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Freitas CAM, Rossi TA, Dourado I, Castellanos MEP, Guimarães NS, Magno L. Mapping evidence on health promotion in HIV testing among men who have sex with men and transgender women using the social-ecological model and the vulnerability theoretical framework: a scoping review. BMC Public Health 2023; 23:1946. [PMID: 37805484 PMCID: PMC10559455 DOI: 10.1186/s12889-023-16860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
This study aimed to map the scientific evidence on health promotion in human immunodeficiency virus) HIV testing among men who have sex with men (MSM) and transgender women (TGW) based on the social-ecological model (i.e., individual, organizational and social levels) and the theoretical framework of vulnerability (i.e., individual, social, and programmatic levels). The reviewed studies indicated several barriers to accessing HIV testing (e.g., economic, structural, and bureaucratic) and demonstrated the potential for community approaches to promote greater access to HIV testing and minimize the stigma and discrimination associated with HIV testing, primarily through community leadership and social support networks. The socio-ecological model of health promotion and the vulnerability approach have the potential to contribute to improving HIV testing services by balancing the technical and political power of health services and providers with community participation while considering the social contexts. Therefore, there is a need for reflection on health promotion policies and programs aimed at expanding access to HIV testing among MSM and TGW through interventions that consider the social contexts and cultural perspectives. Moreover, inter-sectoral strategies aimed at improving living conditions and access to fundamental resources for maintaining health and well-being should be considered.
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Affiliation(s)
- Camila Amaral Moreno Freitas
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil.
| | - Thais Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
| | | | - Nathalia Sernizon Guimarães
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
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Adepoju VA, Grabbe K, Laube C, Umebido C, Hassan Z, Oniyire A. Regarding "Willingness to Pay for HIV Prevention Commodities Among Key Population Groups in Nigeria". GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00445. [PMID: 36853646 PMCID: PMC9972388 DOI: 10.9745/ghsp-d-22-00445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/18/2022] [Indexed: 01/25/2023]
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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.
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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.)
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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.
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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.
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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.
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Sustaining success: a qualitative study of gay and bisexual men's experiences and perceptions of HIV self-testing in a randomized controlled trial. BMC Public Health 2021; 21:2048. [PMID: 34753433 PMCID: PMC8576944 DOI: 10.1186/s12889-021-12011-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/16/2021] [Indexed: 01/07/2023] Open
Abstract
Background HIV self-testing was proved as an effective tool for increasing testing frequency in gay and bisexual men at high risk of infection. Questions remain about understanding why HIVST encouraged testing and how such success can be translated to programmatic implementation. Methods We conducted a qualitative investigation of how FORTH participants experienced and perceived HIVST. Stratified sampling was used to recruit gay and bisexual men participating in the FORTH HIVST intervention to take part in interviews, focusing on infrequent testers and those who had received inaccurate HIVST results. Results Our analysis identified several prominent themes organized into two overarching domains from the 15 interviews: (i) aspects of HIVST contributing to HIV testing frequency, and (ii) sustaining HIVST into the future. Participants also believed that their use of HIVST in the future would depend on the test kit’s reliability, particularly when compared with highly reliable clinic-based testing. Conclusion HIVST increases the frequency of HIV testing among gay and bisexual men due, in part, to the practical, psychological, and social benefits it offers. To capitalize fully on these benefits, however, strategies to ensure the availability of highly reliable HIVST are required to sustain benefits beyond the confines of a structured research study.
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Improving HIV Self-Testing Social Network Interventions: The Role of Sexual Behavior Disclosure Among Chinese Men Who Have Sex with Men. AIDS Behav 2021; 25:1984-1992. [PMID: 33471242 DOI: 10.1007/s10461-020-03128-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
We assessed if same-sex sexual behavior disclosure of index men who have sex with men (MSM) was related to number of HIV self-testing (HIVST) kits requested by index participants, and number of test results successfully uploaded by alters in a network-based HIVST intervention. Index participants are men who accessed and distributed HIVST kits and alters are index's social contacts who received kits. We analyzed treatment arm data [N = 106, mean age = 27 (SD = 5.3)] of an intervention conducted among MSM in Guangzhou, China, May 2019-December 2019. Index MSM who disclosed sexual behavior to their family tended to request more kits [adjusted incidence rate ratio (aIRR) 1.42, 95% CI 1.06, 1.90, p < .05]. Index men who disclosed sexual behavior to their family (aIRR 2.47, 95% CI 1.17, 5.24, p < .05) tended to yield an increase in number of alter test results uploaded. Findings have implications for the development of network-based interventions for key populations.
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Leitinger D, Ryan K, Wilkinson AL, Pedrana A, Hellard M, Stoové M. Implications of HIV Self-Testing for Other Sexually Transmissible Infection Testing and Broader Sexual Health Needs: A Mixed-Methods Study of Gay and Bisexual Men in Australia. Sex Transm Dis 2021; 48:417-423. [PMID: 33122598 DOI: 10.1097/olq.0000000000001324] [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: 11/25/2022]
Abstract
BACKGROUND Although HIV self-tests can support frequent HIV testing, their impact on attending clinics for other sexually transmissible infection (STI) testing and sexual health care is largely unknown. We explored intentions to use HIV self-tests and how this might affect patterns of attending sexual health services among gay, bisexual, and other men who have sex with men (GBM) in Victoria, Australia. METHODS Gay, bisexual, and other men who have sex with men self-completed an online survey between March 10 and June 10, 2019. Among GBM reporting lifetime HIV testing and intentions to self-test at least once annually, we used logistic regression to identify correlates of intending to replace clinic-based HIV testing with self-tests. Qualitative interviews with purposively selected survey participants undertaken between May and June 2019 explored the implications of self-testing on clinic-based sexual health care. RESULTS Of the 279 survey participants, 79 (29%) reported they would replace most or all clinic-based HIV tests with self-tests, with longer time since last testing for HIV and younger age associated with reporting this outcome in the multivariate analysis. Qualitative interviews revealed different perceived roles for self-tests and clinic-based testing, and the importance of integrating HIV self-tests within broader sexual health routines. CONCLUSIONS Although GBM see a distinct role for HIV self-testing, its rollout will likely result in missed opportunities for clinic-based STI testing and education for some GBM, particularly among younger and less-recently tested GBM. Convenient, non-clinic-based approaches to STI testing are needed alongside support platforms to maximize the benefits of HIV self-testing within comprehensive sexual health routines.
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O'Byrne P. HIV self-testing: A review and analysis to guide HIV prevention policy. Public Health Nurs 2021; 38:885-891. [PMID: 34043831 DOI: 10.1111/phn.12917] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
HIV self-testing is a relatively new approach to HIV testing that, with increasing licensure in many countries, is an impending intervention. Considering such current or near-future implementation, it is important for HIV prevention policymakers to reflect on if and how to incorporate HIV self-testing. In this paper, using the Impact Fraction Model and the Anderson-May equation, I discuss how HIV self-testing should be an efficacious prevention approach when targeted appropriately. I then review the potential impacts of self-testing on HIV surveillance and discuss possible ethical concerns about such testing. The outcome of this analysis is that, while some issues may arise related to surveillance, and while some ethical concerns can be raised, no empirical evidence substantiates either, suggesting that HIV self-testing is an important strategy if it can be focused on and used by the persons most affected by HIV.
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O'Byrne P, Musten A, Orser L, Inamdar G, Grayson MO, Jones C, Francoeur M, Lachance S, Paulin V. At-home HIV self-testing during COVID: implementing the GetaKit project in Ottawa. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:587-594. [PMID: 33999399 PMCID: PMC8127455 DOI: 10.17269/s41997-021-00505-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/09/2021] [Indexed: 11/17/2022]
Abstract
Setting In March 2020, COVID-19 shuttered access to many healthcare settings offering HIV testing and there is no licensed HIV self-test in Canada. Intervention A team of nurses at the University of Ottawa and Ottawa Public Health and staff from the Ontario HIV Treatment Network (OHTN) obtained Health Canada’s Special Access approval on April 23, 2020 to distribute bioLytical’s INSTI HIV self-test in Ottawa; we received REB approval on May 15, 2020. As of July 20, 2020, eligible participants (≥18 years old, HIV-negative, not on PrEP, not in an HIV vaccine trial, living in Ottawa, no bleeding disorders) could register via www.GetaKit.ca to order kits. Outcomes In the first 6 weeks, 637 persons completed our eligibility screener; 43.3% (n = 276) were eligible. Of eligible participants, 203 completed a baseline survey and 182 ordered a test. These 203 participants were an average of 31 years old, 72.3% were white, 60.4% were cis-male, and 55% self-identified as gay. Seventy-one percent (n = 144) belonged to a priority group for HIV testing. We have results for 70.9% (n = 129/182) of participants who ordered a kit: none were positive, 104 were negative, 22 were invalid, and 2 “preferred not to say”; 1 participant reported an unreadiness to test. Implications Our results show that HIV self-testing is a pandemic-friendly strategy to help ensure access to sexual health services among persons who are good candidates for HIV testing. It is unsurprising that no one tested positive for HIV thus far, given the 0.08% positivity rate for HIV testing in Ottawa. As such, we advocate for scale-up of HIV self-testing in Canada.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada. .,Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada.
| | | | - Lauren Orser
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.,Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | | | - Marie-Odile Grayson
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | - Clay Jones
- Ontario HIV Treatment Network, Toronto, Canada
| | - Megan Francoeur
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | - Sarah Lachance
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | - Vickie Paulin
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
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Samoh N, Peerawaranun P, Jonas KJ, Lim SH, Wickersham JA, Guadamuz TE. Willingness to Use HIV Self-Testing With Online Supervision Among App-Using Young Men Who Have Sex With Men in Bangkok. Sex Transm Dis 2021; 48:e41-e44. [PMID: 32842048 DOI: 10.1097/olq.0000000000001271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT An online assessment among social media-using young men who have sex with men found that 87% were willing to use HIV self-testing with online supervision. Correlates included never tested, having higher numbers of sexual partners, and seeking partners online. HIV self-testing with online supervision may be appropriate for young men who have sex with men who have high risks and may not access venue-based settings.
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Affiliation(s)
- Nattharat Samoh
- From the Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Science and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Pimnara Peerawaranun
- From the Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Science and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Kai J Jonas
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Williams OD, Dean JA, Crothers A, Gilks CF, Gow J. Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia. BMC Health Serv Res 2021; 21:30. [PMID: 33413386 PMCID: PMC7789789 DOI: 10.1186/s12913-020-06040-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. Methods A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections. Results Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing. Conclusions This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06040-5.
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Affiliation(s)
- Owain D Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Anna Crothers
- School of Medicine, Griffith University, Nathan, Australia
| | - Charles F Gilks
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia. .,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa.
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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.
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Rolland C, de La Rochebrochard E, Piron P, Shelly M, Segouin C, Troude P. Who fails to return within 30 days after being tested positive for HIV/STI in a free testing centre? BMC Infect Dis 2020; 20:795. [PMID: 33109139 PMCID: PMC7590592 DOI: 10.1186/s12879-020-05520-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Some patients who test positive for sexually transmitted infections (STIs) fail to return for results and treatment. To target improvement actions, we need to find out who these patients are. This study aimed to explore factors associated with failure to return within 30 days (FTR30) after testing among patients with positive results in a free STI testing centre in Paris. Methods All patients with at least one positive result between October 2016 and May 2017 and who completed a self-administered questionnaire were included in this cross-sectional study (n = 214). The questionnaire included sociodemographic factors, sexual behaviour and history of testing. Factors associated with FTR30 were assessed using logistic regression models. Results More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (22%). Men who had sex with men represented 36% of the study population. The FTR30 rate was 14% (95% CI [10–19%]). In multivariate analysis, previous HIV testing in younger persons (aOR: 3.36, 95% CI [1.27–8.84]), being accompanied by another person at the pretest consultation (aOR: 3.45, 95% CI [1.36–8.91]), and lower self-perceived risk of HIV infection (aOR: 2.79, 95% CI [1.07–7.30]) were associated with a higher FTR30. Testing for chlamydia/gonorrhoea without presumptive treatment was associated with a lower FTR30 (aOR: 0.21, 95% CI [0.07–0.59]). Conclusions These factors that affect failure to return are related to the patient’s representations and involvement in the STI screening process. Increasing health literacy and patient empowerment could help to decrease failure to return after being tested positive for HIV/STI. Trial registration Not applicable.
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Affiliation(s)
- Camille Rolland
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France. .,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France.
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques (Ined), Aubervilliers, France.,University Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, Paris, Villejuif, France
| | - Prescillia Piron
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France
| | - Marc Shelly
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France
| | - Christophe Segouin
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France
| | - Pénélope Troude
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Institut National d'Etudes Démographiques (Ined), Aubervilliers, France
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15
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Tan RKJ, Chan YY, Bin Ibrahim MA, Ho LP, Lim OZ, Choong BCH, Chio MTW, Chen MIC, Wong CM. Potential interactions between the pathways to diagnosis of HIV and other STIs and HIV self-testing: insights from a qualitative study of gay, bisexual and other men who have sex with men in Singapore. Sex Transm Infect 2020; 97:215-220. [PMID: 33087479 PMCID: PMC8070631 DOI: 10.1136/sextrans-2020-054623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/25/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives This study draws on qualitative insights on the barriers and facilitators to HIV testing, as well as perceptions of HIV self-testing (HIVST), to propose a framework to understand not only the benefits but also potential knock-on implications of introducing HIVST in the context of other STI testing. Methods We conducted semistructured, in-depth interviews with 30 gay, bisexual and other men who have sex with men aged 18 and 39 years old in Singapore. Interview topics included barriers and facilitators to HIV and other STI testing, as well as perceptions of HIVST. Interviews were audio-recorded, transcribed, coded and analysed using thematic analysis. Results For HIV testing, participants cited the perceived risk of acquiring, susceptibility to and symptoms of HIV as internal motivators, while social influence and accessibility of HIV testing services were external motivators. For STI testing, perceived symptoms and partner notification of STI were reported as internal and external motivators, respectively. Availability of bundle tests, starting a new relationship and instances of mandatory testing motivated both simultaneous HIV and other STI testing. The fear of a positive diagnosis and lack of confidentiality were cited as internal and external barriers to HIV testing, respectively, while low perceived severity of other STI and the cost of STI tests were cited as internal and external barriers to other STI testing, respectively. We identified pathways to HIV and other STI testing and discussed how the introduction of HIVST may reduce opportunities for other STI testing. Conclusions The findings of this study suggest that introducing HIVST might weaken linkages to other STI testing if alternative strategies of promoting other STI testing are not simultaneously implemented. We recommend that future interventions address both the risks of HIV and other STI simultaneously, and that structural interventions promoting HIV and other STI preventions be balanced accordingly.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University Singapore and National University Health System, Singapore
| | | | - Muhamad Alif Bin Ibrahim
- National Centre for Infectious Diseases, Singapore.,School of Social and Health Sciences, James Cook University, Singapore
| | - Lai Peng Ho
- National Centre for Infectious Diseases, Singapore
| | | | | | | | - Mark I-Cheng Chen
- Saw Swee Hock School of Public Health, National University Singapore and National University Health System, Singapore .,National Centre for Infectious Diseases, Singapore
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16
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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.
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17
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Wray TB, Chan PA, Klausner JD, Mena LA, Brock JB, Simpanen EM, Ward LM, Chrysovalantis S. eTest: a limited-interaction, longitudinal randomized controlled trial of a mobile health platform that enables real-time phone counseling after HIV self-testing among high-risk men who have sex with men. Trials 2020; 21:654. [PMID: 32677999 PMCID: PMC7366305 DOI: 10.1186/s13063-020-04554-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/24/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND HIV disproportionately affects men who have sex with men (MSM) in the USA, and new infections continue to increase, particularly among African American (AA) and Hispanic/Latino (H/L) MSM. Rates of HIV testing are particularly low among AA and H/L MSM, and innovative approaches to encourage testing may help address high incidence in these men. HIV self-testing (HST) may be an important tool for increasing rates and frequency of testing. HST may be particularly well-suited for AA and H/L MSM, given that stigma and mistrust of medical care contribute to low testing rates. Despite its promise, however, many are concerned that HST does not sufficiently connect users with critical post-testing resources, such as confirmatory testing and care among those who test positive, and that these limitations may result in delayed linkage to care. METHODS We developed a mobile health platform (eTest) that monitors when HST users open their tests in real time, allowing us to provide timely, "active" follow-up counseling and referral over the phone. In this study, 900 high-risk MSM (with targets of 40% AA, 35% H/L) who have not tested in the last year will be recruited from social media and other gay-oriented websites in several major cities. Over 12 months, participants will be randomly assigned to receive (1) HST with post-test phone counseling and referral (eTest condition), (2) HST without active follow-up (standard condition), or (3) reminders to get tested for HIV at a local clinic (control) every 3 months. Primary outcomes include rates of HIV testing, receipt of additional HIV prevention services, and PrEP initiation verified by clinical medical records. DISCUSSION This study tests whether providing more active counseling and referral after HST encourages more regular HIV testing and engagement with other prevention services among MSM, compared to more passive approaches or clinic-based testing alone. It will also explore the cost-effectiveness and emotional/behavioral effects of these two strategies. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03654690 . Registered on 31 August 2018.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Philip A Chan
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA
| | - Leandro A Mena
- Department of Population Health Sciences, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - James B Brock
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Erik M Simpanen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lori M Ward
- Department of Population Health Sciences, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stafylis Chrysovalantis
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA
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18
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Bromberg DJ, Mayer KH, Altice FL. Identifying and managing infectious disease syndemics in patients with HIV. Curr Opin HIV AIDS 2020; 15:232-242. [PMID: 32487816 PMCID: PMC7376494 DOI: 10.1097/coh.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics. RECENT FINDINGS Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach. SUMMARY HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale University School of Public Health
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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19
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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.
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20
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Who is Using the HIV Self-Test among Young Black Men Who Have Sex With Men (MSM) and Transwomen in New York City? J Natl Med Assoc 2020; 112:284-288. [PMID: 32279883 DOI: 10.1016/j.jnma.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND HIV self-testing (HST) is an important complement to existing testing approaches for young Black men who have sex with men (MSM) and transwomen. METHODS In this formative research, we describe prevalence and perceptions of HST using qualitative in-depth interviews (n = 29) and baseline quantitative data (n = 302) from an HST intervention trial for young Black MSM and transwomen. RESULTS In the qualitative analysis, participants preferred the privacy and flexibility of the HST but had concerns about its accuracy and being alone while testing. Quantitative results showed that 14% (44/302) had used an HST in their lifetime; of these, 64% (28/44) used it once and 23% (10/44) in the last 3 months. CONCLUSION To increase consistent testing, HST may provide a new avenue for at-risk individuals that value privacy and control and could benefit from social support during testing.
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21
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Factores psicosociales asociados a la realización de la prueba diagnóstica del VIH en estudiantes universitarios colombianos. ACTA COLOMBIANA DE PSICOLOGIA 2020. [DOI: 10.14718/acp.2020.23.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Los objetivos de esta investigación fueron: (a) relacionar el riesgo sexual, los conocimientos y las actitudes hacia la prueba del VIH con su realización en estudiantes universitarios colombianos; y (b) describir las barreras percibidas en aquellos que no sela habían realizado, identificando las diferencias según el sexo. Se llevó a cabo un estudio transversal en el que particip- aron 1057 estudiantes colombianos, y en el que se utilizó el Cuestionario Confidencial sobre Vida Sexual Activa (CCVSA), el test Barreras Hacia la Prueba del VIH, la Escala de Actitudes hacia el VIH-Sida y un cuestionario ad hoc de conocimien- tos sobre la prueba. Los estudiantes que se realizaron la prueba (n = 214) reportaron una edad inferior de iniciación sexual (p < .01), un número superior de parejas sexuales (p = .01) y un menor uso de condón en la primera (p = .02) y la última (p = .04) relación sexual, así como mayores conocimientos sobre la prueba del VIH (p < .001). Las principales barreras estuvieron relacionadas con la baja percepción del riesgo de la enfermedad (29.8 %), la confianza en las parejas sexuales (29.2 %) y la falta de ofrecimiento de la prueba (25.2 %). En conclusión, la realización de la prueba está relacionada con la exposición a conductas sexuales de riesgo y con los conocimientos, mas no con las actitudes hacia la prueba. La identi- ficación de los factores psicosociales vinculados podría contribuir al diseño de intervenciones orientadas a la prevención y al tratamiento oportuno de la enfermedad.
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22
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Hlongwa M, Mashamba-Thompson T, Makhunga S, Muraraneza C, Hlongwana K. Men's perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis. BMC Public Health 2020; 20:66. [PMID: 31941479 PMCID: PMC6964071 DOI: 10.1186/s12889-020-8184-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the many HIV testing models implemented in Africa, the level of HIV testing uptake remains relatively poor, especially among men. The HIV self-testing (HIVST) model offers an additional approach for encouraging men to get tested. This study aimed to synthesise evidence on men's perspectives regarding HIVST in sub-Saharan Africa (SSA). METHODS The databases searched included PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations; SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; ERIC; CINAH; PsychInfo; Embase, Sociological Abstract, Scopus; and Google Scholar. The World Health Organization (WHO) and The Joint United Nations' Programme on HIV and AIDS (UNAIDS) websites were further searched. We only extracted qualitative information from the included studies, despite the research method used (qualitative or mixed methods). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), as well as the Mixed Method Appraisal Tool (MMAT) version 2018, were used to determine the methodological quality of the included studies. NVivo version 11 was used for thematic analysis. RESULTS A total of 21,184 articles were identified by the initial search criteria, but only 16 articles were included in the data extraction and quality assessment stage. The following key themes emerged: knowledge of HIVST; acceptability of HIVST; need for HIVST counselling; confidentiality of HIVST; convenience of HIVST; and accuracy of HIVST. The study shows that while HIVST provides men with an alternative, confidential and convenient testing model, the potential for psychological and physical harm remains a challenge. CONCLUSION The introduction of the HIVST strategy has the potential of improving men's uptake in HIV testing services, thereby contributing towards addressing the first cascade of the 90-90-90 strategy. While HIVST has a potential for addressing men's barriers to attending clinic settings, such as confidentiality and convenience, it barely addresses the HIVST counselling and accuracy concerns.
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Affiliation(s)
- Mbuzeleni Hlongwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Tivani Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Sizwe Makhunga
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Claudine Muraraneza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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23
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Witzel TC, Weatherburn P, Bourne A, Rodger AJ, Bonell C, Gafos M, Trevelion R, Speakman A, Lampe F, Ward D, Dunn DT, Gabriel MM, McCabe L, Harbottle J, Collaco Moraes Y, Michie S, Phillips AN, McCormack S, Burns FM. Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020466. [PMID: 31936798 PMCID: PMC7014239 DOI: 10.3390/ijerph17020466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/02/2022]
Abstract
SELPHI involves two interventions: A provides one HIV self-testing (HIVST) kit; B offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the mechanisms of action leading to impact for different groups of trial participants. In-depth interviews with 37 cis-men who have sex with men (MSM) were used to inductively categorise participants based on sexual and HIV testing histories. Themes relating to intervention experiences and impacts were mapped onto SELPHI-hypothesised intermediate outcomes to consider intervention impacts. Three groups were identified: ‘inexperienced testers’ engaged with SELPHI to overcome motivational and social and physical opportunity testing barriers. For ‘pro self-testers’, testing frequency was constrained by psychological and social barriers and lack of opportunity. ‘Opportunistic adopters’ engaged in HIVST for novelty and convenience. Perceived impacts for inexperienced testers were most closely aligned with the logic model, but for opportunistic adopters there was little evidence of impact. Distinctive groups were discernible with divergent intervention experiences. Using COM-B as a model for understanding behaviour change in relation to HIVST, our results indicate how HIVST interventions could be adapted to respond to different needs based on the target population’s demographic and behavioural features.
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Affiliation(s)
- T. Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
- Correspondence:
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne 3086, Australia;
| | - Alison J. Rodger
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1h 9SH, UK;
| | | | - Andrew Speakman
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Fiona Lampe
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - David T. Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Michelle M. Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | | | - Yolanda Collaco Moraes
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Susan Michie
- Centre for Behaviour Change, University College London, London WC1N 3AZ, UK;
| | - Andrew N. Phillips
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Fiona M. Burns
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
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24
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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.
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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.
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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.
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Cox J, Gutner C, Kronfli N, Lawson A, Robbins M, Nientker L, Ostawal A, Barber T, Croce D, Hardy D, Jessen H, Katlama C, Mallolas J, Rizzardini G, Alcorn K, Wohlfeiler M, Le Fevre E. A need for implementation science to optimise the use of evidence-based interventions in HIV care: A systematic literature review. PLoS One 2019; 14:e0220060. [PMID: 31425524 PMCID: PMC6699703 DOI: 10.1371/journal.pone.0220060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022] Open
Abstract
To improve health outcomes in people living with HIV, adoption of evidence-based interventions (EBIs) using effective and transferable implementation strategies to optimise the delivery of healthcare is needed. ViiV Healthcare's Positive Pathways initiative was established to support the UNAIDS 90-90-90 goals. A compendium of EBIs was developed to address gaps within the HIV care continuum, yet it was unknown whether efforts existed to adapt and implement these EBIs across diverse clinical contexts. Therefore, this review sought to report on the use of implementation science in adapting HIV continuum of care EBIs. A systematic literature review was undertaken to summarise the evaluation of implementation and effectiveness outcomes, and report on the use of implementation science in HIV care. Ten databases were reviewed to identify studies (time-period: 2013-2018; geographic scope: United States, United Kingdom, France, Germany, Italy, Spain, Canada, Australia and Europe; English only publications). Studies were included if they reported on people living with HIV or those at risk of acquiring HIV and used interventions consistent with the EBIs. A broad range of study designs and methods were searched, including hybrid designs. Overall, 118 publications covering 225 interventions consistent with the EBIs were identified. These interventions were evaluated on implementation (N = 183), effectiveness (N = 81), or both outcomes (N = 39). High variability in the methodological approaches was observed. Implementation outcomes were frequently evaluated but use of theoretical frameworks was limited (N = 13). Evaluations undertaken to assess effectiveness were inconsistent, resulting in a range of measures. This review revealed extensive reporting on implementation science as defined using evaluation outcomes. However, high variability was observed in how implementation outcomes and effectiveness were defined, quantified, and reported. A more specific and consistent approach to conducting and reporting on implementation science in HIV could facilitate achievement of UNAIDS 90-90-90 targets.
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Affiliation(s)
- Joseph Cox
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Nadine Kronfli
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Anna Lawson
- ViiV Healthcare, London, England, United Kingdom
| | | | | | | | - Tristan Barber
- Chelsea and Westminster Hospital, London, England, United Kingdom
| | | | - David Hardy
- Whitman-Walker Centre, Washington, DC, United States of America
| | | | | | | | | | - Keith Alcorn
- NAM publications, London, England, United Kingdom
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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.
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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
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Tonen-Wolyec S, Batina-Agasa S, Muwonga J, Mboumba Bouassa RS, Kayembe Tshilumba C, Bélec L. Acceptability, feasibility, and individual preferences of blood-based HIV self-testing in a population-based sample of adolescents in Kisangani, Democratic Republic of the Congo. PLoS One 2019; 14:e0218795. [PMID: 31260480 PMCID: PMC6602204 DOI: 10.1371/journal.pone.0218795] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background Adolescents living in sub-Saharan Africa constitute a vulnerable population at significant risk of HIV infection. This study aims to evaluate the acceptability, feasibility, and accuracy of home-based, supervised HIV self-testing (HIVST) as well as their predictors among adolescents living in Kisangani, Democratic Republic of the Congo (DRC). Methods A cross-sectional, door-to-door survey using a blood-based HIV self-test and a peer-based supervised HIVST approach was conducted from July to August 2018 in Kisangani, DRC. The acceptability and feasibility of HIVST were assessed among adolescents’ consenting to use and interpret HIV self-test. The accuracy of HIVST was estimated by the sensibility and specificity of adolescent-interpreted HIV self-test. Factors associated with acceptability and feasibility of HIVST were analyzed with logistic regression. Results A total of 628 adolescents (including 369 [58.8%] females) aged between 15 and 19 years were enrolled. Acceptability of HIVST was high (95.1%); 96.1% of participants correctly used the self-test, and 65.2% asked for verbal instructions. The majority of adolescents (93.5%) correctly interpreted their self-test results. The Cohen’s κ coefficient between the results read by adolescents and by supervisors was 0.62. The correct interpretation decreased significantly when adolescents had no formal education or attended primary school as compared to those currently attending university (37.0% versus 100%; adjusted OR: 0.01 [95% CI: 0.004–0.03]). In the hands of adolescents at home, the sensitivity of the Exacto Test HIV Self-test was estimated at 100%, while its specificity was 96.0%. The majority of participants (68.0%) affirmed that post-test counseling was essential, and that face-to-face counseling (78.9%) was greatly preferred. Conclusions Home-based, supervised HIVST using a blood-based self-test and peer-based approach can be used with a high degree of acceptability and feasibility by adolescents living in Kisangani, DRC. Misinterpretation of test results is challenging to obtaining good feasibility of HIVST among adolescents with poor educational level. Face-to-face post-test counseling seems to be preferred among Kisangani’s adolescents.
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Affiliation(s)
- Serge Tonen-Wolyec
- Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon.,Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo.,Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo
| | - Salomon Batina-Agasa
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo
| | - Jérémie Muwonga
- Laboratoire National de Référence du Sida et des IST, Kinshasa, Democratic Republic of the Congo.,Programme National de lutte Contre le VIH/SIDA et les IST, Kinshasa, Democratic Republic of the Congo
| | - Ralph-Sydney Mboumba Bouassa
- Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon.,Laboratoire de virologie, Hôpital Européen Georges Pompidou, and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Charles Kayembe Tshilumba
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo
| | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, and Université Paris Descartes, Paris Sorbonne Cité, Paris, France
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Jamil MS, Guy RJ, Bavinton BR, Fairley CK, Grulich AE, Holt M, Smith KS, Chen M, McNulty AM, Conway DP, Keen P, Bradley J, Russell D, Kaldor JM, Prestage G. HIV testing self-efficacy is associated with higher HIV testing frequency and perceived likelihood to self-test among gay and bisexual men. Sex Health 2019; 14:170-178. [PMID: 27883311 DOI: 10.1071/sh16100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/05/2016] [Indexed: 11/23/2022]
Abstract
Background Regular testing of individuals at higher-risk of HIV is central to current prevention strategies. The aim of the present study was to examine the extent to which confidence in one's perceived ability to undertake various aspects of HIV testing and self-testing (self-efficacy) affected HIV testing outcomes. We assessed factors, including self-efficacy, associated with HIV testing frequency and the likelihood to self-test among gay and bisexual men (GBM). METHODS Participants were HIV-negative GBM at an increased risk of HIV (more than five partners or condomless anal intercourse in the previous 3 months) enrolled in a randomised controlled trial of HIV self-testing. The baseline questionnaire captured data regarding sociodemographic characteristics, HIV and/or sexually transmissible infection testing history, sexual behaviour, beliefs and attitudes towards HIV and eight items capturing confidence in HIV testing ability that were combined as a single broad measure of HIV testing self-efficacy (α=0.81). Factors associated with three or more HIV tests in the past year and the likelihood of self-testing in the future were determined using logistic regression. RESULTS Of 354 GBM, 34% reported three or more HIV tests in the past year, and 64% reported being 'very likely' to self-test. Factors independently associated with three or more HIV tests in the past year were: higher self-efficacy (adjusted odds ratio (aOR) 1.08 per unit increase; 95% confidence interval (CI) 1.02-1.14; P=0.004); >10 male partners in the past 6 months (aOR 1.79; 95% CI 1.05-3.04; P=0.031) and higher optimism regarding the effects of HIV treatments on HIV transmission (aOR 1.14; 95% CI 1.00-1.29; P=0.044). Only higher self-efficacy was independently associated with reporting a greater likelihood to self-test in the future (aOR 1.10; 95% CI 1.05-1.15; P < 0.001). CONCLUSIONS Improving self-efficacy by enhancing GBM's knowledge and experience may lead to higher testing frequency. The self-efficacy measure used in the present study could be useful in identifying GBM likely to face difficulties with HIV testing and self-testing.
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Affiliation(s)
- Muhammad S Jamil
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
| | - Andrew E Grulich
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Goodsell Building, Sydney, NSW 2052, Australia
| | - Kirsty S Smith
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
| | - Anna M McNulty
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Hospital, Macquarie street, Sydney, NSW 2000, Australia
| | - Damian P Conway
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Phillip Keen
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Jack Bradley
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Darren Russell
- Cairns Sexual Health Service, 381 Sheridan Street, Cairns North, Qld 4870, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
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Wray TB, Chan PA, Simpanen EM. Longitudinal effects of home-based HIV self-testing on well-being and health empowerment among men who have sex with men (MSM) in the United States. AIDS Care 2019; 32:148-154. [PMID: 31146548 DOI: 10.1080/09540121.2019.1622636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV self-test (HST) kits have been available for purchase directly by consumers since 2012. However, public health and prevention programs have been slow to adopt self-testing as a strategy for improving testing rates and regularity, in part due to concerns about its effects on the well-being of users and lack of follow-up. This study explored whether there were differences in several constructs related to well-being, including health-related quality of life, social support, health empowerment, and emotional distress, across those who used HSTs versus tested at a clinic over time. Data were drawn from a longitudinal randomized controlled trial exploring methods of encouraging HIV testing (clinic-based, regular home delivery of HSTs) and providing follow-up afterward. Results showed that using HST in a given month was not associated with changes in either distress or well-being that same month. Although social support was lower in months when HST was used (versus clinic-based testing), participants reported that engaging in other health behaviors (e.g., Healthy diet, exercise) were more important in months they used HST compared to testing in a clinic, suggesting that HST may empower MSM to begin making other lifestyle changes that could improve their health.
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Affiliation(s)
- Tyler B Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Erik M Simpanen
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, Rhode Island, USA
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Monteiro SS, Brigeiro M, Vilella WV, Mora C, Parker R. Challenges facing HIV treatment as prevention in Brazil: an analysis drawing on literature on testing. CIENCIA & SAUDE COLETIVA 2019; 24:1793-1807. [PMID: 31166513 DOI: 10.1590/1413-81232018245.16512017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/27/2017] [Indexed: 11/22/2022] Open
Abstract
According to current global AIDS guidelines, HIV testing is key to the success of the 'treatment as prevention' (TasP) strategy and the control of AIDS. In view of Brazil's commitment to these guidelines, this article characterizes the principles and justifications underpinning TasP and discusses implementation challenges. The analysis draws on a systematic review of the literature (2005 to 2015) on recruitment and testing strategies for men who have sex with men. This approach was adopted based on the assumption that current knowledge on HIV testing can offer valuable insights into the foundations of global AIDS policies and their uptake in local contexts. Based on the analysis of the 65 articles selected, we suggest that TasP represents a shift in the AIDS prevention paradigm. There is an overlap between prevention and care and the new approach places major emphasis on biomedical and psychological knowledge. The TasP approach fails to address the factors associated with HIV vulnerability and the stigma surrounding AIDS and undermines the participation of activists and PLWHA as autonomous producers of preventive of preventive practices. We argue that, to ensure the effective implementation of TasP in Brazil, it is necessary to discuss issues such as the protection of human rights and the structural problems facing Brazil's public health system.
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Affiliation(s)
- Simone Souza Monteiro
- Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo Cruz, Fiocruz. Av. Brasil 4365/Pavilhão Lauro Travassos, Manguinhos. 21045-900 Rio de Janeiro RJ Brasil.
| | - Mauro Brigeiro
- Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo Cruz, Fiocruz. Av. Brasil 4365/Pavilhão Lauro Travassos, Manguinhos. 21045-900 Rio de Janeiro RJ Brasil.
| | - Wilza Vieira Vilella
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Claudia Mora
- Departamento de Políticas e Instituições de Saúde, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Richard Parker
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Miners A, Nadarzynski T, Witzel C, Phillips AN, Cambiano V, Rodger AJ, Llewellyn CD. Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment. PLoS Med 2019; 16:e1002779. [PMID: 30973868 PMCID: PMC6459507 DOI: 10.1371/journal.pmed.1002779] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 03/12/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. METHODS AND FINDINGS Between 3 April and 11 May 2017, a cross-sectional online-questionnaire-based discrete choice experiment (DCE) was conducted in which respondents who expressed an interest in online material used by MSM were asked to imagine that they were at risk of HIV infection and to choose between different hypothetical HIV testing options, including the option not to test. A variety of different testing options with different defining characteristics were described so that the independent preference for each characteristic could be valued. The characteristics included where each test is taken, the sampling method, how the test is obtained, whether infections other than HIV are tested for, test accuracy, the cost of the test, the infection window period, and how long it takes to receive the test result. Participants were recruited and completed the instrument online, in order to include those not currently engaged with healthcare services. The main analysis was conducted using a latent class model (LCM), with results displayed as odds ratios (ORs) and probabilities. The ORs indicate the strength of preference for one characteristic relative to another (base) characteristic. In total, 620 respondents answered the DCE questions. Most respondents reported that they were white (93%) and were either gay or bisexual (99%). The LCM showed that there were 2 classes within the respondent sample that appeared to have different preferences for the testing options. The first group, which was likely to contain 86% of respondents, had a strong preference for face-to-face tests by healthcare professionals (HCPs) compared to remote testing (OR 6.4; 95% CI 5.6, 7.4) and viewed not testing as less preferable than remote testing (OR 0.10; 95% CI 0.09, 0.11). In the second group, which was likely to include 14% of participants, not testing was viewed as less desirable than remote testing (OR 0.56; 95% CI 0.53, 0.59) as were tests by HCPs compared to remote testing (OR 0.23; 95% CI 0.15, 0.36). In both classes, free remote tests instead of each test costing £30 was the test characteristic with the largest impact on the choice of testing option. Participants in the second group were more likely to have never previously tested and to be non-white than participants in the first group. The main study limitations were that the sample was recruited solely via social media, the study advert was viewed only by people expressing an interest in online material used by MSM, and the choices in the experiment were hypothetical rather than observed in the real world. CONCLUSIONS Our results suggest that preferences in the context we examined are broadly dichotomous. One group, containing the majority of MSM, appears comfortable testing for HIV but prefers face-to-face testing by HCPs rather than remote testing. The other group is much smaller, but contains MSM who are more likely to be at high infection risk. For these people, the availability of remote testing has the potential to significantly increase net testing rates, particularly if provided for free.
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Affiliation(s)
- Alec Miners
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- Royal South Hants Hospital, Solent NHS Trust, Southampton, United Kingdom
| | - Charles Witzel
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrew N. Phillips
- Institute for Global Health, University College London, London, United Kingdom
| | - Valentina Cambiano
- Institute for Global Health, University College London, London, United Kingdom
| | - Alison J. Rodger
- Institute for Global Health, University College London, London, United Kingdom
| | - Carrie D. Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
- * E-mail:
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Gray C, Lobo R, Narciso L, Oudih E, Gunaratnam P, Thorpe R, Crawford G. Why I Can't, Won't or Don't Test for HIV: Insights from Australian Migrants Born in Sub-Saharan Africa, Southeast Asia and Northeast Asia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1034. [PMID: 30901957 PMCID: PMC6466030 DOI: 10.3390/ijerph16061034] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/10/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022]
Abstract
People born in sub-Saharan Africa and Southeast Asia are overrepresented in HIV notifications in Australia. Just under half of all notifications among people from sub-Saharan Africa and Southeast Asia are diagnosed late. Increased HIV testing among these communities is necessary to ensure early diagnosis, better care and reduce likelihood of HIV onward transmission. Recently, Australia has made new HIV testing methods available: rapid HIV testing and self-testing kits. We conducted 11 focus groups with 77 participants with people from sub-Saharan Africa, Southeast Asia and Northeast Asia in four jurisdictions in Australia. Focus groups discussed barriers to HIV testing and the acceptability of new testing methods. Barriers to HIV testing included: cost and eligibility of health services, low visibility of HIV in Australia, HIV-related stigma, and missed opportunities by general practitioners (GPs) for early diagnosis of HIV and linkage into care. Participants had low levels of knowledge on where to test for HIV and the different methods available. Diverse opportunities for testing were considered important. Interventions to increase HIV testing rates among sub-Saharan African, Southeast Asia and Northeast Asian migrants in Australia need to be multi-strategic and aimed at individual, community and policy levels. New methods of HIV testing, including rapid HIV testing and self-testing, present an opportunity to engage with migrants outside of traditional health care settings.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Lea Narciso
- Communicable Disease Control Branch, Public Health and Clinical Systems, Department for Health and Wellbeing, Government of South Australia, Adelaide, SA 5000, Australia.
| | - Enaam Oudih
- PEACE Multicultural Services, Relationships Australia South Australia, Adelaide, SA 5000, Australia.
| | - Praveena Gunaratnam
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Rachel Thorpe
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
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Okoboi S, Twimukye A, Lazarus O, Castelnuovo B, Agaba C, Immaculate M, Nanfuka M, Kambugu A, King R. Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda: a qualitative study. J Int AIDS Soc 2019; 22:e25269. [PMID: 30932364 PMCID: PMC6441924 DOI: 10.1002/jia2.25269] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/07/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION HIV self-testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the acceptability, perceived reliability and challenges associated with distributing HIV self-test (HIVST) to young men who have sex with men (MSM) in Uganda. METHODS Between February and May, 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management. RESULTS MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non-painful; and non-stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop-in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services. CONCLUSIONS Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow-up, linkage to HIV care and prevention services are needed for effective results.
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Affiliation(s)
- Stephen Okoboi
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
- Clarke International UniversityKampalaUganda
| | - Adelline Twimukye
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
| | | | - Barbara Castelnuovo
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
| | | | | | | | - Andrew Kambugu
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
| | - Rachel King
- University of California, Global Health SciencesSan FranciscoCA
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Harichund C, Karim QA, Kunene P, Simelane S, Moshabela M. HIV self-testing as part of a differentiated HIV testing approach: exploring urban and rural adult experiences from KwaZulu-Natal, South Africa using a cross-over study design. BMC Public Health 2019; 19:53. [PMID: 30634943 PMCID: PMC6329077 DOI: 10.1186/s12889-018-6366-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/21/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Suboptimal HIV testing rates through available testing approaches such as HIV counselling and testing have directed research efforts toward recognizing the potential of HIV self-testing as an additional testing method. However, HIV self-testing is not readily available within HIV testing facilities and data on how HIV self-testing and HIV counselling and testing will co-exist within HIV testing facilities is limited. Therefore, this study sought to fill this knowledge gap. METHODS Forty consenting adults were exposed to HIV counselling and testing and HIV self-testing using a cross-over study design between February 2016 and February 2017 resulting in 80 (20,20) interviews. Participants were randomly exposed to HIV counselling and testing first, followed by self-testing, or HIV self-testing first, followed by counselling and testing. In-depth interviews were conducted at baseline, and after each testing exposure, using a semi-structured interview guide. Interviews were transcribed and translated prior to doing the framework analysis. RESULTS Support through counselling played a central role in the HIV testing process for some participants who desired support or were not confident to perform unsupervised HIV self-testing. The complementary relationship between HIV self-testing and HIV counselling and testing requires a combination of benefits such as availability of counselling, confidence, convenience and confidentiality (4 Cs) derived from HIV self-testing and HIV counselling and testing. Implementation of the 4 Cs will depend on the availability of unsupervised HIV self-testing and/or supervised self-testing with support from HIV counselling and testing. CONCLUSIONS As treatment and prevention efforts expand, the reasons for and frequency of testing is changing and there is a need to develop differentiated models for providing HIV testing services to meet client's needs. HIV self-testing is an important addition to enhance HIV testing efforts and should be offered in combination with HCT.
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Affiliation(s)
- Charlene Harichund
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Department of Epidemiology, Columbia University, New York, USA
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Pinky Kunene
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | | | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
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Zhang C, Li X, Koniak-Griffin D, Goldsamt LA, Zhou J. Effectiveness of self-testing kits availability on improving HIV testing frequency for chinese men who have sex with men and their sexual partners: a protocol for a multicenter randomised controlled trial. BMJ Open 2018; 8:e024423. [PMID: 30552280 PMCID: PMC6303590 DOI: 10.1136/bmjopen-2018-024423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/29/2018] [Accepted: 10/12/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION HIV epidemic is increasing among men who have sex with men (MSM) in China, yet HIV testing uptake remains low. As an emerging approach, HIV self-testing (HIVST) has the potential to promote HIV testing coverage and frequency in this population. However, evidence of the effectiveness on implementation of HIVST among Chinese MSM and their sexual partners is scarce. METHODS AND ANALYSIS The randomised controlled trial will be performed in Changsha, Changde, Shaoyang and Yiyang, Hunan province, China, recruiting 184 recent testers (men who had at least one HIV test within the past 2 years) and 26 non-recent testers (men who did not have HIV tests within 2 years or never had an HIV test). Eligible men will be randomly divided 1:1 into two groups: intervention (with free HIVST kits plus site-based HIV testing services) and control (site-based HIV testing services only). Participants in the intervention group will be provided with two free finger-prick-based HIVST kits, and can apply for two to four kits every 3 months for 1 year.Participants in both groups will complete questionnaires via WeChat at five separate times: baseline, third, sixth, ninth and twelfth month. The primary outcome is the mean number of HIV tests for MSM over the 12-month study period. The secondary outcome is the mean number of HIV tests for sexual partners of MSM over the 12-month study period. The tertiary outcomes are the self-reported proportion of consistent condom usage for anal sex, and the numbers of sexual partners during the 12-month study period. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Board of Behavioural and Nursing Research in Xiangya School of Nursing of Central South University, China (2018002). Study results will be disseminated through conferences and academic journals. TRIAL REGISTRATION NUMBER ChiCTR1800015584; Pre-results.
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Affiliation(s)
- Ci Zhang
- Xiangya Nursing School of Central South University, Changsha, China
| | - Xianhong Li
- Xiangya Nursing School of Central South University, Changsha, China
| | - Deborah Koniak-Griffin
- School of Nursing of University of California at Los Angeles, Los Angeles, California, USA
| | - Lloyd A. Goldsamt
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Jing Zhou
- Xiangya Nursing School of Central South University, Changsha, China
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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.
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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.
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Knowledge and awareness of HIV self-testing among Australian gay and bisexual men: a comparison of never, sub-optimal and optimal testers willingness to use. AIDS Care 2018; 31:224-229. [PMID: 30230360 DOI: 10.1080/09540121.2018.1524120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This paper explores the willingness to use and pay for HIV Self-testing (HIVST) among Australian gay and bisexual men (GBM). Bivariate and univariate multinominal logistic regression of data from an online survey was performed. Thirty-one (13%) had never HIV tested and 41.9% (88) were testing sub-optimally by Australian guidelines. Half (58.4%, 136) had never heard of HIVST, however, 56.2% (131) reported willingness to use HIVST, with sub-optimal (OR=2.13; p < 0.01) and never-testers (OR=2.01; p < 0.10) significantly more likely to do so than optimal-testers. Most were confident (51.7%, 119) or somewhat confident (29.1%, 67) accessing support following a reactive result, however, never-testers were significantly less confident compared to previous testers (OR=3.47; p< 0.05). Less than a quarter (23.6%, 57) were willing to pay for a kit with AUD$15 (R2 = 0.9882) the estimated preferred price. This research confirms that HIVST is an important and accepted adjunct to established HIV testing modalities, particularly among sub-optimal and never-testers and that online (61.6%, 143) or clinic-based (61.6%, 143) dissemination are preferred. Research examining how best to disseminate HIVST in a range of safe and effective models needs to continue to ensure HIVST is part of a comprehensive strategy that facilitates usage and linkages to care.
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Ryan KE, Wilkinson AL, Leitinger D, El-Hayek C, Ryan C, Pedrana A, Hellard M, Stoové M. Characteristics of gay, bisexual and other men who have sex with men testing and retesting at Australia's first shop-front rapid point-of-care HIV testing service. Sex Health 2018; 13:560-567. [PMID: 27509318 DOI: 10.1071/sh16027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND HIV rapid point-of-care (RPOC) testing was approved in Australia in 2012 prompting new testing models. We describe gay, bisexual and other men who have sex with men (GBM) testing in the first year of operations at Australia's first shop-front, community-based RPOC testing service, PRONTO!, and characterise return testers and first-time testers. METHODS Univariable and multivariable logistic regression using data collected at clients' first test at PRONTO! from 15 August 2013 to 14 August 2014 examined correlates of: 1) return-testing within 6 months of GBMs first test at PRONTO!; and 2) reporting a first ever HIV test at PRONTO!. RESULTS In the first year, 1226 GBM tested at PRONTO! (median age=30.4 years, 60.2% Australian born). Condomless anal sex with casual or regular partners was reported by 45% and 66% of GBM, respectively. Almost one-quarter (23%) of GBM returned within 6 months of their first test. Return-testing was associated with being born overseas (adjusted odds ratio (AOR)=1.48, 95% confidence interval (CI)=1.10-2.0), reporting a regular check-up as reason to test (AOR=1.53, 95% CI=1.01-2.30) and reporting a HIV test in the 6 months before first testing at PRONTO! (AOR=1.73, 95% CI=1.09-2.73). Reporting first testing at PRONTO! (17.9%) was positively associated with younger age (<30 years; AOR=1.78, 95% CI=1.18-2.71) and negatively associated with reporting a regular check-up as reason to test (AOR=0.45, 95% CI=0.29-0.71) and recent group sex (AOR=0.37, 95% CI=0.23-0.59). CONCLUSION Despite PRONTO! being designed to reduce barriers to HIV testing, return testing rates in the first year were low and not associated with client risk. Service refinements, including the provision of comprehensive sexually transmissible infection testing, are needed to increase testing frequency and enhance population HIV prevention benefits.
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Affiliation(s)
- Kathleen E Ryan
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Anna L Wilkinson
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - David Leitinger
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Carol El-Hayek
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Claire Ryan
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
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Wray TB, Chan PA, Simpanen E, Operario D. A Pilot, Randomized Controlled Trial of HIV Self-Testing and Real-Time Post-Test Counseling/Referral on Screening and Preventative Care Among Men Who Have Sex with Men. AIDS Patient Care STDS 2018; 32:360-367. [PMID: 30179528 DOI: 10.1089/apc.2018.0049] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV self-testing (HST) could be an effective strategy for helping those at high risk test more regularly. However, concerns about HST's lack of follow-up care and referral have so far limited its use. In a pilot, randomized controlled trial, high-risk HIV-negative, or status unknown men who have sex with men (MSM; N = 65) were recruited from January 2016 to February 2017 and received (1) HST kits by mail, equipped with devices that detected when kits were opened and prompted a follow-up call from a counselor (eTEST); (2) standard HST kits with no follow-up (standard); or (3) informational letters about HIV testing locations (control) at baseline, 3 months, and 6 months. Monthly surveys over 7 months assessed HIV testing, sexually transmitted infection (STI) testing, access to prevention services, and behavioral risk reduction. All participants (100%) in the eTEST and standard HST groups reported HIV testing at least once during the 7-month period compared with 72% of controls. Repeat testing was higher among those in the HST groups versus controls (79% vs. 41%). Participants in the eTEST group were significantly more likely to receive risk reduction counseling, prevention supplies (e.g., condoms and lube), and PrEP referrals during the study period compared with standard HST and controls. No effects on STI testing or PrEP initiation emerged. Delivering HST kits to high-risk MSM at regular intervals could increase HIV testing rates and encourage more regular testing. Providing active post-test referrals alongside HST might also connect high-risk men with some other important services that encourage prevention behaviors.
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Affiliation(s)
- Tyler B. Wray
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Philip A. Chan
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Erik Simpanen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Don Operario
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
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Harichund C, Moshabela M, Kunene P, Abdool Karim Q. Acceptability of HIV self-testing among men and women in KwaZulu-Natal, South Africa. AIDS Care 2018; 31:186-192. [PMID: 30058362 DOI: 10.1080/09540121.2018.1503638] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Successful implementation of Universal Test and Treat as a strategy to achieve the 90-90-90 target requires higher HIV testing rates. Currently, uptake of HIV testing is not optimal which has directed research initiatives towards identification of additional HIV testing methods. HIV self-testing (HIVST) has received growing attention as a complementary testing approach as it overcomes barriers that are commonly associated with current HIV testing methods. In sub-Saharan Africa, acceptability rates showed a gendered pattern of men benefitting more than women, with limited evidence to explain this difference. This study assessed whether men or women in KwaZulu-Natal displayed a higher acceptance of HIVST and also explored factors that influenced and motivated their acceptability. Participants were recruited through purposive sampling at two clinical research sites to participate and underwent qualitative assessments. The outcomes from focus group discussions coupled with findings from a scoping review informed the design and data collection instruments for in-depth interviews. A randomised cross-over study design exposed participants to HIV counselling and testing and HIVST, accompanied by before (baseline) and after in-depth interviews. HIVST was acceptable among most participants with acceptability higher in women. Men preferred HIVST due to convenience and efficiency, whilst women favoured HIVST due to its potential to provide autonomy and empowerment. Also, lack of HIV counselling and managing a positive HIV result as well as linkage to care were raised as deterrents of HIVST. As HIVST was acceptable by most participants, future research efforts should be directed towards evaluating the feasibility of its introduction into the public health sector.
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Affiliation(s)
- Charlene Harichund
- a Centre for the AIDS Programme of Research in South Africa, 2nd Floor, Doris Duke Medical Research Institute , 719 Umbilo Road, Durban 4013 , South Africa
| | - Mosa Moshabela
- b School of Nursing and Public Health , University of KwaZulu-Natal , Durban , South Africa.,c Africa Health Research Institute , Durban , KwaZulu-Natal , South Africa
| | - Pinky Kunene
- a Centre for the AIDS Programme of Research in South Africa, 2nd Floor, Doris Duke Medical Research Institute , 719 Umbilo Road, Durban 4013 , South Africa
| | - Quarraisha Abdool Karim
- a Centre for the AIDS Programme of Research in South Africa, 2nd Floor, Doris Duke Medical Research Institute , 719 Umbilo Road, Durban 4013 , South Africa.,d Department of Epidemiology , Columbia University , New York , NY , USA
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HIV Testing in Men who have Sex with Men: A Follow-up Review of the Qualitative Literature since 2010. AIDS Behav 2018; 22:593-605. [PMID: 28331992 DOI: 10.1007/s10461-017-1752-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The landscape of HIV testing has changed significantly in recent years following the rise in importance of the 'treatment as prevention' strategy and advancements in new HIV testing and prevention technologies. This review provides a synthesis of qualitative research findings published since 2010 on preferences and practices of men who have sex with men (MSM) surrounding HIV testing in high-income settings. MSM are one of the hardest groups to reach with standard or conventional HIV testing approaches. To develop innovative testing strategies for this particular group, a good understanding of their concerns, barriers and facilitators of accessing HIV testing is needed. This updated review provides valuable information for improving existing programs and designing new testing services for MSM.
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Abstract
OBJECTIVE HIV self-testing (HIVST) is now officially recommended by the WHO, yet much of HIVST evidence to date has focused on quantitative data and hypothetical concerns. Effective scale-up of HIVST in diverse local contexts requires qualitative data from experiences using and organizing HIVST. This qualitative systematic review aims to appraise and synthesize research evidence on experiences using and organizing HIVST. METHODS We conducted a systematic search of seven primary literature databases, four gray literature sources, and reference lists reporting qualitative evidence on HIVST. Data extraction and thematic analysis were used to synthesize findings. Quality of studies was assessed using the Critical Appraisal Skills Programme tool. Confidence in review findings was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach. The review protocol was registered (CRD42015027607). RESULTS From 1266 potential articles, we included 18. Four studies were conducted in low-income countries, three in middle-income countries, 10 in high-income countries, and one in multiple countries. Generally, HIVST increased capacity to reach priority populations and expanded opportunities for service delivery. Self-testing was preferred to facility-based testing due to increased convenience and confidentiality, especially among stigmatized populations. HIVST decreased test-associated stigma compared with facility-based testing. HIVST generally empowered people because it provided greater control over individual testing needs. At the same time, HIVST rarely allowed husbands to coerce their wives to test. CONCLUSIONS This review suggests that HIVST should be offered as an additional HIV testing option to expand testing and empower testers. Adapting national policies to incorporate HIVST will be necessary to guide scale-up.
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A Randomized Controlled Trial Evaluating Efficacy of Promoting a Home-Based HIV Self-Testing with Online Counseling on Increasing HIV Testing Among Men Who Have Sex with Men. AIDS Behav 2018; 22:190-201. [PMID: 28831616 DOI: 10.1007/s10461-017-1887-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We developed an innovative home-based HIV self-testing (HIVST) service that included mailing of a free HIVST kit, and providing online real-time instructions and pre-test/post-test counseling (HIVST-OIC). The present parallel-group and non-blinded randomized controlled trial was conducted to evaluate the efficacy of promoting HIVST-OIC in increasing HIV testing rate among 430 men who have sex with men (MSM), with access to online live-chat applications in Hong Kong. At month 6, as compared to the control group, the intervention group reported significantly higher prevalence of HIV testing of any type (89.8 vs. 50.7%; relative risk (RR): 1.77; p < 0.001). Among those who have taken up any HIV testing in the last six months, significant between-group difference was found in multiple male sex partnerships (34.2 vs. 47.7%, RR: 0.72; p = 0.021). HIVST-OIC has a strong potential in increasing prevalence of HIV testing and reducing sexual risk behaviors. Implementation research is warranted.
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Zhang C, Li X, Brecht ML, Koniak-Griffin D. Can self-testing increase HIV testing among men who have sex with men: A systematic review and meta-analysis. PLoS One 2017; 12:e0188890. [PMID: 29190791 PMCID: PMC5708824 DOI: 10.1371/journal.pone.0188890] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 10/19/2017] [Indexed: 01/20/2023] Open
Abstract
Background Globally, four out of ten individuals living with HIV have not been tested for HIV. Testing is especially important for men who have sex with men (MSM), among whom an increasing HIV epidemic has been identified in many regions of the world. As a supplement to site-based HIV testing services, HIV self-testing (HIVST) provides a promising approach to promote HIV testing. However, evidence is scattered and not well-summarized on the effect of HIVST to improve HIV testing behaviors, especially for MSM. Methods Seven databases (PubMed, Web of Science, Cochrane Library, PsycINFO, CINAHL Plus, WanFang, and China National Knowledge Internet) and conference abstracts from six HIV/sexually transmitted infections conferences were searched from January 2000-April 2017. Results Of 1,694 records retrieved, 23 studies were identified, 9 conducted in resource-limited countries and 14 in high-income countries. The pooled results showed that HIVST increased HIV test frequency for MSM by one additional test in a 6-month period (mean difference = 0.88 [95% CI 0.52–1.24]). The pooled proportion of first-time testers among those who took HIVST was 18.7% (95% CI: 9.9–32.4) globally, with a rate 3.32 times higher in resource-limited country settings (32.9% [95% CI: 21.3–47.6]) than in high-income countries (9.9% [95% CI: 7.4–13.8]). The pooled proportions included non-recent testers, 32.9% (95% CI: 28.1–38.3); ever or currently married MSM, 16.7% (95% CI: 14.5–19.4); and HIV positive men, 3.8% (95% CI: 2.0–5.7) globally; 6.5% [95% CI: 0.38–12.3] in resource-limited country settings; and 2.9% [95% CI: 2.0–5.0] in high-income countries). The rates reported for linkage to care ranged from 31.3% to 100%. Conclusions HIVST could increase HIV testing frequency and potentially have capacity equivalent to that of site-based HIV testing services to reach first-time, delayed, married, and HIV-infected testers among MSM and link them to medical care. However, more rigorous study designs are needed to explore the specific self-testing approach (oral-fluid based or finger-prick based) on improving HIV testing for MSM in different social and economic settings.
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Affiliation(s)
- Ci Zhang
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Xianhong Li
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
- * E-mail:
| | - Mary-Lynn Brecht
- UCLA School of Nursing, Los Angeles, California, United States of America
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High acceptability of rapid HIV self-testing among a diverse sample of MSM from Buenos Aires, Argentina. PLoS One 2017; 12:e0180361. [PMID: 28672037 PMCID: PMC5495397 DOI: 10.1371/journal.pone.0180361] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/14/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The objective of this study was to explore the acceptability of rapid HIV self-testing (RHST) among men who have sex with men (MSM). METHODS During 2006-2009, a sample of 500 MSM was recruited through Respondent Driven Sampling for an HIV prevalence/incidence study. Attitude toward RHST was explored among HIV negative MSM. Data were weighted prior to analyses. RESULTS Participants reported they were likely to buy RHST (74%), test themselves more frequently than they currently do (77%), and that the procedure would simplify testing (70%). Furthermore, 71% reported they would probably use it alone, 66% would use it with a steady partner, and 56% with a friend/partner. While a majority acknowledged that RHST use would deprive them of receiving counseling (61%), 74% declared they would go for help if they tested positive; 57% would use an RHST in order to avoid condoms. Probability of use surpassed 70% among gay and non-gay identified MSM as well as those with and without a previous HIV test. Those likely to buy RHST were older (p = 0.025) and more likely to identify as gay (p = 0.036). A total of 17% said they would think about killing themselves and 9% would attempt suicide if they tested positive. These MSM were more likely to be younger (p<0.001), with lower mood level (p<0.001) and greater feelings of loneliness (p = 0.026). CONCLUSIONS The high acceptability of RHST found among MSM should encourage the authorities to consider the possibility of offering it for self-testing, as it can improve early diagnosis and prevention of future transmissions. However, further research is needed to understand how to best disseminate RHST among MSM who wish to use it and to offer support and linkage to care for those who test HIV-positive.
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Wray T, Chan PA, Simpanen E, Operario D. eTEST: Developing a Smart Home HIV Testing Kit that Enables Active, Real-Time Follow-Up and Referral After Testing. JMIR Mhealth Uhealth 2017; 5:e62. [PMID: 28483744 PMCID: PMC5440737 DOI: 10.2196/mhealth.6491] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/24/2017] [Accepted: 03/25/2017] [Indexed: 11/25/2022] Open
Abstract
Background Men who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV. Objective The aim of our study was to use qualitative research methods with high-risk MSM to inform development of a “smart” HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone. Methods In phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST. Results Phase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful. Conclusions Using BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time.
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Affiliation(s)
- Tyler Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Philip A Chan
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI, United States
| | - Erik Simpanen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
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Witzel TC, Weatherburn P, Burns FM, Johnson CC, Figueroa C, Rodger AJ. Consolidating emerging evidence surrounding HIVST and HIVSS: a rapid systematic mapping protocol. Syst Rev 2017; 6:72. [PMID: 28381283 PMCID: PMC5382504 DOI: 10.1186/s13643-017-0452-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) is becoming popular with policy makers and commissioners globally, with a key aim of expanding access through reducing barriers to testing for individuals at risk of HIV infection. HIV self-sampling (HIVSS) was available previously to self-testing but was confined mainly to the USA and the UK. It remains to be seen whether the momentum behind HIVST will also energise efforts to expand HIVSS. Recent years have seen a rapid growth in the type of evidence related to these interventions as well as several systematic reviews. The vast majority of this evidence relates to acceptability as well as values and preferences, although new types of evidence are emerging. This systematic map aims to consolidate all emerging evidence related to HIVST and HIVSS to respond to this rapidly changing area. METHODS We will systematically search databases and the abstracts of five conferences from 2006 to the present date, with monthly-automated database searches. Searches will combine key terms relating to HIV (e.g. HIV, AIDS, human immune-deficiency syndrome) with terms related to self-testing (e.g. home-test, self-test, mail-test, home dried blood spot test). Abstracts will be reviewed against inclusion criteria in duplicate. Data will be manually extracted through a standard form and then entered to an open access relational map (HIVST.org). When new and sufficient evidence emerges which addresses existing knowledge gaps, we will complete a review on a relevant topic. DISCUSSION This innovative approach will allow rapid cataloguing, documenting and dissemination of new evidence and key findings as they emerge into the public domain. SYSTEMATIC REVIEW REGISTRATION This protocol has not been registered with PROSPERO as they do not register systematic maps.
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Affiliation(s)
- T Charles Witzel
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Peter Weatherburn
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Fiona M Burns
- Research Department of Infection & Population Health, UCL and Royal Free London NHS Foundation Trust, London, UK
| | - Cheryl C Johnson
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Carmen Figueroa
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Alison J Rodger
- Research Department of Infection & Population Health, UCL and Royal Free London NHS Foundation Trust, London, UK
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Jamil MS, Prestage G, Fairley CK, Grulich AE, Smith KS, Chen M, Holt M, McNulty AM, Bavinton BR, Conway DP, Wand H, Keen P, Bradley J, Kolstee J, Batrouney C, Russell D, Law M, Kaldor JM, Guy RJ. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. Lancet HIV 2017; 4:e241-e250. [PMID: 28219619 DOI: 10.1016/s2352-3018(17)30023-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 12/04/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frequent testing of individuals at high risk of HIV is central to current prevention strategies. We aimed to determine if HIV self-testing would increase frequency of testing in high-risk gay and bisexual men, with a particular focus on men who delayed testing or had never been tested before. METHODS In this randomised trial, HIV-negative high-risk gay and bisexual men who reported condomless anal intercourse or more than five male sexual partners in the past 3 months were recruited at three clinical and two community-based sites in Australia. Enrolled participants were randomly assigned (1:1) to the intervention (free HIV self-testing plus facility-based testing) or standard care (facility-based testing only). Participants completed a brief online questionnaire every 3 months, which collected the number of self-tests used and the number and location of facility-based tests, and HIV testing was subsequently sourced from clinical records. The primary outcome of number of HIV tests over 12 months was assessed overall and in two strata: recent (last test ≤2 years ago) and non-recent (>2 years ago or never tested) testers. A statistician who was masked to group allocation analysed the data; analyses included all participants who completed at least one follow-up questionnaire. After the 12 month follow-up, men in the standard care group were offered free self-testing kits for a year. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001236785. FINDINGS Between Dec 1, 2013, and Feb 5, 2015, 182 men were randomly assigned to self-testing, and 180 to standard care. The analysis population included 178 (98%) men in the self-testing group (174 person-years) and 165 (92%) in the standard care group (162 person-years). Overall, men in the self-testing group had 701 HIV tests (410 self-tests; mean 4·0 tests per year), and men in the standard care group had 313 HIV tests (mean 1·9 tests per year); rate ratio (RR) 2·08 (95% CI 1·82-2·38; p<0·0001). Among recent testers, men in the self-testing group had 627 tests (356 self-tests; mean 4·2 per year), and men in the standard care group had 297 tests (mean 2·1 per year); RR 1·99 (1·73-2·29; p<0·0001). Among non-recent testers, men in the self-testing group had 74 tests (54 self-tests; mean 2·8 per year), and men in the standard care group had 16 tests (mean 0·7 per year); RR 3·95 (2·30-6·78; p<0·0001). The mean number of facility-based HIV tests per year was similar in the self-testing and standard care groups (mean 1·7 vs 1·9 per year, respectively; RR 0·86, 0·74-1·01; p=0·074). No serious adverse events were reported during follow-up. INTERPRETATION HIV self-testing resulted in a two times increase in frequency of testing in gay and bisexual men at high risk of infection, and a nearly four times increase in non-recent testers, compared with standard care, without reducing the frequency of facility-based HIV testing. HIV self-testing should be made more widely available to help increase testing and earlier diagnosis. FUNDING The National Health and Medical Research Council, Australia.
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Affiliation(s)
| | | | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | | | - Kirsty S Smith
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Marcus Chen
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Anna M McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | | | - Damian P Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Handan Wand
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jack Bradley
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Colin Batrouney
- Victorian AIDS Council/Gay Men's Health Centre, Melbourne, VIC, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns North, QLD, Australia; James Cook University, Townsville, QLD, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
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