, Frickmann H. PCR-based rapid diagnostic tests as a strategy for preventing infections with sexually transmitted diseases-a 'diagnostics-as-prevention' modelling approach. Lett Appl Microbiol 2018; 67:420-424. [PMID: 30074254 DOI: 10.1111/lam.13059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/13/2018] [Accepted: 07/31/2018] [Indexed: 12/18/2022]
Abstract
The potential was modelled of molecular rapid diagnostic tests (RDTs) that target agents of sexually transmitted diseases (STDs) to contribute to a reduction in the exposure risk for sexually active populations who prefer condom-free high-risk contacts. The biostatistical approach is exemplified by considering the use of a PCR-based RDT for Chlamydia trachomatis and Neisseria gonorrhoeae in a population of German men having sex with men. We modelled the exposure risk as risk of sexual contact with individuals infected by a STD in spite of multiple RDTs having been conducted to identify STDs that could lead to avoidance of an infectious sexual contact. The risk for a given specific disease is influenced by the diagnostic accuracy of all diagnostic tests conducted. The simulation showed a reduction in exposure risk through conducting the selected PCR-based RDT as a strategy to prevent infections with C. trachomatis and N. gonorrhoeae in comparison with unprotected sexual contact of >97% for C. trachomatis and ≥96% for N. gonorrhoeae. Reliable knowledge of the performance characteristics of the diagnostic tests applied is essential for a thorough risk assessment based on such diagnostic approaches. SIGNIFICANCE AND IMPACT OF THE STUDY A low-threshold use of molecular rapid diagnostic tests in settings where risky sexual activity is undertaken with deliberate non-use of condoms is modelled. Such an approach might contribute to a considerable reduction in the exposure risk if positively tested individuals are excluded from unprotected sexual intercourse. Protective effects are influenced by the prevalence of the disease and the performance characteristics of the applied tests. Precise knowledge of the performance characteristics of the test assays employed are prerequisites of a reliable risk assessment. The modelling approach is of particular use for preventive health experts.
Collapse
Affiliation(s)
- A Hahn
- Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany
| | - N G Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - T Meyer
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| |
Collapse
|
46
|
HIV Risk Reduction by Avoiding Sex With Partners Unwilling to Undergo HIV Testing Is Not Coercion. J Acquir Immune Defic Syndr 2018; 78:e38. [PMID: 29771794 DOI: 10.1097/qai.0000000000001740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Campbell CK, Lippman SA, Moss N, Lightfoot M. Strategies to Increase HIV Testing Among MSM: A Synthesis of the Literature. AIDS Behav 2018; 22:2387-2412. [PMID: 29550941 DOI: 10.1007/s10461-018-2083-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.
Collapse
Affiliation(s)
- Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA.
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Nicholas Moss
- Division of Communicable Disease Control & Prevention, Alameda County Public Health Department, Oakland, CA, USA
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| |
Collapse
|
48
|
Luo W, Katz DA, Hamilton DT, McKenney J, Jenness SM, Goodreau SM, Stekler JD, Rosenberg ES, Sullivan PS, Cassels S. Development of an Agent-Based Model to Investigate the Impact of HIV Self-Testing Programs on Men Who Have Sex With Men in Atlanta and Seattle. JMIR Public Health Surveill 2018; 4:e58. [PMID: 29959112 PMCID: PMC6045793 DOI: 10.2196/publichealth.9357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/05/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United States HIV epidemic, men who have sex with men (MSM) remain the most profoundly affected group. Prevention science is increasingly being organized around HIV testing as a launch point into an HIV prevention continuum for MSM who are not living with HIV and into an HIV care continuum for MSM who are living with HIV. An increasing HIV testing frequency among MSM might decrease future HIV infections by linking men who are living with HIV to antiretroviral care, resulting in viral suppression. Distributing HIV self-test (HIVST) kits is a strategy aimed at increasing HIV testing. Our previous modeling work suggests that the impact of HIV self-tests on transmission dynamics will depend not only on the frequency of tests and testers' behaviors but also on the epidemiological and testing characteristics of the population. OBJECTIVE The objective of our study was to develop an agent-based model to inform public health strategies for promoting safe and effective HIV self-tests to decrease the HIV incidence among MSM in Atlanta, GA, and Seattle, WA, cities representing profoundly different epidemiological settings. METHODS We adapted and extended a network- and agent-based stochastic simulation model of HIV transmission dynamics that was developed and parameterized to investigate racial disparities in HIV prevalence among MSM in Atlanta. The extension comprised several activities: adding a new set of model parameters for Seattle MSM; adding new parameters for tester types (ie, regular, risk-based, opportunistic-only, or never testers); adding parameters for simplified pre-exposure prophylaxis uptake following negative results for HIV tests; and developing a conceptual framework for the ways in which the provision of HIV self-tests might change testing behaviors. We derived city-specific parameters from previous cohort and cross-sectional studies on MSM in Atlanta and Seattle. Each simulated population comprised 10,000 MSM and targeted HIV prevalences are equivalent to 28% and 11% in Atlanta and Seattle, respectively. RESULTS Previous studies provided sufficient data to estimate the model parameters representing nuanced HIV testing patterns and HIV self-test distribution. We calibrated the models to simulate the epidemics representing Atlanta and Seattle, including matching the expected stable HIV prevalence. The revised model facilitated the estimation of changes in 10-year HIV incidence based on counterfactual scenarios of HIV self-test distribution strategies and their impact on testing behaviors. CONCLUSIONS We demonstrated that the extension of an existing agent-based HIV transmission model was sufficient to simulate the HIV epidemics among MSM in Atlanta and Seattle, to accommodate a more nuanced depiction of HIV testing behaviors than previous models, and to serve as a platform to investigate how HIV self-tests might impact testing and HIV transmission patterns among MSM in Atlanta and Seattle. In our future studies, we will use the model to test how different HIV self-test distribution strategies might affect HIV incidence among MSM.
Collapse
Affiliation(s)
- Wei Luo
- Spatial Analysis Research Center, School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, United States
| | - David A Katz
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States
| | - Jennie McKenney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Steven M Goodreau
- Center for Studies in Demography and Ecology, Department of Anthropology, University of Washington, Seattle, WA, United States
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Eli S Rosenberg
- School of Public Health, Epidemiology and Biostatistics, Rensselaer, Albany, NY, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Susan Cassels
- Department of Geography, University of California Santa Barbara, Santa Barbara, CA, United States
| |
Collapse
|
49
|
Age bias in survey sampling and implications for estimating HIV prevalence in men who have sex with men: insights from mathematical modelling. Epidemiol Infect 2018; 146:1036-1042. [PMID: 29708084 DOI: 10.1017/s0950268818000961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Respondent-driven sampling (RDS) is widely used to estimate HIV prevalence in men who have sex with men (MSM). Mathematical models that are calibrated to these data may be compromised if they fail to account for selection biases in RDS surveys. To quantify the potential extent of this bias, an agent-based model of HIV in South Africa was calibrated to HIV prevalence and sexual behaviour data from South African studies of MSM, first reweighting the modelled MSM population to match the younger age profile of the RDS surveys (age-adjusted analysis) and then without reweighting (unadjusted analysis). The model estimated a median HIV prevalence in South African MSM in 2015 of 34.6% (inter-quartile range (IQR): 31.4-37.2%) in the age-adjusted analysis, compared with 26.1% (IQR: 24.1-28.4%) in the unadjusted analysis. The median lifetime risk of acquiring HIV in exclusively homosexual men was 88% (IQR: 82-92%) in the age-adjusted analysis, compared with 76% (IQR: 64-85%) in the unadjusted analysis. These results suggest that RDS studies may under-estimate the exceptionally high HIV prevalence rates in South African MSM because of over-sampling of younger MSM. Mathematical models that are calibrated to these data need to control for likely over-sampling of younger MSM.
Collapse
|
50
|
Abstract
Objectives: To assess the effect of two health system approaches to distribute HIV self-tests on the number of female sex workers’ client and nonclient sexual partners. Design: Cluster randomized controlled trial. Methods: Peer educators recruited 965 participants. Peer educator–participant groups were randomized 1 : 1 : 1 to one of three arms: delivery of HIV self-tests directly from a peer educator, free facility-based delivery of HIV self-tests in exchange for coupons, or referral to standard-of-care HIV testing. Participants in all three arms completed four peer educator intervention sessions, which included counseling and condom distribution. Participants were asked the average number of client partners they had per night at baseline, 1 and 4 months, and the number of nonclient partners they had in the past 12 months (at baseline) and in the past month (at 1 month and 4 months). Results: At 4 months, participants reported significantly fewer clients per night in the direct delivery arm (mean difference −0.78 clients, 95% CI −1.28 to −0.28, P = 0.002) and the coupon arm (−0.71, 95% CI −1.21 to −0.21, P = 0.005) compared with standard of care. Similarly, they reported fewer nonclient partners in the direct delivery arm (−3.19, 95% CI −5.18 to −1.21, P = 0.002) and in the coupon arm (−1.84, 95% CI −3.81 to 0.14, P = 0.07) arm compared with standard of care. Conclusion: Expansion of HIV self-testing may have positive behavioral effects enhancing other HIV prevention efforts among female sex workers in Zambia. Trial Registration: ClinicalTrials.gov NCT02827240.
Collapse
|