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Daniel D, Hasen H, Sinebo Y, Bereku T, Mekuria M, Jemal Z, Amare M, Habtu Y. Level of knowledge and intention to use oral fluid HIV self-testing and associated factors among Ethiopian health care workers in southern Ethiopia. AIDS Res Ther 2024; 21:56. [PMID: 39182097 PMCID: PMC11344910 DOI: 10.1186/s12981-024-00642-3] [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: 06/03/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The World Health Organization has recommended a new method for HIV self-testing (HIVST) using oral fluid, intending to increase HIV testing rates, and linking individuals to medical care. Healthcare workers are chief health advocates in the community who need adequate knowledge and intention to use the newly recommended HIVST approach. However, studies on awareness and the intention to use oral fluid for HIV self-testing among Ethiopian healthcare workers are limited. Therefore, this study aimed to assess healthcare workers' knowledge of and intentions to use oral fluid for HIV self-testing in Hadiya Zone public hospitals in southern Ethiopia in 2022. METHODS We conducted a facility-based cross-sectional study among a sample of 352 healthcare workers from 1 to 30 June 2022. The data were entered into Epidata version 4.2 and exported to SPSS version 23 for analysis. We used a logistic regression model with a 95% confidence interval for the interpretation of adjusted odds ratios (AORs) with P < 0.05. RESULTS Of the total participants, 40.3% had good knowledge, and 63.1% intended to use oral fluid (HIVST). Approximately 92% of healthcare workers had not received training, and 48.3% had heard about HIVST. Only 12.3% knew about the availability of the kit in hospitals, and 19.9% had ever used HIVST. Being male (AOR = 2.28; 95% CI 1.33-3.95), receiving support for the implementation of HIVST (AOR = 2.07; 95% CI 1.21-3.56), hearing about HIVST (AOR = 5.05; 95% CI 2.89-8.81), having prior experience using HIVST (AOR = 2.94; 95% CI 1.71-5.05), having a spouse or partner (AOR = 2.78; 95% CI 1.14-6.82), and having multiple sexual partners (AOR = 2.76; 95% CI 1.13-6.78) were associated with good knowledge of oral HIVST. Being aged 25-29 years (AOR = 2.54; 95% CI 1.18, 5.41), perceiving the high cost of the HIVST kit (AOR = 0.37; 95% CI 0.16-0.84), and having poor knowledge (AOR = 1.91; 95% CI 1.13-3.23) were significantly associated with the intention to use the oral fluid for HIVST. CONCLUSION This study highlights the need for technical updating training for healthcare workers to increase their knowledge of and intention to use oral fluid for HIVST. Promoting oral fluid HIVST through targeted education, supporting initiatives, and addressing cost concerns related to the testing kit may increase the uptake of oral fluid HIVST among healthcare workers.
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Affiliation(s)
- Dinku Daniel
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
| | - Habtamu Hasen
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia.
| | - Yisak Sinebo
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
| | - Tessema Bereku
- Department of Midwifery, Hossana College of Health Science, Hossana, Ethiopia
| | - Melese Mekuria
- Department of Medical Laboratory, Hossana College of Health Science, Hossana, Ethiopia
| | - Zemzem Jemal
- Department of Midwifery, Hossana College of Health Science, Hossana, Ethiopia
| | - Mesganew Amare
- School of Midwifery, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Yitagesu Habtu
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
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Spence T, Griffiths F, Ross J. Service user experiences of using internet-based testing for sexually transmitted infections (STIs): a qualitative study. Sex Transm Infect 2024; 100:356-361. [PMID: 38821875 PMCID: PMC11347205 DOI: 10.1136/sextrans-2024-056228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVES Internet-based testing for sexually transmitted infections allows individuals to order a self-sampling kit online, send samples to a central laboratory and receive their results electronically, reducing the need to attend a clinic unless for treatment. Its usage has grown rapidly in many high-income countries, such as England, where it now accounts for 44% of tests within the National Chlamydia Screening Programme. However, there is limited data on the experiences of service users, which may offer insights into low uptake and poor return rates among some high-incidence populations. METHODS Participants were recruited via sexual health clinics and the website of an internet-based testing service. Purposive sampling was used to ensure a diversity of genders, sexualities and ethnic backgrounds were included. Semistructured interviews were conducted by phone, email and messenger services and explored participants' perceptions and experiences of both internet-based and clinic-based testing. Data underwent thematic analysis. RESULTS We interviewed 17 participants. Internet-based testing appealed to many due to the privacy and convenience it offered over clinic-based testing. Although most were positive about their experience of internet-based testing, many found the process of finger-prick blood sampling extremely challenging and this contributed to concerns from some participants that test results may be inaccurate. A minority of participants missed the opportunity that clinic-based testing offered to discuss symptoms or concerns with staff. Participants overwhelmingly found the process of receiving test results by short message service (SMS) acceptable and preferable to alternatives. CONCLUSIONS Internet-based testing is viewed positively by most users but uptake may be improved if providers emphasise the privacy and convenience it offers, as well as the accuracy of self-sampling. Providers should also consider measures to address user concerns around blood sampling and access to specialist advice.
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Affiliation(s)
- Tommer Spence
- Institute of Epidemiology and Health Care, UCL, London, UK
| | | | - Jonathan Ross
- Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Diaz JE, Ghanooni D, Atkins L, Sam SS, Kantor R, Miller-Perusse M, Chuku CC, Valentin O, Balise RR, Davis-Ewart L, Tisler A, Horvath KJ, Carrico AW, Hirshfield S. Challenges and Opportunities with at-Home Blood Collection for HIV-1 Viral Load Monitoring among Sexual Minoritized Men who use Stimulants. AIDS Behav 2024:10.1007/s10461-024-04453-5. [PMID: 39126558 DOI: 10.1007/s10461-024-04453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/12/2024]
Abstract
Sexually minoritized men (SMM) with HIV who use stimulants experience difficulties achieving and maintaining an undetectable viral load (VL). Home-based VL monitoring could augment HIV care by supporting interim, early identification of detectable VL. We describe implementation challenges associated with a home-collection device for laboratory-based VL testing among SMM with HIV who use stimulants. From March-May 2022, cisgender SMM with HIV reporting moderate-to-severe stimulant use disorder and suboptimal (< 90%) past-month antiretroviral therapy (ART) adherence were recruited via a consent-to-contact participant registry. Eligible men completed teleconference-based informed consent and were mailed a HemaSpot-HD blood collection device (volume capacity 160 µL; lower limit of detection 839 copies/mL) with detailed instructions for home blood self-collection and return shipment. Implementation process measures included estimated blood volume and VL quantification. Among 24 participants, 21 (88%) returned specimens with a median duration of 23 days (range: 10-71 days) between sending devices to participants and receiving specimens. Of these, 13/21 (62%) included enough blood (≥ 40 µL) for confidence in detectable/undetectable results; 10/13 (77%) had detectable VL, with 4/10 (40%) were quantifiable at ≥ 839 copies/mL. The remaining 8/21 had low blood volume (< 40 µL), but 3/8 (38%) still had detectable VL, with 1/3 (33%) quantifiable at ≥ 839 copies/mL. Home blood collection of ≥ 40 µL using HemaSpot-HD was feasible among this high-priority population, with > 50% having a VL detected. However, interim VL monitoring using HemaSpot-HD among those experiencing difficulties with ART adherence may be strengthened by building rapport via teleconferencing and providing detailed instructions to achieve adequate sample volume.
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Affiliation(s)
- José E Diaz
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Delaram Ghanooni
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Lindsay Atkins
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Soya S Sam
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI, USA
| | - Rami Kantor
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI, USA
| | - Michael Miller-Perusse
- San Diego State University/University of California Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Chika C Chuku
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Omar Valentin
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Leah Davis-Ewart
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Anna Tisler
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Adam W Carrico
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Lippman SA, Grignon JS, Ditshwane B, West RL, Gilmore HJ, Mazibuko S, Mongwe LG, Neilands TB, Gutin SA, O’Connor C, Santana MA, Majam M. Results of the Sukuma Ndoda ("Stand up, Man") HIV Self-Screening and Assisted Linkage to Care Project in Johannesburg: A Quasi-Experimental Pre-Post Evaluation. J Acquir Immune Defic Syndr 2024; 96:367-375. [PMID: 38916430 PMCID: PMC11195924 DOI: 10.1097/qai.0000000000003442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 04/11/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND HIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by community health workers (CHWs) is a scalable option to increase testing coverage, diagnosis, and treatment initiation. We provided HIVSS and assisted linkage to care to men not recently tested (within the past 12 months) residing in high-HIV-burden areas of Johannesburg. METHODS CHWs distributed HIVSS in 6 clinic catchment areas. Follow-up to encourage confirmatory testing and antiretroviral therapy initiation was conducted through personal support (PS) or an automated short message service (SMS) follow-up and linkage system in 3 clinic areas each. Using a quasi-experimental pre-post design, we compared differences in the proportion of men testing in the clinic catchment areas during the HIVSS campaign (June-August 2019) to the 3 months prior (March-May 2019) and compared treatment initiations by assisted linkage strategy. RESULTS Among 4793 participants accepting HIVSS, 62% had never tested. Among 3993 participants with follow-up data, 90.6% reported using their HIVSS kit. Testing coverage among men increased by 156%, from under 4% when only clinic-based HIV testing services were available to 9.5% when HIVSS and HIV testing services were available (z = -11.6; P < 0.01). Reported test use was higher for men followed through PS (99% vs. 68% in SMS); however, significantly more men reported reactive self-test results in the SMS group compared with PS (6.4% vs. 2.0%), resulting in more antiretroviral therapy initiations in the SMS group compared with PS (23 vs. 9; P < 0.01). CONCLUSIONS CHW HIVSS distribution significantly increases testing among men. While PS enabled personalized follow-up, reporting differences indicate SMS is more acceptable and better aligned with expectations of privacy associated with HIVSS.
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Affiliation(s)
- Sheri A. Lippman
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Jessica S. Grignon
- International Training and Education Center for Health (I-TECH), Pretoria, South Africa
- Department of Global Health, University of Washington, Seattle, WA
| | - Boitumelo Ditshwane
- International Training and Education Center for Health (I-TECH), Pretoria, South Africa
| | - Rebecca L. West
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Hailey J. Gilmore
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sipho Mazibuko
- International Training and Education Center for Health (I-TECH), Pretoria, South Africa
| | - Livhuwani G. Mongwe
- International Training and Education Center for Health (I-TECH), Pretoria, South Africa
| | - Torsten B. Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sarah A. Gutin
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- School of Nursing, University of California, San Francisco, San Francisco, CA
| | | | - Maideline A. Santana
- Gauteng Department of Health, Johannesburg District, Johannesburg, South Africa; and
| | - Mohammed Majam
- Ezintsha, University of Witwatersrand, Johannesburg, South Africa
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Tran A, Tran N, Tapa J, Tieosapjaroen W, Fairley CK, Chow EPF, Zhang L, Baggaley RC, Johnson CC, Jamil MS, Ong JJ. A typology of HIV self-testing support systems: a scoping review. Sex Health 2024; 21:SH24037. [PMID: 38950142 DOI: 10.1071/sh24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
To maximise the benefits of HIV self-testing (HIVST), it is critical to support self-testers in the testing process and ensure that they access appropriate prevention and care. To summarise systems and tools supporting HIVST (hereafter, 'support systems') and categorise them for future analysis, we synthesised the global data on HIVST support systems and proposed a typology. We searched five databases for articles reporting on one or more HIVST support systems and included 314 publications from 224 studies. Across 189 studies, there were 539 reports of systems supporting HIVST use; while across 115 studies, there were 171 reports of systems supporting result interpretation. Most commonly, these were pictorial instructions, followed by in-person demonstrations and in-person assistance while self-testing or reading self-test results. Less commonly, virtual interventions were also identified, including online video conferencing and smartphone apps. Smartphone-based automated result readers have been used in the USA, China, and South Africa. Across 173 studies, there were 987 reports of systems supporting post-test linkage to care; most commonly, these were in-person referrals/counselling, written referrals, and phone helplines. In the USA, Bluetooth beacons have been trialled to monitor self-test use and facilitate follow-up. We found that, globally, HIVST support systems use a range of methods, including static media, virtual tools, and in-person engagement. In-person and printed approaches were more common than virtual tools. Other considerations, such as linguistic and cultural appropriateness, may also be important in the development of effective HIVST programs.
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Affiliation(s)
- Arron Tran
- Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia; and Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia
| | - Nghiep Tran
- Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia
| | - James Tapa
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Rachel C Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; and Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Kaptchuk RP, Thakker J, Bell J, Okram S, Gopinath U, Mehta SH, Reddy AK, Loeb TA, Arumugam V, Tandon S, Parthasarathy MR, Ghosh SC, Singh A, Joshi DS, Kaur S, Solomon SS, McFall AM. HIV self-testing in India: implementation and qualitative evaluation of a web-based programme with virtual counsellor support. J Int AIDS Soc 2024; 27:e26302. [PMID: 38861458 PMCID: PMC11166186 DOI: 10.1002/jia2.26302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/16/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION To achieve epidemic control of infectious diseases, engaging higher-burden populations with accessible diagnostic services is critical. HIV self-testing (HIVST) is a promising option. METHODS We implemented an online HIVST programme for key populations across India. Eligible clients were 18 years or older, self-reported a negative or unknown HIV status and reported not taking antiretroviral therapy. Clients who reported a prior HIV diagnosis were not eligible to receive an HIVST kit. HIVST clients received kits via courier or in person at pre-determined pick-up points supported by trained counselling staff. Virtual counsellors engaged clients online and by phone and offered support to register, access, and complete HIVST free of cost. Virtual counsellors supported clients to report results and engage with follow-up services. Follow-up included linking clients with a positive result to confirmatory testing and HIV care services. We assessed programmatic data across HIV continuum outcomes and conducted a qualitative evaluation through interviews with purposively sampled clients. RESULTS Between 30 June 2021 and 30 September 2022, 5324 clients ordered an HIVST kit (76% men, 13% women, 7% transgender people, 4% unknown gender). Of the 4282 clients reporting results (94% of those who received a kit), 6% screened positive, among whom 72% (n = 184) completed confirmatory testing. Themes from 41 client interviews included satisfaction about the convenience and privacy of services and the discreet nature of kit delivery. Respondents were drawn to the convenience of HIVST and appreciated gaining courage and comfort throughout the process from virtual counsellor support. For respondents who screened positive, challenges to care linkage included fearing judgemental questions from public providers and wanting more time before starting treatment. Clients shared concerns about kit accuracy and suggested that instructional materials be provided with more diverse language options. CONCLUSIONS Web-based HIVST services with tailored support appeared to facilitate HIV service access and engagement of harder-to-reach populations across India. Assistance from a community-oriented counsellor proved important to overcome literacy barriers and mistrust in order to support the HIVST process and service linkage. Learnings can inform global efforts to improve the critical step of diagnosis in achieving epidemic control for HIV and other infectious diseases.
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Affiliation(s)
- Rose Pollard Kaptchuk
- Department of International HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jalpa Thakker
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jade Bell
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Saya Okram
- Y.R. Gaitonde Centre for AIDS Research and EducationChennaiIndia
| | - Usha Gopinath
- Y.R. Gaitonde Centre for AIDS Research and EducationChennaiIndia
| | - Shruti H. Mehta
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ajay Kumar Reddy
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Talia A. Loeb
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | | | | | | | - Aditya Singh
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Sukhvinder Kaur
- United States Agency for International DevelopmentWashingtonDCUSA
| | - Sunil Suhas Solomon
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Allison M. McFall
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Morshed Hemel MM, Reza MM, Mohammad Pritom GS, Sarwar G, Morshed Khan MN, Khan S, Rana AKMM, Khan SI. Full title- acceptability and feasibility of HIV self-testing (HIVST) among MSM and transgender women ( hijra) in Bangladesh: A mixed-method study. Heliyon 2024; 10:e31477. [PMID: 38818164 PMCID: PMC11137556 DOI: 10.1016/j.heliyon.2024.e31477] [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: 02/18/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024] Open
Abstract
Background HIV testing coverage among males having sex with males (MSM) and transgender women (locally known as hijra) is low in Bangladesh. Oral fluid-based HIV self-testing (HIVST) may improve coverage due to its convenience and privacy but is yet to be tested in Bangladesh. Therefore, the acceptability and feasibility of supervised HIVST was examined. Methods A cross-sectional study was conducted among 379 MSM and hijra selected from five geographical regions from February-October 2020. Semi-structured questionnaire was used to examine socio-demographics, risk behaviors, and perception to acceptability and feasibility (correct completion) of HIVST. Both bivariate and multivariable logistic regression analyses were performed. Qualitative data collection encompassed in-depth interviews (N = 19), key informant interviews (N = 10), and two focus group discussions (N = 12). Line-by-line content, contextual and thematic analysis were done and triangulated to explore facilitators and challenges of HIVST among MSM and hijra. Results Among 379 participants, the acceptability of HIVST was 99.5 % (n = 377). Reasons for acceptability included interest in independent testing (84.3 %), peer influence (57.3 %), quicker-easier procedure (54.9 %), and painless procedure (52.5 %). Qualitative findings revealed participant's risk perceptions, empowering feelings, social stigma, complementing working hours, and convenience during COVID-19 lockdowns. Around 92 % of the participants correctly completed HIVST. In multivariable analysis, the likelihood of correct test conduction was found higher among metropolitan, younger, married, educated, and participants who felt confident during HIVST process. Qualitative findings underscored the importance of supervising the use of HIVST for first-time users. Participants, particularly the less educated groups, highlighted the video demonstration as a useful tool in the context of difficulties in reading the textual instructions. However, most participants pointed out the result interpretation as the trickiest part of HIVST. All participants demonstrated willingness for future HIVST, were interested in social media-based approaches (84 %), were willing to purchase subsidized kits, and preferred conducting future tests alone at home (83.2 %). Conclusion Oral fluid-based HIVST was an acceptable and feasible approach for MSM and hijra in Bangladesh who were willing to do future tests independently after the supervised approach. Willingness to purchase kits and interest for social media-based approaches indicate scalability and sustainability potential of HIVST.
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Affiliation(s)
| | - Md Masud Reza
- Programme for HIV and AIDS, Health Systems and Population Studies Division, ICDDR,B, Bangladesh
| | - Gazi Sakir Mohammad Pritom
- South Carolina SmartState Center for Health Care Quality, Arnold School of Public Health, University of South Carolina, United States
| | - Golam Sarwar
- Programme for HIV and AIDS, Health Systems and Population Studies Division, ICDDR,B, Bangladesh
| | | | | | - AKM Masud Rana
- Programme for HIV and AIDS, Health Systems and Population Studies Division, ICDDR,B, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, Health Systems and Population Studies Division, ICDDR,B, Bangladesh
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Olum R, Geng EH, Kitutu FE, Musoke PM. Feasibility, acceptability and preliminary effect of a community-led HIV self-testing model among adolescent girls and young women in Rural Northern Uganda: a quasi-experimental study protocol. Implement Sci Commun 2024; 5:56. [PMID: 38773505 PMCID: PMC11110295 DOI: 10.1186/s43058-024-00596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionately higher HIV/AIDS burden despite the global decline in incidence. Existing interventions often fail to adequately address their unique social, economic, and cultural challenges, limiting access to essential HIV/AIDS services, including HIV testing. Emerging evidence indicates that HIV self-testing, a user-friendly and confidential method, enhances HIV diagnosis and linkage to care by targeting these barriers. This study aims to assess the feasibility, acceptability, and preliminary impact of a peer-delivered, community-health worker (CHW)-facilitated HIV self-testing intervention for AGYW in Northern Uganda. METHODS This mixed-methods quasi-experimental implementation science study will employ a three-fold approach. Firstly, we will conduct baseline formative qualitative research with 50 AGYW, 50 parents/partners to AGYW, 30 CHWs, 15 community leaders, and the district health office to inform the design of a peer-delivered CHW-facilitated HIV self-testing intervention tailored to AGYW's needs in Northern Uganda. Secondly, we will implement a mixed-methods pilot study to assess the intervention's feasibility and acceptability, involving 415 AGYW, 30 AGYW peer leaders, and 10 CHWs in selected parishes and villages in Omoro district, Northern Uganda. Lastly, we will evaluate the implementation outcomes and preliminary impact of the intervention on HIV self-testing rates and linkage to care by collecting and analyzing quantitative data pre- and post-intervention, laying the groundwork for a future robust randomized controlled trial. DISCUSSION Our intervention combines CHWs and peer-led strategies to address the unique challenges of AGYW in Northern Uganda, leveraging community resilience and peer influence. Successful completion of this project will provide a scalable model to be evaluated in a randomized trial and replicated in similar contexts. TRIAL REGISTRATION NUMBER PACTR202404851907736. Registered with the Pan-African Clinical Trials Registry on April 22, 2024.
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Affiliation(s)
- Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda.
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, MO, St Louis, USA
| | - Freddy E Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa M Musoke
- Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University-John Hopkins University (MU-JHU) Collaboration, Kampala, Uganda
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Ho WY, Neelamegam M, Earnshaw VA, Chong V, Lee HG, Rajasuriar R. Poor HIV-related Knowledge, Perceived Risks and Attitudes Among Urban-dwelling Malaysian Older Adults: Key Barriers to Zero HIV Transmission by 2030. AIDS Behav 2024; 28:1601-1611. [PMID: 38261221 DOI: 10.1007/s10461-024-04272-8] [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] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Globally and in Malaysia, there are increasing rates of HIV infection among older adults but a corresponding decline in other younger age groups. We aimed to investigate the HIV-related knowledge, perceived risks, attitudes, and risk behaviours among multi-ethnic urban-dwelling older adults in Malaysia. A cross-sectional, questionnaire-based study was conducted among 320 adults aged 50 years and above residing in urban Klang Valley, Malaysia. Participants were recruited via convenience sampling in the community and in the outpatient clinics and pharmacy of University Malaya Medical Centre, Malaysia, from April 2021 to January 2022. The median (IQR) age of participants was 58 (55-64) and 42.5% were males. The median (IQR) knowledge score was 10 (8-12) out of 14. Significant knowledge gaps were noted and ethnic Chinese, higher education levels and better HIV-related attitudes were associated with better scores. The median (IQR) attitude score was 49 (41-55) out of 65. Ethnic Chinese and Indian, knowing people living with HIV (PLHIV), and better HIV-related knowledge were associated with better attitude scores. Many (43.8%) older adults were sexually active however rates of consistent condom use was low (19%) and the majority (89.9%) of participants had low self-perceived risk of HIV. These findings highlight underlying drivers for HIV transmission and delayed treatment among older adults in Malaysia and indicate a need for targeted HIV prevention programs for this population.
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Affiliation(s)
- Wen Ying Ho
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Malinee Neelamegam
- Department of Population and Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, USA
| | - Vivian Chong
- School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Hong Gee Lee
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
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10
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Chen S, Fang Y, Chan PSF, Kawuki J, Mo P, Wang Z. Counseling Supporting HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e45647. [PMID: 38265866 PMCID: PMC10851126 DOI: 10.2196/45647] [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: 01/11/2023] [Revised: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Counseling supporting HIV self-testing (HIVST) is helpful in facilitating linkage to care and promoting behavior changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care. OBJECTIVE This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care. METHODS A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from the MEDLINE, Global Health, Web of Science, Embase, APA PsycINFO, and Scopus databases. This search encompassed papers and preprints published between July 3, 2012, and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST or quantitative outcomes for linkage to care among MSM and were published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institutes of Health quality assessment tool. Data were extracted using random effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and metaregression were conducted to assess whether linkage to care varied according to study characteristics. All analyses were performed with R (version 4.2.1; R Foundation for Statistical Computing) using the metafor package. RESULTS A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials, were identified. Among these studies, 50 (91%) provided active counseling support and 5 (9%) provided passive counseling support. In studies providing active counseling support, most MSM HIVST users were linked to various forms of care, including reporting test results (97.2%, 95% CI 74.3%-99.8%), laboratory confirmation (92.6%, 95% CI 86.1%-96.2%), antiretroviral therapy initiation (90.8%, 95% CI 86.7%-93.7%), and referral to physicians (96.3%, 95% CI 85%-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%, 95% CI 17.8%-98.4%), antiretroviral therapy initiation (79.1%, 95% CI 48.8%-93.7%), and referral to physicians (79.1%, 95% CI 0%-100%). Multivariate metaregression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the use of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of the studies varied from fair to good with a low to high risk of bias. CONCLUSIONS Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase the linkage to care among MSM HIVST users. TRIAL REGISTRATION PROSPERO CRD42022346247; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346247.
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Affiliation(s)
- Siyu Chen
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Paul Shing-Fong Chan
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Phoenix Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zixin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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11
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Witzel TC, Nicholls EJ, McCabe L, Weatherburn P, McCormack S, Bonell C, Gafos M, Lampe FC, Speakman A, Dunn D, Ward D, Phillips AN, Pebody R, Gabriel MM, Collaco-Moraes Y, Rodger AJ, Burns FM. Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study. Sex Transm Infect 2023; 99:534-540. [PMID: 37607814 PMCID: PMC10715485 DOI: 10.1136/sextrans-2023-055840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIV Self-testing Public Health Intervention), the largest randomised trial of HIVST in a high-income country to date. METHODS 10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively. RESULTS Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did. DISCUSSION HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up. TRIAL REGISTRATION NUMBER ISRCTN20312003.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Weatherburn
- Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Christopher Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mitzy Gafos
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Michelle M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
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12
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Marcus ME, Mahlalela N, Drame ND, Rohr JK, Vollmer S, Tollman S, Berkman L, Kahn K, Gómez-Olivé FX, Manne-Goehler J, Bärnighausen T. Home-based HIV testing strategies for middle-aged and older adults in rural South Africa. AIDS 2023; 37:2213-2221. [PMID: 37696252 PMCID: PMC10615729 DOI: 10.1097/qad.0000000000003698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE More than one in four adults over 40 years with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing strategies for middle-aged and older adults in rural South Africa. DESIGN Two thousand nine hundred and sixty-three individuals in the 'Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)' cohort study were randomized 1 : 1 : 1 to one of three types of home-based and home-delivered HIV testing modalities: rapid testing with counseling; self-testing, and both rapid testing with counselling and self-testing. METHOD In OLS regression analyses, we estimated the treatment effects on HIV testing and HIV testing frequency at about 1 year after delivery. Finally, we assessed the potential adverse effects of these strategies on the secondary outcomes of depressive symptom as assessed by the CESD-20, linkage to care, and risky sexual behavior. RESULTS There were no significant differences in HIV testing uptake or testing frequency across groups. However, respondents in the self-testing treatment arms were more likely to shift from testing at home and a facility [self-testing (HIVST), -8 percentage points (pp); 95% confidence interval (CI) -14 to -2 pp; self-testing plus rapid testing and counselling (ST+RT+C); -9 pp, 95% CI -15 to -3 pp] to testing only at home (HIVST 5 pp; 95% CI 2 to 9 pp; ST+RT+C: 5 pp, 95% CI 1 to 9 pp) - suggesting a revealed preference for self-testing in this population. We also found no adverse effects of this strategy on linkage to care for HIV and common comorbidities, recent sexual partners, or condom use. Finally, those in the self-testing only arm had significantly decreased depressive symptom scores by 0.58 points (95% CI -1.16 to -0.01). CONCLUSION We find HIV self-testing to be a well tolerated and seemingly preferred home-based testing option for middle-aged and older adults in rural South Africa. This approach should be expanded to achieve the UNAIDS 95-95-95 targets.
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Affiliation(s)
- Maja E. Marcus
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nomsa Mahlalela
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ndeye D. Drame
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Julia K Rohr
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for Global Health Research, Umea University, Umea, Sweden
| | - Lisa Berkman
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for Global Health Research, Umea University, Umea, Sweden
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Till Bärnighausen
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, Mtubatuba, South Africa
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13
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Empringham B, Karellis A, Kashkary A, D’Silva O, Carmona S, Suarez MF, Addae A, Pai NP, Zwerling AA. How much does HIV self-testing cost in low and middle income countries? A systematic review of evidence from economic studies. Front Public Health 2023; 11:1135425. [PMID: 38026397 PMCID: PMC10679730 DOI: 10.3389/fpubh.2023.1135425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives HIV self-testing (HIVST) has been proposed as an innovative strategy to diagnose human immunodeficiency virus (HIV). While HIVST offers the potential to broaden accessibility of early HIV diagnosis and treatment initiation, this testing strategy incurs additional cost and requires confirmatory testing and treatment. We have conducted the first systematic review to summarize the current economic literature for HIVST in low- and middle-income countries (LMICs). Design A search strategy was developed including key terms for HIV, self-testing and cost-effectiveness and was conducted in Medline and Embase databases. Studies were included that reported costs per outcome and included both cost-effectiveness and cost-utility outcome measures. The search strategy identified publications up until August 15, 2023 were included. Abstract and full text screening was conducted and a standardized data abstraction form was used for included studies. Costs are reported in USD, 2020. Results Our search strategy identified 536 total titles from the search strategy, which were screened down to 25 relevant studies that provided both cost and outcome data on HIVST. There was significant heterogeneity in the HIVST intervention, study population, costs and outcomes reported among included studies. Cost per person tested ranged from $1.09-155. Cost per case diagnosed ranged from $20-1,277. Cost-utility estimates ranged from cost-saving to $1846 per DALY averted. Higher cost-effectiveness estimates were associated with more expensive testing algorithms with increased support for linkage to care and post-test counseling. Conclusion All studies considered HIVST cost-effective although major drivers were identified included underlying HIV prevalence, testing cost and linkage to care. HIVST is likely to be cost-effective in a LMIC context, however policy makers should be aware of the drivers of cost-effectiveness when implementing HIVST programs as these underlying factors can impact the overall cost-effectiveness of HIVST.
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Affiliation(s)
- Brianna Empringham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Angela Karellis
- Division of Clinical Epidemiology & Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Abdulhameed Kashkary
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Public Health Authority, Riyadh, Saudi Arabia
| | - Olivia D’Silva
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sergio Carmona
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | | | - Angelina Addae
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Nitika Pant Pai
- Division of Clinical Epidemiology & Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Alice Anne Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Pepiot A, Supervie V, Breban R. Impact of voluntary testing on infectious disease epidemiology: A game theoretic approach. PLoS One 2023; 18:e0293968. [PMID: 37934734 PMCID: PMC10629633 DOI: 10.1371/journal.pone.0293968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
The World Health Organization recommends test-and-treat interventions to curb and even eliminate epidemics of HIV, viral hepatitis, and sexually transmitted infections (e.g., chlamydia, gonorrhea, syphilis and trichomoniasis). Epidemic models show these goals are achievable, provided the participation of individuals in test-and-treat interventions is sufficiently high. We combine epidemic models and game theoretic models to describe individual's decisions to get tested for infectious diseases within certain epidemiological contexts, and, implicitly, their voluntary participation to test-and-treat interventions. We develop three hybrid models, to discuss interventions against HIV, HCV, and sexually transmitted infections, and the potential behavioral response from the target population. Our findings are similar across diseases. Particularly, individuals use three distinct behavioral patterns relative to testing, based on their perceived costs for testing, besides the payoff for discovering their disease status. Firstly, if the cost of testing is too high, then individuals refrain from voluntary testing and get tested only if they are symptomatic. Secondly, if the cost is moderate, some individuals will test voluntarily, starting treatment if needed. Hence, the spread of the disease declines and the disease epidemiology is mitigated. Thirdly, the most beneficial testing behavior takes place as individuals perceive a per-test payoff that surpasses a certain threshold, every time they get tested. Consequently, individuals achieve high voluntary testing rates, which may result in the elimination of the epidemic, albeit on temporary basis. Trials and studies have attained different levels of participation and testing rates. To increase testing rates, they should provide each eligible individual with a payoff, above a given threshold, each time the individual tests voluntarily.
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Affiliation(s)
- Amandine Pepiot
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France
| | - Virginie Supervie
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France
| | - Romulus Breban
- Institut Pasteur, Unité d’Epidémiologie des Maladies Emergentes, Paris, France
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15
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Khezri M, Goldmann E, Tavakoli F, Karamouzian M, Shokoohi M, Mehmandoost S, Ghalekhani N, Haghdoost AA, Des Jarlais D, Mirzazadeh A, Sharifi H. Awareness and willingness to use HIV self-testing among people who inject drugs in Iran. Harm Reduct J 2023; 20:145. [PMID: 37805505 PMCID: PMC10560425 DOI: 10.1186/s12954-023-00881-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Most people who inject drugs (PWID) in Iran have not undergone recent HIV testing. While PWID face barriers when seeking HIV testing at health facilities, HIV self-testing (HIVST) could be a promising approach to improve HIV testing uptake. We examined the awareness and willingness to use HIVST among PWID in Iran. We also identified participants' characteristics associated with a higher willingness to use HIVST. METHODS PWID were recruited in 11 cities using a respondent-driven sampling method. Willingness to use HIVST was defined as a binary variable (very low/low willingness vs. high/very high willingness). We performed multivariable modified Poisson regression to examine associated factors and report adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS Of 2,252 PWID, 362 (16.2%; 95% CI 14.7, 17.8) had ever heard of HIVST; however, 1,658 (73.6%; 95% CI 71.7, 75.4) reported high/very high willingness to use HIVST. Willingness to use HIVST was higher among PWID who reported having a high/moderate HIV risk perception (aPR 1.22; 95% CI 1.09, 1.37), ever experiencing homelessness (aPR 1.15; 95% CI 1.03, 1.28), > 10 years of injecting history (aPR 1.16; 95% CI 1.00, 1.34), and high injection frequency in the last three months (aPR 1.18; 95% CI 1.05, 1.32). CONCLUSION Most PWID in Iran, particularly those experiencing homelessness, have a longer injecting history, engage in more frequent injection practices, and possess a heightened perception of HIV risk would be willing to adopt HIVST. Enhancing HIVST awareness through increased access to HIVST and health education programs are needed. Additionally, conducting implementation science studies to effectively design and run HIVST programs in Iran can also increase PWID's access to HIV testing.
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Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Emily Goldmann
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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16
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Olakunde BO, Alemu D, Conserve DF, Mathai M, Mak’anyengo MO, Mayo-Wilson LJ. Awareness of and willingness to use oral HIV self-test kits among Kenyan young adults living in informal urban settlements: a cross-sectional survey. AIDS Care 2023; 35:1259-1269. [PMID: 35266433 PMCID: PMC9463408 DOI: 10.1080/09540121.2022.2050176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
Self-administered HIV testing may be a promising strategy to improve testing in hard-to-reach young adults, provided they are aware of and willing to use oral HIV self-testing (HIVST). This study examined awareness of and willingness to use oral HIVST among 350 high-risk young adults, aged 18-22, living in Kenya's informal urban settlements. Bivariate and multivariate logistic regressions were used to examine differences in HIVST awareness and willingness by demographic and sexual risk factors. Findings showed that most participants were male (56%) and less than 20 years old (60%). Awareness of oral HIVST was low (19%). However, most participants (75%) were willing to use an oral HIV self-test in the future and ask their sex partner(s) to self-test before having sex (77%). Women (OR = 1.80, 95%CI:1.11, 2.92), older participants (aged 20+) (OR = 2.57, 95% CI:1.48, 4.46), and more educated participants (OR = 2.25, 95%CI:1.36, 3.70) were more willing to use HIVST as compared to men, teen-aged, and less educated participants, respectively. Young adults who reported recent engagement in high-risk sexual behaviors, such as unprotected sex, sex while high or drunk, or sex exchange, were significantly less likely to be willing to use an oral HIV self-test kit (OR = 0.34, 95%CI:0.13,0.86). Those with the highest monthly income (OR = 0.47, 95%CI: 0.25, 0.89) were also less willing to use HIVST. More community- and peer-based efforts are needed to highlight the range of benefits of HIVST (i.e., social, clinical, and structural) to appeal to various youth demographics, in addition to addressing concerns relating to HIVST.
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Affiliation(s)
- Babayemi O. Olakunde
- National Agency for the Control of AIDS, Department of Community Prevention and Care Services, 3, Ziguinchor Street, Wuse Zone 4, Abuja, Nigeria USA
| | - Dawit Alemu
- Ohio University, Heritage College of Osteopathic Medicine, Department of Social Medicine, 204 Grosvenor Hall, Athens, OH 45701 USA
| | - Donaldson F. Conserve
- Milken Institute School of Public Health, George Washington University, Department of Prevention and Community Health, 950 New Hampshire Ave, Washington, DC 20052 USA
| | - Muthoni Mathai
- University of Nairobi, College of Health Sciences, Department of Psychiatry. Kenyatta National Hospital, Off-Ngong Road, Nairobi, Kenya
| | - Margaret O. Mak’anyengo
- National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Department of Mental Health, Ralph Bunche Road, P.O. Box 20453, Nairobi, Kenya
| | - NAHEDO Study Group
- National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Department of Mental Health, Ralph Bunche Road, P.O. Box 20453, Nairobi, Kenya
| | - Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Sciences, 1025 E. 7th Street, Bloomington IN 47405 USA
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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17
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Lee JJ, Robles G, Leyva Vera CA, Orellana ER, Graham SM, Nguyen AM, Wei Y, Sanchez AH, Dombrowski JC, Simoni JM. A Peer-Based Intervention to Increase HIV and Sexually Transmitted Infection Testing Among Latinx Immigrant Sexual Minority Men in the US Pacific Northwest: Pilot Randomized Controlled Trial Conducted During the COVID-19 Pandemic. JMIR Form Res 2023; 7:e45871. [PMID: 37436792 PMCID: PMC10372765 DOI: 10.2196/45871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Hispanic and Latinx gay, bisexual, and other sexual minority men (SMM) are disproportionately affected by HIV in the United States. With the availability of self-testing services, HIV and sexually transmitted infection (STI) testing may be more accessible for Latinx immigrant SMM who face obstacles to obtaining HIV-related services. Combining the potential of self-testing kits and the influence of peer educators may present an opportunity to increase HIV and STI testing and preexposure prophylaxis (PrEP) uptake or linkage to HIV care among Latinx immigrant SMM. OBJECTIVE This study aimed to develop and pilot a peer intervention to distribute HIV and STI self-testing kits and provide peer counseling based on the information-motivation-behavioral skills model to increase PrEP uptake and HIV and STI testing among Latinx immigrant SMM. Our evaluation focused on determining the differences in HIV testing, STI testing, and PrEP uptake outcomes between the intervention and control groups. METHODS We conducted semistructured interviews with community stakeholders to elicit factors to consider for training and intervention. The interview findings informed the development of the intervention and peer training protocols. We piloted the intervention with Latinx immigrant SMM and randomly assigned participants to the intervention group, who received peer counseling and HIV and STI self-testing kits, or the control group, who only received peer counseling. We administered baseline, 1-week, 6-week, and 12-week follow-up surveys to assess behaviors related to HIV testing, STI testing, and PrEP uptake. Owing to the COVID-19 pandemic, the intervention components were delivered via web-based modalities. Chi-square tests were performed to examine the associations between HIV testing, STI testing, and PrEP motivation and behaviors across the study arms (intervention vs control). We conducted Cramer V test to determine the strength of the association between study arm and each of the outcome variables. We also assessed the impact of the COVID-19 pandemic on participants. RESULTS Overall, 50 (intervention, n=30 and control, n=20) Latinx immigrant SMM participated in the program. Participants reported life disruptions owing to COVID-19, with 68% (34/50) reporting job loss after the declaration of the pandemic. After intervention participation, a higher proportion of participants in the intervention group reported having been tested for STIs (76% vs 36.8%; P=.01; Cramer V=0.394). Among the participants in the intervention group, 91% (21/23) reported being motivated to use PrEP compared with 59% (10/17) in the control group (P=.02; Cramer V=0.385). CONCLUSIONS By facilitating access to HIV and STI testing through peer-delivered information, motivational support, and behavioral skills training as well as the provision of self-testing kits, our intervention demonstrated the potential to increase HIV prevention behaviors in Latinx immigrant SMM. Peer-based programs that offer self-testing and internet-based modes of accessing information may be a feasible strategy for reaching Latinx immigrant SMM. TRIAL REGISTRATION ClinicalTrials.gov NCT03922126; https://clinicaltrials.gov/ct2/show/NCT03922126.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, Seattle, WA, United States
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, United States
| | - Christopher A Leyva Vera
- School of Social Work, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - E Roberto Orellana
- School of Social Work, University of Washington, Seattle, WA, United States
| | - Susan M Graham
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Anh-Minh Nguyen
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Yingying Wei
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | | | - Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, WA, United States
- HIV/STD Program, Public Health - Seattle & King County, Seattle, WA, United States
| | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Psychology, University of Washington, Seattle, WA, United States
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18
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Zapata JP, Petroll AE, Quinn KG, Zamantakis A, John SA. Implementation determinants of HIV Self-Testing among young sexual minority men. Arch Public Health 2023; 81:113. [PMID: 37344899 DOI: 10.1186/s13690-023-01126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has shown the potential for reaching people with heightened vulnerability to HIV, including young sexual minority men (YSMM), yet implementation of HIVST among YSMM aged 17-24 is scarce as a prevention method. Moreover, despite the consistent finding that offering HIVST increases HIV testing rates, barriers remain that need to be reduced in order to maximize the potential of this biomedical technology. Such information is necessary to direct implementation efforts to increase HIVST among YSMM, including HIV counseling and linkage to care. The current study was therefore intended to investigate perspectives for HIVST among YSMM and how HIVST can be marketed to increase implementation. METHODS Between March and September 2020, we enrolled 41 YSMM to participate in one of nine online synchronous focus group discussions about their general experience with HIV preventive services. Guided by the Consolidated Framework (CFIR) for Implementation Research, we explored YSMM perspectives on facilitators and barriers to HIVST implementation. Data were analyzed using a deductive thematic content analysis approach. RESULTS Many participants had never used HIVST before their participation in this study (n = 30; 73.2%). Qualitative results exhibited a variety of implementation determinants across the five CFIR 2.0 domains. Barriers included concerns about the format in which the testing materials would be provided (i.e., nature of packaging) and about the method in which the sample would need to be collected, particularly for those who had the testing kit mailed to their home address. These reservations were nested in the fear of unwanted disclosure of their sexual behavior, namely among the respondents who had to cohabitate with family due to the COVID-19 pandemic. Participants also discussed the limited local resources for HIVST. Many participants suggested programs that could be implemented to support HIVST, such as collaborations with trusted community agencies. CONCLUSIONS Understanding YSMM' perspectives of HIVST may help identify implementation deficiencies within the delivery system and aid the development of implementation strategies to promote reach of HIVST.
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Affiliation(s)
- Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave 14th Floor, Chicago, IL, 60611, USA.
| | - Andrew E Petroll
- Health Intervention Sciences Group, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Health Intervention Sciences Group, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave 14th Floor, Chicago, IL, 60611, USA
| | - Steven A John
- Health Intervention Sciences Group, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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19
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Balakrishnan P, Smiline Girija AS, Shanmugam S, Kannan I, Vignesh R, Shankar EM, Sucharitha ST. The Implementation of HIV Self-Testing in Resource-Limited Settings Where the HIV Disease Burden is High. Int J Public Health 2023; 68:1605790. [PMID: 37266035 PMCID: PMC10229772 DOI: 10.3389/ijph.2023.1605790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
In resource-limited settings, there is growing evidence that HIV testing is lacking among high-risk key populations such as men having sex with men, injection drug users, and transgenders largely due to stigma, discrimination, and lack of confidentiality. Findings from recent studies among high-risk key populations and the general population from various regions including resource-limited settings support the need for wider accessibility of HIV self-testing (HIV-ST) to reach those who may not otherwise have access to testing. Therefore, HIV-ST has untapped potential as a strategy to improve access to HIV testing and to increase testing frequency among key high-risk populations and their partners. Though HIV-ST has emerged as a safe, acceptable, and effective way to reach people, there are several roadblocks to implementing the HIV-ST policy, and fast-track policy implementation needs to be necessitated with newer or modified strategic plans.
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Affiliation(s)
- Pachamuthu Balakrishnan
- Department of Microbiology, Centre for Infectious Diseases, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - A. S. Smiline Girija
- Department of Microbiology, Centre for Infectious Diseases, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - Saravanan Shanmugam
- Department of Microbiology, Centre for Infectious Diseases, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - Iyanar Kannan
- Global Biomedical Research Foundation, Chennai, India
| | - Ramachandran Vignesh
- Preclinical Department, Faculty of Medicine, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh, Malaysia
| | - Esaki M. Shankar
- Infection and Inflammation, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur, India
| | - Sree T. Sucharitha
- Department of Community Medicine, Annaii Medical College and Hospital, Sriperumbudur, Tamil Nadu, India
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20
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Sharma A, Gandhi M, Sallabank G, Merrill L, Stephenson R. Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States. AIDS Behav 2023; 27:1091-1105. [PMID: 36094639 PMCID: PMC9466335 DOI: 10.1007/s10461-022-03846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/04/2022]
Abstract
Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one's HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM.
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Affiliation(s)
- Akshay Sharma
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA.
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA.
| | - Monica Gandhi
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Leland Merrill
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
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21
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John SA, Zapata JP, Dang M, Pleuhs B, O'Neil A, Hirshfield S, Walsh JL, Petroll AE, Quinn KG. Exploring preferences and decision-making about long-acting injectable HIV pre-exposure prophylaxis (PrEP) among young sexual minority men 17-24 years old. Sci Rep 2023; 13:5116. [PMID: 36991027 PMCID: PMC10052280 DOI: 10.1038/s41598-023-32014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Intramuscular cabotegravir for long-acting injectable HIV pre-exposure prophylaxis (i.e., LAI-PrEP) was approved by the U.S. FDA in 2021. We sought to explore LAI-PrEP decision-making among a nationwide sample of young sexual minority men (YSMM) 17-24 years old. In 2020, HIV-negative/unknown YSMM (n = 41) who met CDC criteria for PrEP were recruited online to participate in synchronous online focus groups eliciting preferences and opinions about LAI-PrEP, as well as the impact of a potential self-administered option. Data were analyzed using inductive and deductive thematic analysis with constant comparison. Preferences and decision-making about LAI-PrEP varied widely among YSMM, with participants frequently comparing LAI-PrEP to oral PrEP regimens. We identified five key themes related to LAI-PrEP decision-making including concerns about adherence to PrEP dosing and clinic appointments, awareness and knowledge of PrEP safety and efficacy data, comfort with needles, minimizing PrEP stigma, and considerations of self-administration. YSMM acknowledged more PrEP options as beneficial to supporting uptake and persistence.
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Affiliation(s)
- Steven A John
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA.
| | - Juan P Zapata
- Department of Psychology, Marquette University, Milwaukee, WI, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Madeline Dang
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Benedikt Pleuhs
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Andrew O'Neil
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Jennifer L Walsh
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Andrew E Petroll
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Katherine G Quinn
- Health Intervention Sciences Group/Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
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22
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Hu S, Lu Y, He X, Zhou Y, Wu D, Tucker JD, Yang B, Tang W. Effectiveness of the secondary distribution of HIV self-testing with and without monetary incentives among men who have sex with men living with HIV in China: study protocol for a randomized controlled trial. BMC Infect Dis 2023; 23:160. [PMID: 36918824 PMCID: PMC10013267 DOI: 10.1186/s12879-023-08062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The HIV epidemic is still expanding among men who have sex with men (MSM) in China, but HIV testing rates remain suboptimal. Network-based interventions, such as secondary distribution, have shown promise to expand HIV self-testing (HIVST) among partners of MSM living with HIV (MLWH) but have not been widely implemented. Monetary incentives could enhance the secondary distribution of HIVST in some settings. We will conduct a randomized controlled trial to examine the effectiveness of monetary incentives in expanding the secondary distribution of HIVST among MLWH in China. METHODS We will recruit 200 eligible participants at three antiretroviral therapy (ART) clinics in China. Participants are eligible if they are 18 years of age or over, assigned as male at birth, have had anal sex with men, are living with HIV, are willing to apply for the HIVST kit at ART clinics, and are willing to provide personal contact information for follow-up. Eligible participants will be randomly assigned in a 1:1 ratio to one of two groups: standard secondary distribution group and secondary distribution group with monetary incentives. Participants (defined as "index") will distribute the HIVST kits to members of their social network (defined as "alter") and will be required to complete a baseline survey and a 3-month follow-up survey. All alters will be encouraged to report their testing results by taking photos of used kits and completing an online survey. The primary study outcomes will compare the mean number of alters and newly-tested alters motivated by each index participant in each group. Secondary study outcomes will include the mean number of alters who tested positive, the cost per person tested, and the cost per HIV diagnosed for each group. DISCUSSION Few studies have evaluated interventions to enhance the implementation of secondary distribution. Our study will provide information on the effectiveness of monetary incentives in expanding HIVST secondary distribution among MLWH. The findings of this trial will contribute to implementing HIVST secondary distribution services among MLWH in China and facilitating HIV case identifications. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200064517; http://www.chictr.org.cn/showproj.aspx?proj=177896 . Registered on 10th October 2022.
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Affiliation(s)
- Siyue Hu
- School of Public Health, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,University of North Carolina Project - China, Guangzhou, China
| | - Ying Lu
- University of North Carolina Project - China, Guangzhou, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project - China, Guangzhou, China.,London School of Hygiene and Tropical Medicine, London, UK.,West China School of Public Health, Sichuan University, Chengdu, China
| | - Joseph D Tucker
- University of North Carolina Project - China, Guangzhou, China.,London School of Hygiene and Tropical Medicine, London, UK
| | - Bin Yang
- School of Public Health, Southern Medical University, Guangzhou, China. .,Dermatology Hospital of Southern Medical University, Guangzhou, China.
| | - Weiming Tang
- School of Public Health, Southern Medical University, Guangzhou, China. .,Dermatology Hospital of Southern Medical University, Guangzhou, China. .,University of North Carolina Project - China, Guangzhou, China.
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23
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Choko AT, Coates TJ, Mphande M, Balakasi K, Robson I, Phiri K, Phiri S, Kulich M, Sweat M, Cornell M, Hoffman RM, Dovel K. Engaging men through HIV self-testing with differentiated care to improve ART initiation and viral suppression among men in Malawi (ENGAGE): A study protocol for a randomized control trial. PLoS One 2023; 18:e0281472. [PMID: 36827327 PMCID: PMC9956026 DOI: 10.1371/journal.pone.0281472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/22/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Men experience twice the mortality of women while on ART in sub-Saharan Africa (SSA) largely due to late HIV diagnosis and poor retention. Here we propose to conduct an individually randomized control trial (RCT) to investigate the impact of three-month home-based ART (hbART) on viral suppression among men who were not engaged in care. METHODS AND DESIGN A programmatic, individually randomized non-blinded, non-inferiority-controlled trial design (ClinicalTrials.org NCT04858243). Through medical chart reviews we will identify "non-engaged" men living with HIV, ≥15years of age who are not currently engaged in ART care, including (1) men who have tested HIV-positive and have not initiated ART within 7 days; (2) men who have initiated ART but are at risk of immediate default; and (3) men who have defaulted from ART. With 1:1 computer block randomization to either hbART or facility-based ART (fbART) arms, we will recruit men from 10-15 high-burden health facilities in central and southern Malawi. The hbART intervention will consist of 3 home-visits in a 3-month period by a certified male study nurse ART provider. In the fbART arm, male participants will be offered counselling at male participant's home, or a nearby location that is preferred by participants, followed with an escort to the local health facility and facility navigation. The primary outcome is the proportion of men who are virally suppressed at 6-months after ART initiation. Assuming primary outcome achievement of 24.0% and 33.6% in the two arms, 350 men per arm will provide 80% power to detect the stated difference. DISCUSSION Identifying effective ART strategies that are convenient and accessible for men in SSA is a priority in the HIV world. Men may not (re-)engage in facility-based care due to a myriad of barriers. Two previous trials investigated the impact of hbART on viral suppression in the general population whereas this trial focuses on men. Additionally, this trial involves a longer duration of hbART i.e., three months compared to two weeks allowing men more time to overcome the initial psychological denial of taking ART.
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Affiliation(s)
- Augustine T. Choko
- Partners in Hope, Lilongwe, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Thomas J. Coates
- David Geffen School of Medicine, Division of Infectious Diseases, Los Angeles, California, United States of America
| | | | | | | | | | | | - Michal Kulich
- Department of Probability and Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Michael Sweat
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Risa M. Hoffman
- David Geffen School of Medicine, Division of Infectious Diseases, Los Angeles, California, United States of America
| | - Kathryn Dovel
- Partners in Hope, Lilongwe, Malawi
- David Geffen School of Medicine, Division of Infectious Diseases, Los Angeles, California, United States of America
- * E-mail:
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24
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Fischer AE, Abrahams M, Shankland L, Lalla-Edward ST, Edward VA, De Wit J. The evolution of HIV self-testing and the introduction of digital interventions to improve HIV self-testing. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1121478. [PMID: 36864847 PMCID: PMC9971956 DOI: 10.3389/frph.2023.1121478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/12/2023] [Indexed: 02/16/2023] Open
Abstract
HIV self-testing (HIVST) complements traditional HIV testing programmes by removing barriers and increasing access to testing for key populations, and digital interventions have been developed for HIVST to improve the testing and linkage to care experience for users. The first HIVST kit was proposed in 1986, but it took 10 years for the home sample collection (HSC) HIVST to become available and another 16 years for rapid diagnostic test HIVST to be approved by the Federal Drug Administration. Since then, studies have shown high usability and performance of HIVST, which led the World Health Organization formally recommending HIVST in 2016, and currently almost 100 countries have incorporated HIVST into their national testing strategy. Despite the popularity, HIVST present challenges around pre-and post-test counselling, as well as the ability to report results and link users to care, and digital interventions for HIVST have been introduced to address these challenges. The first digital intervention for HIVST was introduced in 2014 and showed that digital interventions could be used to distribute HIVST kits, report results and link users to care. Since then, dozens of studies have been conducted, which have validated and expanded on these early findings, but many were pilot studies with small sample sizes and lacked the standardization of indicators required to aggregate data across platforms to prove impact at scale. For digital interventions for HIVST to be championed for scale-up, they must continue to show measurable impact at larger scales, while still maintaining and standardizing data security and integrity.
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Affiliation(s)
- Alex Emilio Fischer
- Aviro Health, Cape Town, South Africa
- Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, Netherlands
| | | | | | | | - Vinodh A. Edward
- Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, Netherlands
- The Aurum Institute, Johannesburg, South Africa
- School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - John De Wit
- Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, Netherlands
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25
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De Luca A, Zalazar V, Salusso D, Frontini E, Fabian S, Cardozo NF, Cesar C, Cahn P, Sued O, Aristegui I. "If I'm at home, I do it at home": Qualitative study on HIV self-testing among transgender women in Argentina. Int J STD AIDS 2023; 34:25-30. [PMID: 36287178 DOI: 10.1177/09564624221132624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Evidence among key populations supports acceptability of HIV self-testing (HIVST) due to its privacy and convenience. However, insufficient research has been done among transgender women (TGW), especially in Latin America. Consequently, the aim of this study was to explore the acceptability, perceptions and recommendations for HIVST implementation among TGW in Buenos Aires. METHODS A focus group was conducted in July 2019. Particpants were invited to touch and learn about a displayed HIVST kit. The following main topics were explored: acceptability, reasons for seeking self-testing, preferences for training, distribution, periodicity and recommendations for HIVST implementation. RESULTS The sample consisted of 12 TGWs; mean age of 26 years (IQR = 22-28); 66% had history of sex-work. The main motivations for seeking HIVST were convenience, privacy, and usage to reduce stigma and discrimination by health-care providers. Recommendations for HIVST were: distribution from primary health centers and trans-sensitive centers; affordable price; assistance by peer health promoters; and the provision of clear written and video instructions. CONCLUSIONS Tailored implementation of HIVST can increase HIV testing rates, early detection, and linkage to HIV-care in this high-prevalence group. This study provided community-driven suggestions to inform and adapt an HIVST feasibility pilot study and future implementation in Argentina.
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Affiliation(s)
- Amalia De Luca
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Virginia Zalazar
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Diego Salusso
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Emilia Frontini
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Solange Fabian
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Asociación Civil Gondolin, Buenos Aires, Argentina
| | - Nadir Fernana Cardozo
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Asociación de Travestis, Transexuales y Transgéneros de Argentina (A.T.T.T.A.), Buenos Aires, Argentina.,RedLacTrans, Red Latinoamericana y del Caribe de Personas Trans.,Casa Trans, Buenos Aires, Argentina
| | - Carina Cesar
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Pedro Cahn
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Asociación Civil Gondolin, Buenos Aires, Argentina
| | - Omar Sued
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Inés Aristegui
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Department of Research in Psychology, Universidad de Palermo, Buenos Aires, Argentina
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Sison OT, Baja ES, Bermudez ANC, Quilantang MIN, Dalmacion GV, Guevara EG, Garces-Bacsal RM, Hemingway C, Taegtmeyer M, Operario D, Biello KB. Association of anticipated HIV testing stigma and provider mistrust on preference for HIV self-testing among cisgender men who have sex with men in the Philippines. BMC Public Health 2022; 22:2362. [PMID: 36527003 PMCID: PMC9756449 DOI: 10.1186/s12889-022-14834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND New HIV infections in the Philippines are increasing at an alarming rate. However, over three quarters of men who have sex with men (MSM) have never been tested for HIV. HIV self-testing (HIVST) may increase overall testing rates by removing barriers, particularly fear of stigmatization and mistrust of providers. This study aimed to determine if these factors are associated with preference for HIVST among Filipino cisgender MSM (cis-MSM), and whether there is an interaction between anticipated HIV testing stigma and provider mistrust on preference for HIVST. METHODS We conducted secondary analysis of a one-time survey of 803 cis-MSM who were recruited using purposive sampling from online MSM dating sites and MSM-themed bar locations in Metro Manila, Philippines. Summary statistics were computed to describe participant characteristics. Multivariable modified Poisson regression analyses were conducted to determine if anticipated HIV testing stigma and provider mistrust were associated with preference for HIVST among cis-MSM. Other variables such as age, education, monthly income, relationship status, HIV serostatus, and knowing where to get HIV testing were the minimal sufficient adjustment set in the analyses. RESULTS Average age of participants was 28.6 years (SD = 8.0); most had received college degrees (73%) and were employed (80%). Most respondents (81%) preferred facility-based testing, while 19% preferred HIVST. A high percentage of participants reported anticipated HIV testing stigma (66%) and provider mistrust (44%). Anticipated HIV testing stigma (aPR = 1.51; 95% CI = 1.01-2.25, p = 0.046) and provider mistrust (aPR = 1.49; 95% CI = 1.07-2.09, p = 0.020) were independently associated with a preference for HIVST. There was a positive, additive interaction between provider mistrust and anticipated HIV testing stigma on preference for HIVST (RERI = 1.13, 95% CI: 0.20-2.06; p = 0.017), indicating that the association between anticipated HIV testing stigma and preference for HIVST is greater among those with provider mistrust compared to those without provider mistrust. CONCLUSIONS HIVST should be offered as a supplement to traditional facility-based HIV testing services in the Philippines to expand testing and reach individuals who may not undergo testing due to anticipated HIV testing stigma and provider mistrust.
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Affiliation(s)
- Olivia T. Sison
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Emmanuel S. Baja
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Amiel Nazer C. Bermudez
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Ma. Irene N. Quilantang
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
- Department of Behavioral Sciences, College of Arts and Sciences, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Godofreda V. Dalmacion
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Ernest Genesis Guevara
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Rhoda Myra Garces-Bacsal
- Department of Special Education, College of Education, United Arab Emirates University, P.O. Box 15551, Al Ain, UAE
| | - Charlotte Hemingway
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool, L3 5QA UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool, L3 5QA UK
- Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP UK
| | - Don Operario
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Katie B. Biello
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
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Kabir R, Alradie-Mohamed A, Ferdous N, Vinnakota D, Arafat SMY, Mahmud I. Exploring Women's Decision-Making Power and HIV/AIDS Prevention Practices in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16626. [PMID: 36554507 PMCID: PMC9778757 DOI: 10.3390/ijerph192416626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Decisions regarding sexual and reproductive health significantly impact women's health and their protection against HIV/AIDS and other sexually transmitted infections. These decisions also impact females' ability to reach their reproductive goals. Women's autonomy is recognized to be vital to women's access to reproductive healthcare, the use of contraceptives, the capacity to avoid or receive treatment for STIs (including HIV), and other reproductive and sexual health issues. This research investigated the association between the decision-making power of South African women (of reproductive age) and their knowledge and practices regarding HIV/AIDS preventive measures. The present study used data from the South Africa Demographic and Health Survey 2016. A total of 8514 women aged 15-49 years who participated in the survey were used for this research. The mean age of the women was 30.21 years, with an SD of 9.86. Approximately 38.5% of the women decided on contraceptive use, and only 11.7% of women's partners and 49.8% of respondents were jointly involved in the decision-making process of contraceptive use. All HIV preventive measures under study were statistically significantly associated with high decision-making power; the use of a condom by the husband or partner of the women was the most significant; husbands or partners of the women with high autonomy were three times more likely to use condoms.
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Affiliation(s)
- Russell Kabir
- School of Allied Health, Anglia Ruskin University, Chelmsford CM11SQ, UK
| | | | | | - Divya Vinnakota
- Department of Nursing and Public Health, The University of Sunderland, London E14 9SG, UK
| | | | - Ilias Mahmud
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah 52741, Saudi Arabia
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28
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O’Byrne P, Musten A, Ho N. HIV self-testing in the real world is acceptable for many: post-test participant feedback from the GetaKit study in Ottawa, Canada. J Res Nurs 2022; 27:757-764. [DOI: 10.1177/17449871221137761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: HIV self-testing is the latest strategy to improve access to testing, diagnosis and treatment. Such strategies are beneficial due to the improved individual- and population-level health outcomes that emerge from early HIV diagnosis. Aims: While most research shows that HIV self-testing is acceptable and feasible, yielding higher numbers of first-time testers and positivity rates, compared to clinic-based testing, little evidence exists outside low- and middle-income countries about such testing. Methods: We implemented GetaKit.ca, a website through which eligible participants could register for and obtain an INSTI® HIV self-testing to their home, and then report the result back. Results: Those who returned to the website were asked to complete a post-test survey, which had a low response rate (42%), but identified satisfaction scores of 92%. Notably, 5% of testers sought in-person care after ordering the self-test, and only 80% of participants agreed that the INSTI® HIV self-test was easy to use. Conclusions: Participants provided tangible solutions to improve this test, which we feel are easy to incorporate and essential to maintain HIV self-testing efforts.
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Affiliation(s)
- Patrick O’Byrne
- Nurse Practitioner and Fellow of the American Academy of Nursing, School of Nursing, University of Ottawa, Canada
| | | | - Nikki Ho
- Registered Nurse, School of Nursing, University of Ottawa, Canada
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Lyu H, Feng Y, Zhou Y, Guo Z, Wang Y, Cui M, Tang H, Du M, Huang S, Li J, Tang W, Mei W. Factors Associated with First-Time HIV Testing Among MSM via Secondary Distribution of HIV Self-test Kits in Zhuhai, China. AIDS Behav 2022; 27:1942-1949. [PMID: 36418658 DOI: 10.1007/s10461-022-03927-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/25/2022]
Abstract
HIV self-testing (HIVST) is an effective method to expand HIV testing coverage worldwide. We analyze the results of HIVST and sexual behaviors of first-time testers among Men who have sex with men (MSM) who participated in a secondary distribution of HIVST kits. A total of 589 participants were recruited, including 173 first-time testers and 416 non-first-time testers. The first-time testers were mainly of Han ethnicity (aOR 1.88, 95% CI 1.10, 3.24), more likely to be HIV positive (aOR 7.18, 95% CI 2.37, 21.72), and had higher income (aOR 2.01, 95% CI 1.10, 3.69). Both groups were less likely to have anal sex with male partners (χ2: 146.24, P < 0.01), (χ2: 582.72, P < 0.01) or have sex with female partners (χ2: 19.01, P < 0.01), (χ2: 35.74, P < 0.01) after HIVST. We should expand HIVST among MSM and other key populations to identify first-time testers.
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30
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Kersh EN. Advances in Sexually Transmitted Infection Testing at Home and in Nonclinical Settings Close to the Home. Sex Transm Dis 2022; 49:S12-S14. [PMID: 35001014 PMCID: PMC9259751 DOI: 10.1097/olq.0000000000001597] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A commentary on recent successes and challenges for home STI specimen collection, for point-of-care test usage close to the home, and implications of COVID-19 self-tests for future STI self-test development.
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Affiliation(s)
- Ellen N Kersh
- From the Centers for Disease Control and Prevention, Atlanta, GA
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31
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Schliemann D, Ramanathan K, Ibrahim Tamin NSB, O'Neill C, Cardwell CR, Ismail R, Nanu P, Mohd Ghazali ANB, Kee F, Su TT, Donnelly M. Implementation of a colorectal cancer screening intervention in Malaysia (CRC-SIM) in the context of a pandemic: study protocol. BMJ Open 2022; 12:e058420. [PMID: 36581978 PMCID: PMC9438210 DOI: 10.1136/bmjopen-2021-058420] [Citation(s) in RCA: 1] [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] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is the second most common cancer in Malaysia and cases are often detected late. Improving screening uptake is key in down-staging cancer and improving patient outcomes. The aim of this study is to develop, implement and evaluate an intervention to improve CRC screening uptake in Malaysia in the context of the COVID-19 pandemic. The evaluation will include ascertaining the budgetary impact of implementing and delivering the intervention. METHODS AND ANALYSIS The implementation research logic model guided the development of the study and implementation outcome measures were informed by the 'Reach, Effectiveness, Adoption, Implementation and Maintenance' (RE-AIM) framework. This CRC screening intervention for Malaysia uses home-testing and digital, small media, communication to improve CRC screening uptake. A sample of 780 people aged 50-75 years living in Segamat district, Malaysia, will be selected randomly from the South East Asia Community Observatory (SEACO) database. Participants will receive a screening pack as well as a WhatsApp video of a local doctor to undertake a stool test safely and to send a photo of the test result to a confidential mobile number. SEACO staff will inform participants of their result. Quantitative data about follow-up clinic attendance, subsequent hospital tests and outcomes will be collected. Logistic regression will be used to investigate variables that influence screening completion and we will conduct a budget impact-analysis of the intervention and its implementation. Qualitative data about intervention implementation from the perspective of participants and stakeholders will be analysed thematically. ETHICS AND DISSEMINATION Ethics approval has been granted by Monash University Human Research Ethics Committee (MUHREC ID: 29107) and the Medical Review and Ethics Committee (Reference: 21-02045-O7G(2)). Results will be disseminated through publications, conferences and community engagement activities. TRIAL REGISTRATION NUMBER National Medical Research Register Malaysia: 21-02045-O7G(2).
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Kogila Ramanathan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Ciaran O'Neill
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Christopher R Cardwell
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Prathibha Nanu
- Surgical Department, Hospital Segamat, Segamat, Malaysia
| | | | - Frank Kee
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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Neary J, Bulterys MA, Ogutu EA, O’Malley G, Otieno AA, Omondi VO, Wang Y, Zhai X, Katz DA, Oyiengo L, Wamalwa DC, Slyker JA, John-Stewart GC, Njuguna IN, Wagner AD. Brief Report: Pediatric Saliva-Based HIV Testing: Health care Worker and Caregiver Acceptability. J Acquir Immune Defic Syndr 2022; 90:517-523. [PMID: 35499505 PMCID: PMC9283261 DOI: 10.1097/qai.0000000000003004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric HIV testing remains suboptimal. The OraQuick test [saliva-based test (SBT)] is validated in pediatric populations ≥18 months. Understanding caregiver and health care worker (HCW) acceptability of pediatric SBT is critical for implementation. METHODS A trained qualitative interviewer conducted 8 focus group discussions (FGDs): 4 with HCWs and 4 with caregivers of children seeking health services in western Kenya. FGDs explored acceptability of pediatric SBT and home- and facility-based SBT use. Two reviewers conducted consensus coding and thematic analyses of transcripts using Dedoose. RESULTS Most HCWs but few caregivers had heard of SBT. Before seeing SBT instructions, both had concerns about potential HIV transmission through saliva, which were mostly alleviated after kit demonstration. Noted benefits of SBT included usability and avoiding finger pricks. Benefits of facility-based pediatric SBT included shorter client waiting and service time, higher testing coverage, and access to HCWs, while noted challenges included ensuring confidentiality. Benefits of caregivers using home-based SBT included convenience, privacy, decreased travel costs, increased testing, easier administration, and child comfort. Perceived challenges included not receiving counseling, disagreements with partners, child neglect, and negative emotional response to a positive test result. Overall, HCWs felt that SBT could be used for pediatric HIV testing but saw limited utility for caregivers performing SBT without an HCW present. Caregivers saw utility in home-based SBT but wanted easy access to counseling in case of a positive test result. CONCLUSIONS SBT was generally acceptable to HCWs and caregivers and is a promising strategy to expand testing coverage.
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Affiliation(s)
- Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Emily A. Ogutu
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, Seattle, WA
- International Training and Education Center for Health, University of Washington, Seattle, WA
| | | | | | - Yu Wang
- Department of Global Health, University of Washington, Seattle, WA
| | - Xinyi Zhai
- Department of Global Health, University of Washington, Seattle, WA
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA
| | - Laura Oyiengo
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jennifer A. Slyker
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | - Grace C. John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Irene N. Njuguna
- Department of Global Health, University of Washington, Seattle, WA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA
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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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Cassell MM, Girault P, Nith S, Rang C, Sokhan S, Tuot S, Kem V, Dork P, Chheav A, Sos M, Im C, Meach S, Mao K, Ly PS, Khol V, Samreth S, Ngauv B, Ouk V, Seng S, Wignall FS. A Cross-Sectional Assessment of HIV Self-Testing Preferences and Uptake Among Key Populations in Phnom Penh, Cambodia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00412. [PMID: 36332061 PMCID: PMC9242604 DOI: 10.9745/ghsp-d-21-00412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
Offering HIV self-testing services to key populations in Cambodia expanded HIV testing access to a large proportion of individuals with no prior testing history and resulted in high rates of new HIV case detection and subsequent linkages to HIV treatment. Background: HIV self-testing (HIVST) is recommended by the World Health Organization, but implementation remains limited. This cross-sectional study evaluated HIVST uptake among female entertainment workers (EWs), men who have sex with men (MSM), and transgender women in Phnom Penh, Cambodia, to inform national implementation. Methods: Between December 2018 and September 2019, individuals reached through community outreach or via online advertising were offered HIVST or referrals to facility-based testing. Participants opting for HIVST could choose between test kits employing oral-fluid or finger-prick-based sample collection; and between an “assisted” option in which outreach staff offered instructions and assistance and an “unassisted” option in which participants received a kit with instructions for use. A structured questionnaire was administered to facilitate descriptive statistics and tests for associations between participant characteristics and HIV testing preferences and outcomes. Results: Among 1,241 eligible individuals; 1,210 (97.5%) provided responses for analysis. Of these, 1,203 (99.4%) were recruited through outreach; 7 (0.6%) through online advertising. Among those recruited by outreach, 1,186 (98.6%) opted for assisted HIVST, and 1,065 (88.5%) opted for oral-fluid versus finger-prick testing. All individuals recruited through online advertisements opted for unassisted oral-fluid testing. Among all participants, 455 (37.6%) were MSM, 325 (26.9%) were transgender women, 430 (35.5%) were female EWs, and overall, 71.7% reported never previously testing for HIV. A total of 84 participants (6.9%) received reactive screening results and 81 (97.5%) were linked to treatment. Conclusion: Uptake of HIVST was high, and most participants preferred oral-fluid over finger-prick-based testing. Many individuals (72%) who had never previously accessed HIV testing services participated in HIVST, with high rates of reactivity.
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Affiliation(s)
| | | | | | | | | | - Sovannary Tuot
- Khmer HIV/AIDS Nongovernmental Organization Alliance, Phnom Penh, Cambodia
| | - Vichet Kem
- Men's Health Cambodia, Phnom Penh, Cambodia
| | - Pagna Dork
- Men's Health Social Services, Phnom Penh, Cambodia
| | - Aphyra Chheav
- Cambodian Women for Peace and Development, Phnom Penh, Cambodia
| | - Mary Sos
- Chhouk Sar Association Clinic, Phnom Penh, Cambodia
| | | | - Sotheary Meach
- Cambodian Women for Peace and Development, Phnom Penh, Cambodia
| | - Kimrun Mao
- Men's Health Cambodia, Phnom Penh, Cambodia
| | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | - Sovannarith Samreth
- National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | - Bora Ngauv
- National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | - Vichea Ouk
- National Center for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
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35
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Joseph Davey DL, Wall KM, Naidoo N, Naidoo D, Xaba G, Serao C, Malone T, Dovel K. HIV testing and linkage to ART following secondary distribution of HIV self-test kits to male partners of women living with HIV: a pilot randomized control trial in Mpumalanga, South Africa. J Int AIDS Soc 2022; 25:e25937. [PMID: 35690880 PMCID: PMC9188623 DOI: 10.1002/jia2.25937] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/12/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION South African men are underrepresented in HIV testing and treatment services. Secondary distribution of oral HIV self-test (HIVST) kits by women living with HIV (WLHIV) to their male partners (i.e. index partner HIVST) may increase men's testing and treatment but has been understudied. METHODS Between March and July 2021, we evaluated the effectiveness of index partner HIVST versus the standard of care (SOC) (invitations for men's facility-based testing) on men's testing in a 1:1 randomized control trial. Eligibility criteria included: WLHIV; ≥18 years of age; attending one of four high-density rural clinics; have a working cell phone; and self-reported having a primary male partner of unknown serostatus. The primary outcome was the proportion of WLHIV reporting that her partner tested for HIV within 3 months after enrolment. RESULTS We enrolled 180 WLHIV and 176 completed an endline survey (mean age = 35 years, 15% pregnant, 47% unmarried or non-cohabiting). In the HIVST arm, 78% of male partners were reported to have tested for HIV versus 55% in SOC (RR = 1.41; 95% CI = 1.14-1.76). In the HIVST arm, nine men were reactive with HIVST (14% positivity), six were confirmed HIV positive with standard testing (67%) and all of those started antiretroviral therapy (ART), and four HIV-negative men started pre-exposure prophylaxis (PrEP) (5%). In SOC, six men were diagnosed with HIV (12% positivity), 100% started ART and seven HIV-negative men started PrEP (16%). One case of verbal intimate partner violence was reported in the HIVST arm. CONCLUSIONS Secondary distribution of HIVST to partners of WLHIV was acceptable and effective for improving HIV testing among men in rural South Africa in our pilot study. Interventions are needed to link reactive HIVST users to confirmatory testing and ART.
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Affiliation(s)
- Dvora L Joseph Davey
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Gugu Xaba
- BroadReach Healthcare, Johannesburg, South Africa
| | - Claire Serao
- BroadReach Healthcare, Johannesburg, South Africa
| | - Todd Malone
- BroadReach Healthcare, Johannesburg, South Africa
| | - Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Jordão T, Magno L, Pereira M, Rossi TRA, de Almeida Silva P, Figueiredo MAA, de Brito Lima Prado NM, Dos Santos AM, Cangussu MC, Dourado I. Willingness of health care providers to offer HIV self-testing from specialized HIV care services in the northeast of Brazil. BMC Health Serv Res 2022; 22:713. [PMID: 35637470 PMCID: PMC9149328 DOI: 10.1186/s12913-022-08091-2] [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: 07/13/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background The insufficient knowledge regarding the serological status of people affected with human immunodeficiency virus (HIV) is a concern in Brazil. HIV self-testing (HIVST) has been proved to have great potential for increasing testing, especially among vulnerable populations. The large-scale distribution of HIVST by the Brazilian public health system has increased in recent years. We aimed to investigate the awareness of HIVST among health care providers (HCP) from specialized HIV/AIDS care services in the state of Bahia, Northeast Brazil. Further we investigated HCP acceptability and willingness to offer its use. Methods A cross-sectional study on HCP from 29 specialized care services (SCS) located in 21 cities in the state of Bahia. HCP working in the service for at least 6 months were included. Sociodemographic, occupational, and behavioral data were collected using a questionnaire. Descriptive statistics were carried out. Bivariate, and multivariate analyses estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using logistic regression were conducted. Results The awareness and acceptability of HIVST and the willingness to provide it were 79.8, 55.2, and 47.1%, respectively. Few HCP reported that the SCS where they worked dispensed HIVST (3.6%), and 13.5% received some information or training on HIVST. Factors associated with willingness to offer HIVST were: HIVST acceptability (aOR = 9.45; 95% CI: 4.53–19.71), willingness to use HIVST on themselves (aOR = 4.45; 95% CI: 1.62–12.24), confidence in offering HIVST to clients (aOR = 5.73; 95% CI: 2.26–12.72), and considering everyone eligible for HIVST (aOR = 2.88; 95% CI: 1.25–6.59). Conclusions Although most HCP were aware of HIVST, acceptability and willingness to provide it to the clients was moderate. The scale up of HIVST as a mean for the HIV prevention and control policy in Brazil, requires further training of HCP and better implementation of this program. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08091-2.
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Affiliation(s)
- Tiago Jordão
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Diretoria de Vigilância Epidemiológica da Bahia, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil. .,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
| | - Marcos Pereira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Thais Regis Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | - Pedro de Almeida Silva
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | | | | | - Adriano Maia Dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brazil
| | | | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Invalid Results in the GetaKit Study in Ottawa: A Real-World Observation of the INSTI® HIV Self-test Among Persons At Risk for HIV. J Assoc Nurses AIDS Care 2022; 33:567-573. [PMID: 35472138 PMCID: PMC9398507 DOI: 10.1097/jnc.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT HIV self-testing corresponds with more frequent testing, better user satisfaction, and higher positivity rates compared with clinic-based testing. We implemented an open cohort prospective observational study, which provided a website through which persons could do online HIV self-assessments and, if eligible, receive a free HIV self-test. We implemented this project on July 20, 2021 and used the bioLytical INSTI® test. Herein, we describe the number of tests participants reported as invalid, which started at a rate of one fifth of all ordered tests and decreased to 8% after we provided more instructions on completing the test. Our data suggest that a high rate of invalids occur with self-testing in the real-world. Although this has cost implications, we feel this rate is acceptable, considering that 25% of our cohort reported no previous HIV testing. Our take-away message is that HIV self-testing requires additional supports and resources to function as an effective testing intervention.
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Widyanthini DN, Januraga PP, Wisaksana R, Subronto YW, Sukmaningrum E, Kusmayanti NA, Dewi H, Law M, Kaldor JM, Wirawan DN. HIV self-testing for men who have sex with men: an implementation trial in Indonesia. AIDS Care 2022; 34:527-534. [PMID: 33550846 DOI: 10.1080/09540121.2021.1883509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We investigated oral fluid testing (OFT) among men who have sex with men (MSM) to increase HIV testing in Bali, Indonesia. We distributed OFT in January-December 2018 to 813 MSM in Bali. Supervised testing was offered first, and unsupervised was only offered to an individual who declined supervised testing. Included participants were MSM who did not have a HIV test result in the last 6 months and declined referral to facility-based testing. Of 813 participants, 93% (765/813) chose supervised testing and 7% (57/813) unsupervised. The OFT result was reactive for 83 (10%), of whom 52/83 (63%) underwent confirmatory testing with 47/52 (90%) found HIV positive. Among confirmed positives, 43/47 (92%) were enrolled in HATI study cohort, of whom 39 (91%) started treatment. At six months follow up, 25/39 (64%) of those initiating treatment were still receiving it, and all had a suppressed viral load. There was an increase in the mean number of MSM tested for HIV by HATI study Bali sites per month, from 100 (95%CI: 85-112) before the intervention to 152 (95% CI: 130-172) during the intervention. Our findings show the potential utility of offering HIV oral fluid self-test kits to scale-up HIV testing in MSM.Trial registration: ClinicalTrials.gov identifier: NCT03429842.
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Affiliation(s)
- Desak Nyoman Widyanthini
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rudi Wisaksana
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | - Yanri Wijayanti Subronto
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Evi Sukmaningrum
- AIDS Research Center, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Nur Aini Kusmayanti
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Helen Dewi
- Ministry of Health of Indonesia, Jakarta, Indonesia
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Boisvert Moreau M, Kintin FD, Atchekpe S, Batona G, Béhanzin L, Guédou FA, Gagnon MP, Alary M. HIV self-testing implementation, distribution and use among female sex workers in Cotonou, Benin: a qualitative evaluation of acceptability and feasibility. BMC Public Health 2022; 22:589. [PMID: 35346119 PMCID: PMC8962183 DOI: 10.1186/s12889-022-12917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background In Benin, the burden of HIV is disproportionately high among female sex workers (FSWs). HIV testing and knowledge of status are starting points for HIV treatment and prevention interventions. Despite the importance given to testing services in HIV control, its uptake among FSWs remains suboptimal in Benin. HIV self-testing (HIVST) may be useful for increasing testing rates in FSWs. Methods We conducted a pilot study of the distribution of saliva-based HIVST among FSWs in Cotonou and its surroundings, Benin. The HIVST promotion and distribution model included three complementary strategies: community-based, facility-based and secondary distribution. In this qualitative study, we explored the elements influencing HIVST implementation, distribution and use among FSWs. We assessed HIVST acceptability and feasibility in this population. We conducted 29 semi-structured individual interviews with FSWs. Data were interpreted with a thematic analysis method, using the Theoretical Domains Framework. Results Only two FSWs (6.9%) were aware of HIVST before participating in the study. All participants were interested in using HIVST if available in Benin. Many advantages of HIVST were mentioned, including: autonomy, privacy, accessibility, time saving, and the fact that it is a painless test. Barriers to the use of HIVST included: the fear of unreliability, the lack of psychological support and medical follow-up and the possibility of result dissimulation. Participants thought HIVST was easy to use without assistance. HIVST enabled linkage to care for a few FSWs in denial of their HIV-positive status. No case of suicide or violence associated with HIVST was reported. HIVST secondary distribution within FSWs social network was well received. FSWs’ boyfriends and clients showed interest in using the device. Some FSWs reported using HIVST to practice serosorting or to guide their decisions regarding condom use. Conclusions Our study shows a very high level of acceptability for HIVST among FSWs in Cotonou and its surroundings. Results also demonstrate the feasibility of implementing HIVST distribution in Benin. HIVST should be implemented in Benin quickly and free of charge for all individuals at risk of HIV. HIVST offer should be integrated with comprehensive sexual health and prevention services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12917-3.
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Dinglasan JLG, Rosadiño JDT, Pagtakhan RG, Cruz DP, Briñes MT, Regencia ZJG, Baja ES. 'Bringing testing closer to you': barriers and facilitators in implementing HIV self-testing among Filipino men-having-sex-with-men and transgender women in National Capital Region (NCR), Philippines - a qualitative study. BMJ Open 2022; 12:e056697. [PMID: 35314474 PMCID: PMC8938691 DOI: 10.1136/bmjopen-2021-056697] [Citation(s) in RCA: 1] [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] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Our study identified barriers and facilitators in implementing HIV self-testing (HIVST), including the perceptions of men-having-sex-with-men (MSM) and transgender women (TGW) on HIVST. Furthermore, we explored the current knowledge, practices and potential of HIVST among the MSM and TGW populations. DESIGN Qualitative in-depth key informant interviews were administered using semistructured interviews administered in both English and Filipino. Thematic analysis of the findings was done after transcribing all audio recordings. SETTING The study was done in the National Capital Region (NCR), Philippines using online video conferencing platforms due to mobility restrictions and lockdowns caused by the COVID-19 pandemic. PARTICIPANTS All study participants were either MSM or TGW, 18-49 years old and residing/working in NCR. Exclusion criteria include biologically born female and/or currently on pre-exposure prophylaxis, antiretroviral therapy medications or an HIV-positive diagnosis. RESULTS Twenty informants were interviewed, of which 75% were MSM, and most of them preferred the use of HIVST. Facilitators and barriers to the use of HIVST were grouped into three main themes: Acceptability, distribution and monitoring and tracking. Convenience and confidentiality, overcoming fears and normalisation of HIV testing services (HTS) in the country were the participants' perceived facilitators of HIVST. In contrast, lack of privacy and maintenance of confidentiality during kit delivery were perceived as barriers in HIVST implementation. Moreover, social media was recognised as a powerful tool in promoting HIVST. The use of a welcoming tone and positive language should be taken into consideration due to the prevalent HIV stigma. CONCLUSIONS The identified facilitators and barriers from the study may be considered by the Philippine HTS programme implementers. The HIVST strategy may complement the current HTS. It will be very promising to involve the MSM and TGW communities and other key populations to know their HIV status by bringing testing closer to them.
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Affiliation(s)
| | - John Danvic T Rosadiño
- LoveYourself Inc, Mandaluyong City, NCR, Philippines
- Faculty of Management and Development Studies, University of the Philippines Open University, Laguna, Calabarzon, Philippines
| | | | - Denis P Cruz
- LoveYourself Inc, Mandaluyong City, NCR, Philippines
- Faculty of Management and Development Studies, University of the Philippines Open University, Laguna, Calabarzon, Philippines
| | - Matthew T Briñes
- LoveYourself Inc, Mandaluyong City, NCR, Philippines
- College of Medicine, Pamantasan ng Lungsod ng Maynila, Manila, NCR, Philippines
| | - Zypher Jude G Regencia
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, NCR, Philippines
- Department of Clinical Epidemiology, University of the Philippines Manila College of Medicine, Manila, Metro Manila, Philippines
| | - Emmanuel S Baja
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, NCR, Philippines
- Department of Clinical Epidemiology, University of the Philippines Manila College of Medicine, Manila, Metro Manila, Philippines
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Rotsaert A, Sibanda E, Hatzold K, Johnson C, Corbett E, Neuman M, Cowan F. Did you hear about HIV self-testing? HIV self-testing awareness after community-based HIVST distribution in rural Zimbabwe. BMC Infect Dis 2022; 22:51. [PMID: 35027000 PMCID: PMC8895763 DOI: 10.1186/s12879-022-07027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Several trials of community-based HIV self-testing (HIVST) provide evidence on the acceptability and feasibility of campaign-style distribution to reach first-time testers, men and adolescents. However, we do not know how many remain unaware of HIVST after distribution campaigns, and who these individuals are. Here we look at factors associated with never having heard of HIVST after community-based campaign-style HIVST distribution in rural Zimbabwe between September 2016 and July 2017. METHODS Analysis of representative population-based trial survey data collected from 7146 individuals following community-based HIVST distribution to households was conducted. Factors associated with having never heard of HIVST were determined using multivariable mixed-effects logistic regression adjusted for clustered design. RESULTS Among survey participants, 1308 (18.3%) self-reported having never heard of HIVST. Individuals who were between 20 and 60 years old {20-29 years: [aOR = 0.74, 95% CI (0.58-0.95)], 30-39 years: [aOR = 0.56, 95% CI (0.42-0.74)], 40-49 years: [aOR = 0.50, 95% CI (0.36-0.68)], 50-59 years [aOR = 0.58, 95% CI (0.42-0.82)]}, who had attained at least ordinary level education [aOR = 0.51, 95% CI (0.34-0.76)], and who had an HIV test before [aOR = 0.30, 95% CI (0.25-0.37)] were less likely to have never heard of HIVST compared with individuals who were between 16 and 19 years old, who had a lower educational level and who had never tested for HIV before, respectively. In addition, non-household heads or household head representatives [aOR = 1.21, 95% CI (1.01-1.45)] were more likely to report never having heard of HIVST compared to household head and representatives. CONCLUSIONS Around one fifth of survey participants remain unaware of HIVST even after an intensive community-based door-to-door HIVST distribution. Of note, those least likely to have heard of self-testing were younger, less educated and less likely to have tested previously. Household heads appear to play an important role in granting or denying access to self-testing to other household members during door-to-door distribution. Differentiated distribution models are needed to ensure access to all. Trial registration PACTR, PACTR201607001701788. Registered 29 June 2016, https://pactr.samrc.ac.za/ PACTR201607001701788.
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Affiliation(s)
- Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Euphemia Sibanda
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Department of Clinical Research and Infection Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Corbett
- Department of Clinical Research and Infection Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Neuman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, UK
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Elorreaga OA, Torres TS, Vega-Ramirez EH, Konda KA, Hoagland B, Benedetti M, Pimenta C, Diaz-Sosa D, Robles-Garcia R, Grinsztejn B, Caceres CF, Veloso VG. Awareness, willingness and barriers to HIV Self-testing (HIVST) among Men who Have Sex with Men (MSM) in Brazil, Mexico, and Peru: A web-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000678. [PMID: 36962436 PMCID: PMC10021908 DOI: 10.1371/journal.pgph.0000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.
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Affiliation(s)
- Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Cristina Pimenta
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico DF, Mexico
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Carlos F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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Aluisio AR, Lim RK, Tang OY, Sugut J, Kinuthia J, Bosire R, Guthrie KM, Katz DA, Farquhar C, Mello MJ. Acceptability and uptake of HIV self-testing in emergency care settings: A systematic review and meta-analysis. Acad Emerg Med 2022; 29:95-104. [PMID: 34133822 PMCID: PMC8674381 DOI: 10.1111/acem.14323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Emergency departments (ED) interface with large numbers of patients that are often missed by conventional HIV testing approaches. ED-based HIV self-testing (HIVST) is an innovative engagement approach which has potential for testing gains among populations that have failed to be reached. This systematic review and meta-analysis evaluated acceptability and uptake of HIVST, as compared to standard provider-delivered testing approaches, among patients seeking care in ED settings. METHODS Six electronic databases were systematically searched (Dates: January 1990-May 2021). Reports with data on HIVST acceptability and/or testing uptake in ED settings were included. Two reviewers identified eligible records (κ= 0.84); quality was assessed using formalized criteria. Acceptability and testing uptake metrics were summarized, and pooled estimates were calculated using random-effects models with assessments of heterogeneity. RESULTS Of 5773 records identified, seven met inclusion criteria. The cumulative sample was 1942 subjects, drawn from three randomized control trials (RCTs) and four cross-sectional studies. Four reports assessed HIVST acceptability. Pooled acceptability of self-testing was 92.6% (95% confidence interval [CI]: 88.0%-97.1%). Data from two RCTs demonstrated that HIVST significantly increased testing uptake as compared to standard programs (risk ratio [RR] = 4.41, 95% CI: 1.95-10.10, I2 = 25.8%). Overall, the quality of evidence was low (42.9%) or very low (42.9%), with one report of moderate quality (14.2%). CONCLUSIONS Available data indicate that HIVST may be acceptable and may increase testing among patients seeking emergency care, suggesting that expanding ED-based HIVST programs could enhance HIV diagnosis. However, given the limitations of the reports, additional research is needed to better inform the evidence base.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of
Brown University, Providence, USA
| | | | - Oliver Y. Tang
- Alpert Medical School of Brown University, Providence,
USA
| | - Janet Sugut
- Department of Accident and Emergency, Kenyatta National
Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National
Hospital, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research
Institute (KEMRI), Nairobi, Kenya
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical
School, Brown University, Providence, RI, USA
| | - David A. Katz
- Department of Global Health, University of Washington,
Seattle, US
| | - Carey Farquhar
- Department of Global Health, University of Washington,
Seattle, US
- Department Epidemiology, University of Washington, Seattle,
USA
- Department Medicine, University of Washington, Seattle,
USA
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of
Brown University, Providence, USA
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Mphande M, Campbell P, Hoffman RM, Phiri K, Nyirenda M, Gupta SK, Wong V, Dovel K. Barriers and facilitators to facility HIV self-testing in outpatient settings in Malawi: a qualitative study. BMC Public Health 2021; 21:2200. [PMID: 34856958 PMCID: PMC8638200 DOI: 10.1186/s12889-021-12213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Facility HIV self-testing (HIVST) within outpatient departments can increase HIV testing coverage by facilitating HIVST use in outpatient waiting spaces while clients wait for routine care. Facility HIVST allows for the majority of outpatients to test with minimal health care worker time requirements. However, barriers and facilitators to outpatients’ use of facility HIVST are still unknown. Methods As part of a cluster randomized trial on facility HIVST in Malawi, we conducted in-depth interviews with 57 adult outpatients (> 15 years) who were exposed to the HIVST intervention and collected observational journals that documented study staff observations from facility waiting spaces where HIVST was implemented. Translated and transcribed data were analyzed using constant comparison analysis in Atlas.ti. Results Facility HIVST was convenient, fast, and provided autonomy to outpatients. The strategy also had novel facilitators for testing, such as increased motivation to test due to seeing others test, immediate support for HIVST use, and easy access to additional HIV services in the health facility. Barriers to facility HIVST included fear of judgment from others and unwanted status disclosure due to lack of privacy. Desired changes to the intervention included private, separate spaces for kit use and interpretation and increased opportunity for disclosure and post-test counseling. Conclusions Facility HIVST was largely acceptable to outpatients in Malawi with novel facilitators that are unique to facility HIVST in OPD waiting spaces. Trial registration The parent trial is registered with ClinicalTrials.gov, NCT03271307, and Pan African Clinical Trials, PACTR201711002697316.
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Affiliation(s)
| | - Paula Campbell
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Risa M Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Sundeep K Gupta
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vincent Wong
- Office of HIV/AIDS, United States Agency for International Development, Washington D.C, USA
| | - Kathryn Dovel
- Partners in Hope, Box, 302, Lilongwe, Malawi.,Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Rousseau E, Julies RF, Madubela N, Kassim S. Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations - Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine. Curr HIV/AIDS Rep 2021; 18:500-507. [PMID: 34708316 PMCID: PMC8549812 DOI: 10.1007/s11904-021-00578-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW A gap exists between PrEP interest and PrEP uptake in key populations (KP) for HIV prevention that may be ascribed to PrEP delivery services not being acceptable. This review summarizes novel platforms for HIV prevention outside of the traditional health facilities environment. RECENT FINDINGS Mobile health clinics provide highly acceptable integrated, KP-focused services at convenient locations with the potential of high PrEP uptake. Telemedicine and health apps decongest health systems and allow for personal agency and informed decision-making on personal health. Pharmacy-led PrEP delivery provides de-medicalized, confidential PrEP services at extended hours in community locations, from trusted medical professionals. Peer-supported delivery encourages continued PrEP use. Community-based, differentiated and de-medicalized PrEP delivery can address uptake and continued use barriers in key populations. Future research should assess scalability, cost-effectiveness and sustainability of these PrEP delivery platforms, as well as focus on ways to simplify PrEP provision.
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Affiliation(s)
- E Rousseau
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - R F Julies
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - N Madubela
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - S Kassim
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Vrana-Diaz CJ, Korte JE, Gebregziabher M, Richey L, Selassie A, Sweat M, Kisa R, Musoke W, Chemusto H, Buregyeya E, Matovu JK, Wanyenze RK. Low acceptance of intimate partner violence by pregnant women in Uganda predicts higher uptake of HIV self-testing among their male partners. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:287-296. [PMID: 34905449 DOI: 10.2989/16085906.2021.2000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Heterosexual couples are at high risk for HIV acquisition in sub-Saharan Africa, and HIV self-testing (HST) is an additional approach to expand access to HIV testing services. However, it is not well known how gender equality is associated with HST.Methods: We used intervention-arm data from a cluster-randomised controlled HST intervention trial (N = 1 618) conducted in Uganda to determine the association between attitudes towards intimate partner violence (IPV), decision-making power and male partner's uptake of HST among heterosexual couples expecting a child in south-central Uganda. The original study question was to assess the impact of providing pregnant women with HST kits to improve male partner's HIV testing rates. For this analysis, the primary exposures were gender equality (measured by male partner's and female partner's attitudes towards IPV and the female partner's household decision-making power), and the primary outcome was the male partner's uptake of HST. Multivariate logistic regression was used for analysis.Results: We found that male partner HST uptake did not vary depending on male partner's attitudes towards IPV or decision-making power; however, male partner HST uptake did depend on the female partner's attitude towards IPV, with 1.76 times more testing (95% CI 1.06-2.92) in couples where the woman had "medium" versus "high" acceptance of IPV, and 1.82 times more testing (95% CI 1.08-3.08) in couples where the woman had "low" versus "high" acceptance of IPV.Conclusions: This study shows the importance of appropriate negative attitudes by women to IPV in increasing male partner's HST uptake to integrate HST into national health care policies.
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Affiliation(s)
- Caroline J Vrana-Diaz
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Lauren Richey
- Infectious Disease section, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Anbesaw Selassie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Michael Sweat
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Rose Kisa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Kb Matovu
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S, Boehme C, Cherniak W, Cheung AN, Dahn B, Donoso-Bach L, Douglas T, Garcia P, Hussain S, Iyer HS, Kohli M, Labrique AB, Looi LM, Meara JG, Nkengasong J, Pai M, Pool KL, Ramaiya K, Schroeder L, Shah D, Sullivan R, Tan BS, Walia K. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398:1997-2050. [PMID: 34626542 PMCID: PMC8494468 DOI: 10.1016/s0140-6736(21)00673-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | - Bertha Aguilar
- Médicos e Investigadores de la Lucha Contra el Cáncer de Mama, Mexico City, Mexico
| | - Savvas Andronikou
- Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | | | - William Cherniak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie Ny Cheung
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Sarwat Hussain
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Hari S Iyer
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alain B Labrique
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Lee Schroeder
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devanshi Shah
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Kamini Walia
- Indian Council of Medical Research, Delhi, India
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48
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Shava E, Bogart LM, Manyake K, Mdluli C, Maribe K, Monnapula N, Nkomo B, Mosepele M, Moyo S, Mmalane M, Bärnighausen T, Makhema J, Lockman S. Feasibility of oral HIV self-testing in female sex workers in Gaborone, Botswana. PLoS One 2021; 16:e0259508. [PMID: 34748576 PMCID: PMC8575243 DOI: 10.1371/journal.pone.0259508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Oral HIV self-testing (HIVST) may be useful for increasing testing in persons at elevated risk of acquiring HIV. METHODS We conducted a pilot study to evaluate the feasibility (defined by uptake) of HIVST among FSW in Gaborone, Botswana. FSW age 18 years and above were recruited through a non-governmental organization serving FSW. FSW with unknown or negative HIV status at screening performed HIVST in the study clinic following brief training. FSW testing HIV-negative were each given two test kits to take home: one kit to perform unassisted HIVST and another to share with others. Feasibility (use) of HIVST (and sharing of test kits with others) was assessed in these women at a study visit four months later. RESULTS Two hundred FSW were screened. Their average age was 34 years (range 18-59), and 115 (58%) were HIV-positive. Eighty-five (42%) tested HIV-negative at entry and were eligible to take part in the HIVST pilot study. All 85 (100%) agreed to take home HIVST kits. Sixty-nine (81%) of these 85 participants had a follow-up visit, 56 (81%) of whom reported performing HIVST at a mean of three and half months after the initial visit. All 56 participants who performed HIVST reported negative HIVST results. Fifty (73%) of the 69 participants who took HIVST kits home shared them with others. Of the 50 women sharing HIVST kits, 25 (50%) shared with their non-client partners, 15 with a family member, 8 with friends, and 3 with a client. One participant did not test herself but shared both her test kits. Most participants 53/56 (95%) found oral HIVST very easy to use whilst 3/56 (5%) felt it was fairly easy. CONCLUSION Oral HIVST is feasible among FSW in Gaborone, Botswana. The majority of FSW used the HIVST kits themselves and also shared extra HIVST kits with other individuals.
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Affiliation(s)
- Emily Shava
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, California, United States of America
| | - Kutlo Manyake
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | | | | | - Mosepele Mosepele
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- University of Botswana, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Till Bärnighausen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- University of Heidelberg, Heidelberg, Germany
- Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba, South Africa
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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49
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Majam M, Rhagnath N, Msolomba V, Singh L, Urdea MS, Lalla-Edward ST. Assessment of the Sedia HIV Self-Test Device: Usability and Performance in the Hands of Untrained Users in Johannesburg, South Africa. Diagnostics (Basel) 2021; 11:diagnostics11101816. [PMID: 34679514 PMCID: PMC8534357 DOI: 10.3390/diagnostics11101816] [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: 08/11/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
The prevalence of HIV across South Africa places a strain on testing facilities. The use of HIV self-testing (HIVST) devices has been identified as a strategy to ease the burden on these facilities. The usability and performance of the Asante HIV−1/2 Oral Self-Test (Asante) (Sedia Biosciences, Portland OR, USA) device by novice users was assessed and reported on, to inform for the implementation of such devices in South Africa and elsewhere. Convenience sampling was used. Participants used the Asante HIVST device and recorded their interpretation of their results. Participants’ interpretations were compared with those of trained professionals and, thereafter, verified using the rapid diagnostic testing algorithm. Out of the eligible participants, 410 of the 524 (78.2%) were between the ages of 18–35. The usability assessment indicates that 100% of participants used the HIVST device’s information leaflet. However, 19/524 (3.6%) of participants who yielded an invalid result due to critical errors were excluded from the primary efficacy analysis. The average usability score was 98.1%. The sensitivity and specificity results were, 94.7% and 99.8%, respectively. This study shows that the Asante HIV self-test, and similar devices, can be valuable in providing convenient HIV self-testing and immediately available results. To accommodate a greater number of inexperienced users, the instructions may need to be revised.
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Affiliation(s)
- Mohammed Majam
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (N.R.); (V.M.); (L.S.)
| | - Naleni Rhagnath
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (N.R.); (V.M.); (L.S.)
| | - Vanessa Msolomba
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (N.R.); (V.M.); (L.S.)
| | - Leanne Singh
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (N.R.); (V.M.); (L.S.)
| | - Michael S. Urdea
- Halteres Associates, 2010 Crow Canyon Place, Suite 100, San Ramon, CA 94583, USA;
| | - Samanta Tresha Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (M.M.); (N.R.); (V.M.); (L.S.)
- Correspondence: ; Tel.: +27-82-6172490
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50
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Pai N, Esmail A, Saha Chaudhuri P, Oelofse S, Pretorius M, Marathe G, Daher J, Smallwood M, Karatzas N, Fadul M, de Waal A, Engel N, Zwerling AA, Dheda K. Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa. BMJ Glob Health 2021; 6:bmjgh-2021-006032. [PMID: 34475026 PMCID: PMC8413877 DOI: 10.1136/bmjgh-2021-006032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/15/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. Methods In a quasirandomised study (n=3095), we recruited consenting adults with undiagnosed HIV infection from township clinics. To the HIVST arm participants (n=1535), we offered a choice of an offsite (home, office or kiosk based), unsupervised digital HIVST program (n=962), or an onsite, clinic-based, supervised digital HIVST program (n=573) with 24/7 linkages services. With propensity score analyses, we compared outcomes (ie, linkages, new HIV infections and test referrals) with conventional HIV testing (ConvHT) arm participants (n=1560), recruited randomly from geographically separated clinics. Results In both arms, participants were young (HIVST vs ConvHT) (mean age: 28.2 years vs 29.2 years), female (65.0% vs 76.0%) and had monthly income <3000 rand (80.8% vs 75%). Participants chose unsupervised HIVST (62.7%) versus supervised HIVST and reported multiple sex partners (10.88% vs 8.7%), exposure to sex workers (1.4% vs 0.2%) and fewer comorbidities (0.9% vs 1.9%). Almost all HIVST participants were linked (unsupervised HIVST (99.7%), supervised HIVST (99.8%) vs ConvHT (98.5%)) (adj RR 1.012; 95% CI 1.005 to 1.018) with new HIV infections: overall HIVST (9%); supervised HIVST (10.9%) and unsupervised HIVST (7.6%) versus ConvHT (6.79%) (adj RR 1.305; 95% CI 1.023 to 1.665); test referrals: 16.7% HIVST versus 3.1% ConvHT (adj RR 5.435; 95% CI 4.024 to 7.340). Conclusions Our flexible, personalised, app-based HIVST program, offered by healthcare workers, successfully linked almost all HIV self-testers, detected new infections and increased referrals to self-test. Data are relevant for digital HIVST initiatives worldwide.
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Affiliation(s)
- Nitika Pai
- Department of Medicine, McGill University, Montreal, Québec, Canada .,Research Institute of McGill University, Montreal, Québec, Canada
| | - Aliasgar Esmail
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.,Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Paramita Saha Chaudhuri
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Suzette Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Marietjie Pretorius
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Gayatri Marathe
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Jana Daher
- Research Institute of McGill University, Montreal, Québec, Canada
| | - Megan Smallwood
- Research Institute of McGill University, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Nicolaos Karatzas
- Department of Experimental Medicine, McGill University, Montreal, Québec, Canada
| | - Mohammed Fadul
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Anna de Waal
- Research Institute of McGill University, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Nora Engel
- Department of Health, Ethics & Society/CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Alice Anne Zwerling
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Keertan Dheda
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.,Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa.,Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
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