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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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2
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Goodman MD. Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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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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Hoyos J, Maté T, Guerras JM, Donat M, Agustí C, Kuske M, Fuertes R, Chanos S, Pichon F, Sordo L, Pulido J, Belza MJ. Preference towards HIV Self-Testing above Other Testing Options in a Sample of Men Who Have Sex with Men from Five European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094804. [PMID: 33946300 PMCID: PMC8125199 DOI: 10.3390/ijerph18094804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022]
Abstract
We analyzed men who have sex with men (MSM) from Denmark, Germany, Greece, Portugal and Spain to identify who would choose HIV self-testing as their preferred testing method and assessed their preferred setting to acquire a self-testing kit and to confirm a reactive result. In 2016, we recruited an online sample of 3725 HIV-negative MSM. We used Poisson regression to identify factors associated with choosing self-testing as the preferred testing option. For those choosing it as their preferred option, we assessed the preferred settings to acquire a self-testing kit and to confirm a reactive result. Not being open about one's sexual behaviors with men was associated with choosing self-testing as the preferred option, except in Greece; older age in Greece and Spain; reporting condomless anal intercourses (CAI) in Germany and Portugal; reporting one previous test in Greece; between 2 and 5 in Spain and with having been tested ≥ 12 months ago in Germany, Portugal and Spain. The internet (32.8%) was the preferred place to acquire a self-testing kit and primary care (34.0%) for confirmation purposes. Self-testing was highly valued, especially among individuals who were not open about their sexual behaviors with men. In certain countries, it was also associated with older age, CAI and being undertested.
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Affiliation(s)
- Juan Hoyos
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
| | - Tomás Maté
- Gerencia de Atención Primaria de Valladolid Este, Gerencia Regional de Salud de Castilla y León (SACYL), 47010 Valladolid, Spain
- Correspondence:
| | - Juan-Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Donat
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Cristina Agustí
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Departament de Salut, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Generalitat de Catalunya, 08005 Badalona, Spain
| | | | - Ricardo Fuertes
- GAT-Grupo de Ativistas em Tratamentos, 1000-228 Lisboa, Portugal;
| | | | | | - Luis Sordo
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
| | - José Pulido
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain;
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5
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Hoyos J, Guerras JM, Maté T, Agustí C, Fernández-López L, de la Fuente L, Belza MJ. Opinions Towards Key Operational Aspects for the Implementation of HIV Self-Testing in Spain: A Comparison between Stakeholders and Potential Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041428. [PMID: 33546500 PMCID: PMC7913712 DOI: 10.3390/ijerph18041428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2021] [Accepted: 01/30/2021] [Indexed: 11/16/2022]
Abstract
We assessed previous knowledge about the existence of HIV self-testing of stakeholders in Spain, as well as their personal position towards this methodology. We also assessed their views on potential users’ (PU) opinions towards several key operational aspects surrounding self-testing, and compared them to those expressed by a sample of PU comprised of men who have sex with men. In 2017, we recruited three types of stakeholders: public health professionals and policy makers (PHPPM) (n = 33), clinical providers (n = 290) and community-based/non-governmental organization (CBO/NGO) workers (n = 55). Data on PU (n = 3537) were collected in 2016. Previous knowledge about the existence of self-testing was higher in stakeholders than in PU, but being in favor was less frequent. PUs’ willingness to pay 25–30 euros for a self-test was higher than that which stakeholders considered. According to clinical providers and PHPPM, pharmacies would be PUs’ preferred place to obtain a self-test, which was in line with PUs’ actual choice. CBO/NGO workers on the other hand thought it would be CBO/NGOs. PHPPM and clinical providers considered primary care as PUs’ preferred setting to confirm a reactive self-test and CBO/NGO chose CBO/NGOs, but PUs preferred an HIV/STI testing service or clinic. Stakeholders’ opinions significantly differed from those of PUs. This divergence needs to be brought up to stakeholders as it could vary their position towards self-testing as well as the actions taken in the implementation of a testing option with the potential of increasing testing frequency.
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Affiliation(s)
- Juan Hoyos
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Juan-Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid 28029, Spain
- Correspondence:
| | - Tomás Maté
- Gerencia de Atención Primaria Valladolid Este, 47010 Valladolid, Spain;
| | - Cristina Agustí
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, 08005 Badalona, Spain
| | - Laura Fernández-López
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, 08005 Badalona, Spain
| | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Hoyos J, Guerras JM, Koutentakis K, de la Fuente L, Pulido J, Sordo L, Vallejo F, Belza MJ. The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study. BMC Public Health 2020; 20:1865. [PMID: 33276743 PMCID: PMC7718697 DOI: 10.1186/s12889-020-09976-9] [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: 03/26/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test. Methods We conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past. Results Nearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25–34 (PR:1.1, 95%CI:1.0–1.3), 35–44 (PR:1.3, 95%CI:1.2–1.5), 45–49 (PR:1.5, 95%CI:1.3–1.7) and > 50 (PR:1.5, 95%CI:1.3–1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0–1.2) or having paid for sex (PR:1.2, 95%CI:1.0–1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2–9 tests (PR:1.3, 95%CI:1.1–1.4); 1 test (PR:1.5, 95%CI:1.3–1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3–1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0–1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn’t know how to react. Only one individual expressed that he would do nothing at all. Conclusion HIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09976-9.
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Affiliation(s)
- J Hoyos
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - J M Guerras
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain. .,National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain.
| | - K Koutentakis
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - L de la Fuente
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - L Sordo
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - F Vallejo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,Department of Biostatistics and Epidemiology, National School of Health, Carlos III Health Institute, Madrid, Spain
| | - M J Belza
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,Department of Biostatistics and Epidemiology, National School of Health, Carlos III Health Institute, Madrid, Spain
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Croxford S, Tavoschi L, Sullivan AK, Combs L, Raben D, Delpech V, Jakobsen SF, Amato‐Gauci AJ, Desai S. HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance. HIV Med 2020; 21:142-162. [PMID: 31682060 PMCID: PMC7065225 DOI: 10.1111/hiv.12807] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/05/2019] [Accepted: 09/16/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA). METHODS Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010-2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014-2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Eighty studies on HIV testing in non-health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1). CONCLUSIONS This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage.
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Affiliation(s)
- S Croxford
- National Infection ServicePublic Health EnglandLondonUK
| | - L Tavoschi
- European Centre for Disease Prevention and ControlStockholmSweden
- University of PisaPisaItaly
| | - AK Sullivan
- National Infection ServicePublic Health EnglandLondonUK
- Directorate of HIV and Sexual HealthChelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - L Combs
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagenDenmark
| | - D Raben
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagenDenmark
| | - V Delpech
- National Infection ServicePublic Health EnglandLondonUK
| | - SF Jakobsen
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagenDenmark
| | - AJ Amato‐Gauci
- European Centre for Disease Prevention and ControlStockholmSweden
| | - S Desai
- National Infection ServicePublic Health EnglandLondonUK
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Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_44-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koutentakis K, Hoyos J, Rosales-Statkus ME, Guerras JM, Pulido J, de la Fuente L, Belza MJ. HIV self-testing in Spain: A valuable testing option for men-who-have-sex-with-men who have never tested for HIV. PLoS One 2019; 14:e0210637. [PMID: 30759090 PMCID: PMC6373894 DOI: 10.1371/journal.pone.0210637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We assessed the capacity of HIV self-testing to promote testing among untested men who have sex with men (MSM) and determined the most benefited subpopulations. METHODS An online questionnaire was disseminated on several gay websites in Spain from September 2012 to April 2013. We used Poisson regression to estimate factors associated with the intention to use self-testing if already available. Among those who reported intention of use, we assessed several aspects related to the testing and linkage to care process by type of barrier reported: low perceived risk (LR), structural barriers (SB) and fear of testing positive (FTP). RESULTS Of 2589 never-tested MSM, 83% would have used self-testing if already available. Intention of use was associated with age ≥30 (adj.PR, 95%CI: 1.05, 1.01-1.10), having had protected (adj.PR, 95%CI: 1.15, 1.02-1.30) or unprotected (adj.PR, 95%CI: 1.21, 1.07-1.37) anal intercourse and reporting FTP (adj.PR, 95%CI: 1.12, 1.05-1.20) or SB to access HIV testing (adj.PR, 95%CI: 1.23, 1.19-1.28). Among those who reported intention of using a self-testi, 78.3% declared it their preferred option (83.8% in the SB group; p<0.001), and 56.8% would always use this testing option (60.9% among the SB group; p = 0.001). In the case of obtaining a positive self-test, 69.3% would seek confirmatory testing, 15.3% would self-test again before taking any decision and 13.0% reported not being sure of what they would do. CONCLUSION HIV self-testing in Spain has the potential of becoming a highly used testing methodology for untested MSM and could represent the gateway to testing especially among older, at risk MSM who report SB or FTP as main barriers to testing.
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Affiliation(s)
| | - Juan Hoyos
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain.,Department of Public and Mother-child health, Faculty of Medicine, Madrid Complutense University, Madrid, Spain
| | - María-Elena Rosales-Statkus
- Carlos III Health Institute, National Center of Epidemiology, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain
| | | | - Jose Pulido
- Department of Public and Mother-child health, Faculty of Medicine, Madrid Complutense University, Madrid, Spain.,Carlos III Health Institute, National School of Health, Department of Health Programs, Madrid, Spain
| | - Luis de la Fuente
- Carlos III Health Institute, National Center of Epidemiology, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain
| | - María-José Belza
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain.,Carlos III Health Institute, National School of Health, Department of Epidemiology and Biostatistics, Madrid, Spain
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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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Benefits and Potential Harms of Human Immunodeficiency Virus Self-Testing Among Men Who Have Sex With Men in China: An Implementation Perspective. Sex Transm Dis 2017; 44:233-238. [PMID: 28282650 DOI: 10.1097/olq.0000000000000581] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human immunodeficiency virus self-testing (HIVST) holds great promise for reaching high-risk key populations who do not access facility-based services. We sought to characterize unsupervised HIVST implementation among men who have sex with men in China. METHODS We conducted a nationwide online survey in China. Eligible men were at least 16 years, had anal sex with a man, and had recent condomless sex. We assessed benefits (first-time testing, increased testing frequency, confirmatory testing) and potential harms (coercion, violence, suicidality) of HIVST. Among men who have sex with men who reported ever testing for human immunodeficiency virus (HIV), we identified correlates of HIVST as first-time HIV test being a self-test using multivariable logistic regression. RESULTS Among 1610 men who met the eligibility criteria and started the survey, 1189 (74%) completed it. Three hundred forty-one (29%) of 1189 reported ever self-testing for HIV. Human immunodeficiency virus prevalence was 7% (24/341) among self-testers and 5% (15/306) among non-self-testers. Two hundred (59%) of 341 men who self-tested reported HIVST as a first-time HIV test. Thirty-one (9%) men experienced coercion with HIVST. Thirty-one (78%) of 40 men with positive HIV self-tests sought confirmation. Multivariable analysis revealed that HIVST as first-time HIV test was associated with younger age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.99), not being "out" (OR, 2.28; 95% CI, 1.60-3.28), not using the internet to meet sex partners (OR, 0.39; 95% CI, 0.22-0.69), and group sex (OR, 1.74; 95% CI, 1.02-2.9). CONCLUSIONS Human immunodeficiency virus self-testing reached high-risk individuals that had never received facility-based testing. Further implementation research is needed to better understand HIVST outside of research programs.
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Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gruson D, Ko G. Laboratory medicine and mobile health technologies at crossroads: Perspectives for the management of chronic diseases. Crit Rev Clin Lab Sci 2016; 53:352-7. [PMID: 26983900 DOI: 10.3109/10408363.2016.1167163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Management of chronic diseases represents a leading health and economic issue worldwide. Biomarkers are critical for the diagnosis and management of both communicable and non-communicable chronic diseases, and mobile health (mHealth) technologies are about to change the "game" with regard to the management of patients with such chronic diseases. The development of efficient, accurate and interactive solutions that integrate biomarkers and mHealth opens new perspectives for caregivers for the management of chronic illness.
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Affiliation(s)
- Damien Gruson
- a Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain , Brussels , Belgium .,b Department of Laboratory Medicine , Cliniques Universitaires St-Luc and Université Catholique de Louvain , Brussels , Belgium , and
| | - Gabriel Ko
- c GKo and Co Consulting , Paris , France
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Monge S, Pérez-Molina JA. [HIV infection and immigration]. Enferm Infecc Microbiol Clin 2016; 34:431-8. [PMID: 27016136 DOI: 10.1016/j.eimc.2016.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
Abstract
Migrants represent around one third of patients newly diagnosed with HIV in Spain and they constitute a population with higher vulnerability to its negative consequences due to the socio-cultural, economical, working, administrative and legal contexts. Migrants are diagnosed later, which worsens their individual prognosis and facilitates the maintenance of the HIV epidemic. In spite of the different barriers they experience to access healthcare in general, and HIV-related services in particular, access to antiretroviral treatment has been similar to that of the autochthonous population. However, benefits of treatment have been not, with women in general and men from Sub-Saharan Africa exhibiting the worse response to treatment. We need to proactively promote earlier diagnosis of HIV infection, the adoption of preventive measures to avoid new infections, and to deliver accessible, adapted and high-quality health-care.
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Affiliation(s)
- Susana Monge
- Facultad de Medicina, Universidad de Alcalá de Henares; CIBERESP, Madrid, España.
| | - José A Pérez-Molina
- CSUR de Medicina Tropical, Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal; IRYCIS, Madrid, España
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Jamil MS, Prestage G, Fairley CK, Smith KS, Kaldor JM, Grulich AE, McNulty AM, Chen M, Holt M, Conway DP, Wand H, Keen P, Batrouney C, Bradley J, Bavinton BR, Ryan D, Russell D, Guy RJ. Rationale and design of FORTH: a randomised controlled trial assessing the effectiveness of HIV self-testing in increasing HIV testing frequency among gay and bisexual men. BMC Infect Dis 2015; 15:561. [PMID: 26653203 PMCID: PMC4676114 DOI: 10.1186/s12879-015-1300-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Gay and bisexual men (GBM) are a major risk group for HIV acquisition, yet the majority of higher-risk GBM test for HIV less often than recommended (3-6 monthly). HIV self-testing has the potential to increase testing frequency and improve awareness of personal HIV status. HIV self-tests have been approved in some countries, however there are concerns whether self-testing would increase HIV testing frequency enough to compensate for the reduced sensitivity of self-tests in early infection. We describe here a randomised controlled trial to assess the effectiveness of self-testing in increasing HIV testing frequency among higher-risk GBM, and its acceptability. METHODS/DESIGN Participants are higher-risk HIV negative GBM (>5 partners or condomless anal intercourse in previous 3 months; n = 350), including 50 GBM who tested for HIV over two years ago or never tested before ('infrequent-testers'). Participants are recruited from sexual health clinics and community-based organisations, and randomised 1:1 to either self-testing or standard-care (routine clinic-based testing) arms. The trial employs a wait-list control design: participants in the standard-care arm switch to self-testing arm in the second year, and gain access to self-test kits. Participants in the self-testing arm receive four oral-fluid self-test kits at enrolment, with additional kits provided on request. Demographics, sexual behaviour and HIV testing preferences are collected at baseline, and the frequency and pattern of HIV and sexually transmissible infection (STI) testing is collected via online 3-monthly questionnaires. The acceptability of self-testing is assessed at 12 months via an online questionnaire and in-depth interviews. A 24-h telephone support is provided, with expedited follow-up of those with reactive self-test results. The primary outcome is HIV testing frequency (mean number of HIV tests per person) over 12 months, and the secondary outcomes are: mean number of STI tests (chlamydia, gonorrhoea, syphilis) per person; reasons for HIV testing; and acceptability of HIV self-testing. DISCUSSION This is the first trial to evaluate the use of self-testing among GBM in Australia, and the first internationally among infrequent testers. The study will provide evidence on whether self-testing increases HIV testing frequency, and its acceptability among GBM. The findings will improve our understanding of self-testing patterns, and whether GBM supplement or replace their existing testing routine. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registration number: ACTRN12613001236785 , registered on November 12, 2013.
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Affiliation(s)
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia.
| | - 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 Australia, Sydney, NSW, Australia.
| | - John M Kaldor
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
| | | | - Anna M McNulty
- Sydney Sexual Health Centre, Sydney Hospital, 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 Australia, Sydney, NSW, Australia.
| | - Damian P Conway
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
| | - Handan Wand
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
| | - Phillip Keen
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
| | - Colin Batrouney
- Victorian AIDS Council/Gay Men's Health Centre, Melbourne, VIC, Australia.
| | - Jack Bradley
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
| | | | | | - Darren Russell
- Cairns Sexual Health Service, Cairns North, QLD, Australia.
- James Cook University, Townsville, QLD, Australia.
| | - Rebecca J Guy
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
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Goodman MD. Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_44-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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