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Nabukenya AM, Matovu JKB. Correlates of HIV status awareness among older adults in Uganda: results from a nationally representative survey. BMC Public Health 2018; 18:1128. [PMID: 30223821 PMCID: PMC6142637 DOI: 10.1186/s12889-018-6027-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/09/2018] [Indexed: 11/16/2022] Open
Abstract
Background Recent evidence suggests that HIV prevalence is generally higher among older than younger persons. However, few studies have explored issues regarding HIV testing and awareness of HIV status among older persons. We explored the correlates of HIV status awareness among older adults (aged 45+ years) in Uganda. Methods This paper is based on secondary analysis of existing data on persons aged between 45 and 59 years from a nationally representative Uganda AIDS Indicator Survey which was conducted between February and September 2011. Records on the socio-demographics and HIV/AIDS-specific indicators for 2472 persons were extracted for analysis. Individuals were considered to be aware of their HIV status if they reported that they had tested and received their HIV test results within the past 12 months. Data analyses were done using the sample survey procedures to take into account the sampling structure of the data. Odds ratios were used to quantify the associations between receipt of HIV test results and potential factors. Results Of the 2472 respondents, 48% had ever tested and received their HIV test results while 23% tested and received their HIV results in the past 12 months or already knew that they are HIV positive. Individuals with the following characteristics had higher odds of being aware of their HIV status: being female (adjusted Odds Ratio (AOR) = 1.26; 95% CI: (1.04, 1.53), having high comprehensive knowledge of HIV/AIDS (AOR = 1.28; 95% CI: 1.04, 1.58), having attended secondary school education (AOR = 2.10; 95% CI: 1.47, 2.99) and engagement in high risk sexual behaviors (AOR = 1.53; 95% CI: (1.11, 2.10). A high level of stigma (holding at least three stigmatizing attitudes toward people living with HIV) was negatively correlated with awareness of HIV status (AOR =0.60; 95% CI: (0.45, 0.78). Conclusion Less than a quarter of older Ugandans are aware of their current HIV status. High levels of stigma and low comprehensive knowledge of HIV/AIDS remained critical barriers to HIV testing and awareness of HIV status. These findings suggest a need for innovative HIV testing strategies to increase HIV status awareness among older adults in Uganda.
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Affiliation(s)
- Anne M Nabukenya
- MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph K B Matovu
- MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda. .,Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
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Moodley Y, Tomita A. Relationship between HIV serostatus, CD4 count and rehospitalisation: Potential implications for health systems strengthening in South Africa. S Afr J Infect Dis 2016; 32:23-28. [PMID: 28393071 PMCID: PMC5384337 DOI: 10.1080/22201181.2016.1201935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Despite three decades of scientific response to HIV/AIDS, the generalised HIV epidemic continues to persist in South Africa. There is growing acknowledgement that health system strengthening will be critical in tackling HIV/AIDS. Patient rehospitalisation is an important quality benchmark of health service delivery, but there is currently limited data on rehospitalisation of patients with HIV/AIDS in South Africa, a setting with a high burden of HIV disease. OBJECTIVES To determine the relationship between combined HIV serostatus and CD4 count, and rehospitalisation in South Africa. METHODS This study was a retrospective analysis of data from 11,362 non-surgical adult patients who attended the Hlabisa Hospital in South Africa. Data related to patient age, gender, HIV serostatus, CD4 count (for HIV-positive patients) and comorbidity were analysed through univariate (Fisher's Exact or χ2 tests) and multivariate (Cox regression) statistical methods to determine associations with rehospitalisation within 1 month (acute rehospitalisation) or 12 months (long term rehospitalisation). RESULTS An HIV-positive serostatus with CD4 count < 350 cells/mm3 or an HIV-positive serostatus with an unknown CD4 count were independently associated with a higher risk of acute (p = 0.010 and p = 0.003) and long term rehospitalisation (p < 0.001 for both categories) when compared with an HIV-negative serostatus group. CONCLUSIONS HIV-positive individuals with immune deficiency, or lacking a CD4 count measurement are at risk of rehospitalisation. Strengthening primary healthcare service delivery of these key affected inpatient populations should be a priority.
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Affiliation(s)
- Yoshan Moodley
- Discipline of Anaesthesiology and Critical Care Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa
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Ngo AD, Ha TH, Rule J, Dang CV. Peer-based education and the integration of HIV and Sexual and Reproductive Health services for young people in Vietnam: evidence from a project evaluation. PLoS One 2013; 8:e80951. [PMID: 24312253 PMCID: PMC3843003 DOI: 10.1371/journal.pone.0080951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/11/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This paper reports changes in behavioral outcomes related to the use of HIV testing service of a project that employed peer-based education strategies and integration of HIV voluntary counseling and testing (VCT) and Sexual and Reproductive Health (SRH) services targeting young people aged 15-24 across 5 provinces in Vietnam. METHODS A pre-test/post-test, non-experimental evaluation design was used. Data were collected from cross-sectional surveys of youth and client exit interviews at project supported SRH clinics conducted at baseline and again at 24 months following implementation. The baseline samples consisted of 813 youth and 399 exit clients. The end line samples included 501 youths and 399 exit clients. Z test was used to assess changes in behavioral outcomes. RESULTS Results show that there was a significant increase (p<0.05) in the percentage of youth who wanted to obtain a HIV test (from 33% to 51%), who had ever had a test (from 7.5% to 15%), and who had a repeat test in the last 12 months (from 54.5% to 67.5%). Exit client interviews found a nearly five-fold increase in the percentage of clients seeking HIV VCT in their current visit (5.0% vs. 24.5%) and almost two-fold increase in the percentage of those having their last test at a project supported clinic (9.3% vs. 17.8%). There were also positive changes in some aspects of youth HIV/AIDS knowledge, attitudes, and risk perceptions. CONCLUSIONS This study provides preliminary evidence regarding the benefits of the integration of HIV VCT-SRH services in terms of increased access to HIV services and testing in Vietnam. Benefits of peer-based education regarding increased HIV knowledge were also identified. Further investigations, including experimental studies with assessment of health outcomes and the uptake of HIV testing services, are required to better elucidate the effectiveness and challenges of this intervention model in Vietnam.
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Affiliation(s)
- Anh D. Ngo
- Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Center for Promotion of Advancement of Society (CPAS), Hanoi, Vietnam
- * E-mail:
| | | | - John Rule
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Chinh V. Dang
- Ho Chi Minh Institute of Hygiene and Public Health, Ho Chi Minh, Vietnam
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Mobile VCT: reaching men and young people in urban and rural South African pilot studies (NIMH Project Accept, HPTN 043). AIDS Behav 2013; 17:2946-53. [PMID: 23142856 DOI: 10.1007/s10461-012-0368-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mounting evidence exists that mobile voluntary counselling and testing (VCT) is able to extend coverage to new localities and populations. We describe two feasibility and acceptability pilot studies conducted in rural and urban South Africa in preparation for the larger NIMH Project Accept HIV prevention trial. A total of 1,015 individuals participated in the pilot studies. Participants in rural Vulindlela were younger (median 22 years) compared to urban Soweto (p < 0.001). Young people were more likely to be first time testers in both sites (p = 0.01 in Vulindlela, p < 0.001 in Soweto), with significantly more men likely to be first time testers than women (p = 0.01 in Vulindlela, p < 0.001 in Soweto). User satisfaction with mobile VCT was extremely high in both sites. Our study shows that providing mobile, high-quality and easy to access services in a high prevalence context is a feasible way to engage youth, men and more rural populations in HIV counselling and testing.
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Waters RC, Ostermann J, Reeves TD, Masnick MF, Thielman NM, Bartlett JA, Crump JA. A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa. J Acquir Immune Defic Syndr 2011; 56:443-52. [PMID: 21297484 PMCID: PMC3143215 DOI: 10.1097/qai.0b013e3182118f8c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines in sub-Saharan Africa on when HIV-seronegative persons should retest range from never to annually for lower-risk populations and from annually to every 3 months for high-risk populations. METHODS We designed a mathematical model to compare the cost-effectiveness of alternative HIV retesting frequencies. Cost of HIV counseling and testing, linkage to care, treatment costs, disease progression, and mortality, and HIV transmission are modeled for three hypothetical cohorts with posited annual HIV incidence of 0.8%, 1.3%, and 4.0%, respectively. The model compared costs, quality-adjusted life-years gained, and secondary infections averted from testing intervals ranging from 3 months to 30 years. Input parameters from sub-Saharan Africa were used and explored in sensitivity analyses. RESULTS Accounting for secondary infections averted, the most cost-effective testing frequency was every 7.5 years for 0.8% incidence, every 5 years for 1.3% incidence, and every 2 years for 4.0% incidence. Optimal testing strategies and their relative cost-effectiveness were most sensitive to assumptions about HIV counseling and testing and treatment costs, rates of CD4 decline, rates of HIV transmission, and whether tertiary infections averted were taken into account. CONCLUSIONS While higher risk populations merit more frequent HIV testing than low risk populations, regular retesting is beneficial even in low-risk populations. Our data demonstrate benefits of tailoring testing intervals to resource constraints and local HIV incidence rates.
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Affiliation(s)
- Richard C. Waters
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Jan Ostermann
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
| | - Travis D. Reeves
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Max F. Masnick
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
| | - Nathan M. Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - John A. Bartlett
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
| | - John A. Crump
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
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Bateganya M, Abdulwadud OA, Kiene SM. Home-based HIV voluntary counselling and testing (VCT) for improving uptake of HIV testing. Cochrane Database Syst Rev 2010; 2010:CD006493. [PMID: 20614446 PMCID: PMC6464814 DOI: 10.1002/14651858.cd006493.pub4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The low uptake of HIV voluntary counselling and testing (VCT) has hindered global attempts to prevent new HIV infections and has limited scale-up of HIV care and treatment. Globally, only 10% of HIV-infected individuals are aware of their HIV status. One approach to increase uptake is home-based HIV VCT, which may be effective in increasing the number of patients on treatment and preventing new infections. OBJECTIVES To establish the effect of home-based HIV VCT on uptake of HIV testing SEARCH STRATEGY We searched MEDLINE (February 2007), EMBASE (February 2007), CENTRAL (February 2007), AIDSearch (February 2007), LILACS, CINAHL and Sociofile. We also contacted relevant researchers. The original review search strategy was updated in 2008. SELECTION CRITERIA Randomised controlled trials comparing home-based HIV VCT with other testing models DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed methodological quality, and extracted data. We planned to conduct statistical analysis using the Review Manager software and calculate summary statistics (relative risks (RRs) with 95% confidence intervals (CI)) for primary outcomes. MAIN RESULTS Only one study from developing countries met the inclusion criteria and was included in the review. The study, a cluster randomised trial (10 clusters, n=849) compared VCT uptake between an optional location (including home-based) and a local clinic location in a population-based HIV survey. The study showed a higher uptake of VCT among participants in the optional-location group. Uptake was significantly greater in the optional-location group in those who were pre-test counselled only (RR=4.6; 95% CI 3.58 to 5.91); pretest counselled and tested (RR=4.6; 95% CI 3.51 to 5.92); and post-test counselled and received the test result (RR=4.8; 95% CI 3.62 to 6.21). This study, however, had significant methodological problems limiting further analysis and interpretation. AUTHORS' CONCLUSIONS Although home-based HIV VCT has the potential to enhance VCT uptake in developing countries, insufficient data exist to recommend large-scale implementation of home-based HIV testing. Further studies are needed to determine if home-based VCT is better than facility-based VCT in improving VCT uptake.
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Affiliation(s)
- Moses Bateganya
- University of WashingtonDepartment of Global Health901 Boren Avenue, Suite 1100SeattleWashingtonUSA98104‐3508
| | - Omar A Abdulwadud
- American International Health Alliance ‐ Twinning CenterPO Box 56ASEBE TEFERIEthiopia
| | - Susan M Kiene
- Brown UniversityThe Warren Alpert Medical School593 Eddy StreetPlain St. BuildingProvidenceUSARI 02903
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Srithanaviboonchai K, Celentano DD, Visaruratana S, Kawichai S, Wichajarn M, Genberg B, Chariyalertsak C, Kulich M, Chariyalertsak S. Awareness about antiretroviral treatment, intentions to use condoms, and decisions to have an HIV test among rural Northern Lowland Thai and ethnic minority young adults. Asia Pac J Public Health 2010; 22:212-8. [PMID: 20457650 DOI: 10.1177/1010539510362912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young adults aged 18 to 32 years were randomly selected from a household probability sample participating in Project Accept in the remote areas of Chiang Mai province in northern Thailand in 2005. Among 2989 respondents, 44.4% had never heard of antiretroviral treatment (ART). Lack of awareness of ART was independently associated with having had no formal education compared with some formal education and being an ethnic minority compared with being Thai. In all, 57% of the respondents who had ever heard of ART stated that if ART were easily available in their communities it would affect their intentions to be tested for HIV, whereas only 36% stated that this would affect their intentions to use condoms. Younger participants were less likely to intend to get an HIV test as compared with older individuals, and ethnic minorities were less likely to report that they would get an HIV test compared with Thai lowlanders. Single individuals and people who lived separately from their spouses were more likely to have the intention to use condoms if ART were available.
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Bateganya M, Abdulwadud OA, Kiene SM. WITHDRAWN: Home-based HIV voluntary counseling and testing in developing countries. Cochrane Database Syst Rev 2010:CD006493. [PMID: 20166084 DOI: 10.1002/14651858.cd006493.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The low uptake of HIV voluntary counseling and testing (VCT), an effective HIV prevention intervention, has hindered global attempts to prevent new HIV infections, as well as limiting the scale-up of HIV care and treatment for the estimated 38 million infected persons. According to UNAIDS, only 10% of HIV-infected individuals worldwide are aware of their HIV status. At this point in the HIV epidemic, a renewed focus has shifted to prevention, and with it, a focus on methods to increase the uptake of HIV VCT. This review discusses home-based HIV VCT delivery models, which, given the low uptake of facility-based testing models, may be an effective avenue to get more patients on treatment and prevent new infections. OBJECTIVES (1) To identify and critically appraise studies addressing the implementation of home-based HIV voluntary counseling and testing in developing countries. (2) To determine whether home-based HIV voluntary counseling and testing (HBVCT) is associated with improvement in HIV testing outcomes compared to facility-based models. SEARCH STRATEGY We searched online for published and unpublished studies in MEDLINE (February 2007), EMBASE (February 2007), CENTRAL (February 2007). We also searched databases listing conference proceedings and abstracts; AIDSearch (February 2007), The Cochrane Library (Issue 2, 2007), LILACS, CINAHL and Sociofile. We also contacted authors who have published on the subject of review. SELECTION CRITERIA We searched for randomized controlled trials (RCTs) and non-randomized trials (e.g., cohort, pre/post-intervention and other observational studies) comparing home-based HIV VCT against other testing models. DATA COLLECTION AND ANALYSIS We independently selected studies, assessed study quality and extracted data. We expressed findings as odds ratios (OR), and relative Risk (RR) together with their 95% confidence intervals (CI). MAIN RESULTS We identified one cluster-randomized trial and one pre/post-intervention (cohort) study, which were included in the review. An additional two ongoing RCTs were identified. All identified studies were conducted in developing countries. The two included studies comprised one cluster-randomized trial conducted in an urban area in Lusaka, Zambia and one pre/post-intervention (cohort) study, part of a rural community cohort in Southwestern Uganda. The two studies, while differing in methodology, found very high acceptability and uptake of VCT when testing and or results were offered at home, compared to the standard (facility-based testing and results). In the cluster-randomized trial (n=849), subjects randomized to an optional testing location (including home-based testing) were 4.6 times more likely to accept VCT than those in the facility arm (RR 4.6, 95% CI 3.6-6.2). Similarly, in the pre/post study (n=1868) offering participants the option of home delivery of results increased VCT uptake. In the intervention year (home delivery) participants were 5.23 times more likely to receive their results than during the year when results were available only at the facility. (OR 5.23 95% CI 4.02-6.8). AUTHORS' CONCLUSIONS Home-based testing and/or delivery of HIV test results at home, rather than in clinics, appears to lead to higher uptake in testing. However, given the limited extant literature and the limitations in the included existing studies, there is not sufficient evidence to recommend large-scale implementation of the home-based testing model.
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Affiliation(s)
- Moses Bateganya
- Department of Global Health, University of Washington, 901 Boren Avenue, Suite 1100, Seattle, Washington, USA, 98104-3508
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Mugore L, Engelsmann B, Ndoro T, Dabis F, Perez F. An assessment of the understanding of the offer of routine HIV testing among pregnant women in rural Zimbabwe. AIDS Care 2008; 20:660-6. [PMID: 18576167 DOI: 10.1080/09540120701687034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study is to assess the understanding of routine offer of HIV testing among women using antenatal care (ANC) services in a rural African district. A descriptive cross-sectional survey was conducted in Murewa district, Zimbabwe, among women consecutively enrolled during their first ANC visit in 10 health centres offering prevention of mother-to-child transmission (PMTCT) of HIV services including routine offer of HIV testing. Ninety-three (64%) of the 146 respondents had received some form of education on the importance of HIV testing before visiting the health centre on the day of their interview. Almost all respondents (n=139; 95%) felt that the information provided during the group education was sufficient to make a decision on whether or not they should have an HIV test. HIV testing uptake was high with 136 (93%) women being tested for HIV on the day of the interview. Of these, 128 (94%) were aware that they had been tested for HIV when interviewed before the time of receiving results. Fifty percent (n=67) of the women who accepted HIV testing directly after group education as part of their routine ANC blood tests were not aware, however, of the possibility of opting for individual pre-test counseling. The study found that in Zimbabwe, implementation of routine offer of HIV testing allowed women using ANC services to make an informed conscious decision to undertake an HIV test as part of the PMTCT package of services. There is a need to emphasize the availability of further individual pre-test counseling if necessary since a selected subgroup of women may still benefit from it.
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Affiliation(s)
- L Mugore
- Institute of Public Health, Epidemiology and Development (ISPED)-Zimbabwe, Harare, Zimbabwe
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Delva W, Wuillaume F, Vansteelandt S, Claeys P, Verstraelen H, Broeck DV, Temmerman M. HIV testing and sexually transmitted infection care among sexually active youth in the Balkans. AIDS Patient Care STDS 2008; 22:817-21. [PMID: 18847388 DOI: 10.1089/apc.2007.0237] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In light of the imminent threat of a growing HIV epidemic in east and southeast Europe, optimal accessibility of primary and secondary HIV preventative interventions, including HIV testing and sexually transmitted infection (STI) care, are fast becoming public health priorities. We surveyed 2150 high school students in Bosnia and Herzegovina, FYR of Macedonia, Serbia, and Montenegro to examine the uptake of HIV testing and associated predictors. Among sexually active youth (n = 651), 5.9% had already been tested for HIV. In marginal logistic regression, country of origin, type of high school, knowing a friend or relative with HIV, poor self-assessed health status, suspicion of having had an STI, and not having used a condom at first sex were independently associated with HIV testing. Fear of the diagnosis, fear of violation of confidentiality, and not knowing where to go for HIV testing were reported as barriers to HIV testing. Of sexually active adolescents who thought they might have contracted an STI, only 42% had subsequently visited a doctor or health facility. The main reasons for not doing so were spontaneous disappearance of the complaints, fear of the diagnosis and being ashamed of discussing the problem. In conclusion, the uptake of HIV testing among this population of sexually active, urban high school students was found to be low, although a higher prevalence of HIV testing history was observed among students showing evidence of risky sexual behavior. Practical and psychological factors seem to challenge the accessibility of facilities for HIV testing and STI care.
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Affiliation(s)
- Wim Delva
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Françoise Wuillaume
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics and Computer Science, Ghent University, Ghent, Belgium
| | - Patricia Claeys
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Hans Verstraelen
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Davy Vanden Broeck
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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Bwambale FM, Ssali SN, Byaruhanga S, Kalyango JN, Karamagi CA. Voluntary HIV counselling and testing among men in rural western Uganda: implications for HIV prevention. BMC Public Health 2008; 8:263. [PMID: 18664301 PMCID: PMC2529297 DOI: 10.1186/1471-2458-8-263] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 07/30/2008] [Indexed: 11/16/2022] Open
Abstract
Background Voluntary HIV counselling and testing (VCT) is one of the key strategies in the prevention and control of HIV/AIDS in Uganda. However, the utilization of VCT services particularly among men is low in Kasese district. We therefore conducted a study to determine the prevalence and factors associated with VCT use among men in Bukonzo West health sub-district, Kasese district. Methods A population-based cross-sectional study employing both quantitative and qualitative techniques of data collection was conducted between January and April 2005. Using cluster sampling, 780 men aged 18 years and above, residing in Bukonzo West health sub-district, were sampled from 38 randomly selected clusters. Data was collected on VCT use and independent variables. Focus group discussions (4) and key informant interviews (10) were also conducted. Binary logistic regression was performed to determine the predictors of VCT use among men. Results Overall VCT use among men was 23.3% (95% CI 17.2–29.4). Forty six percent (95% CI 40.8–51.2) had pre-test counselling and 25.9% (95%CI 19.9–31.9) had HIV testing. Of those who tested, 96% returned for post-test counselling and received HIV results. VCT use was higher among men aged 35 years and below (OR = 2.69, 95%CI 1.77–4.07), the non-subsistence farmers (OR = 2.37, 95%CI 2.37), the couple testing (OR = 2.37, 95%CI 1.02–8.83) and men with intention to disclose HIV test results to sexual partners (OR = 1.64, 95%CI 1.04–2.60). The major barriers to VCT use among men were poor utilization of VCT services due to poor access, stigma and confidentiality of services. Conclusion VCT use among men in Bukonzo West, Kasese district was low. In order to increase VCT use among men, the VCT programme needs to address HIV stigma and improve access and confidentiality of VCT services. Among the more promising interventions are the use of routine counselling and testing for HIV of patients seeking health care in health units, home based VCT programmes, and mainstreaming of HIV counselling and testing services in community development programmes.
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Affiliation(s)
- Francis M Bwambale
- Clinical Epidemiology Unit, Makerere University, POBox 7072, Kampala, Uganda.
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Jereni BH, Muula AS. Availability of supplies and motivations for accessing voluntary HIV counseling and testing services in Blantyre, Malawi. BMC Health Serv Res 2008; 8:17. [PMID: 18215263 PMCID: PMC2254383 DOI: 10.1186/1472-6963-8-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 01/23/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV counseling and testing is an important intervention in the prevention, control and management of the human immunodeficiency virus (HIV). Counseling and testing can be an entry point for prevention, care and support. Knowledge of the quality of services and motivations for testing by individuals is important for effective understanding of the testing environment. METHODS A cross sectional explorative study of clients accessing HIV voluntary counseling and testing (VCT) and counselors was conducted in 6 government health centers in Blantyre City, Malawi. We aimed to assess the availability of critical clinic supplies and identify the motivations of clients seeking counseling and testing services. We also aimed to identify the health professional cadres that were providing VCT in Blantyre city. RESULTS 102 VCT clients and 26 VCT counselors were interviewed. Among the VCT clients, 74% were < or =29 years, 58.8% were females and only 7% reported no formal education. 42.2% were single, 45.1% married, 8.8% widowed and 3.9% divorced or separated. The primary reasons for seeking HIV counseling and testing were: recent knowledge about HIV (31.4%), current illness (22.5%), self-assessment of own behavior as risky (15.5%), suspecting sexual partner's infidelity (13.7%) and seeking HIV confirmatory test (9.8%) and other reasons (6.9%). Of the 26 VCT counselors, 14 were lay volunteers, 7 health surveillance assistants and 5 nurses. All except one had been trained specifically for HIV counseling and testing. All 6 facilities were conducting rapid HIV testing with same day test results provided to clients. Most of the supplies were considered adequate for testing. CONCLUSION HIV counseling and testing facilities were available in Blantyre city in all the six public health facilities assessed. The majority of counseling and testing clients were motivated by perceptions of being at risk of HIV infection. In a country with 12% of individuals 15 to 49 years infected, there is need to encourage testing among population groups that may not perceive themselves to be at risk of infection.
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Bateganya MH, Abdulwadud OA, Kiene SM. Home-based HIV voluntary counseling and testing in developing countries. Cochrane Database Syst Rev 2007:CD006493. [PMID: 17943913 DOI: 10.1002/14651858.cd006493.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The low uptake of HIV voluntary counseling and testing (VCT), an effective HIV prevention intervention, has hindered global attempts to prevent new HIV infections, as well as limiting the scale-up of HIV care and treatment for the estimated 38 million infected persons. According to UNAIDS, only 10% of HIV-infected individuals worldwide are aware of their HIV status. At this point in the HIV epidemic, a renewed focus has shifted to prevention, and with it, a focus on methods to increase the uptake of HIV VCT. This review discusses home-based HIV VCT delivery models, which, given the low uptake of facility-based testing models, may be an effective avenue to get more patients on treatment and prevent new infections. OBJECTIVES (1) To identify and critically appraise studies addressing the implementation of home-based HIV voluntary counseling and testing in developing countries.(2) To determine whether home-based HIV voluntary counseling and testing (HBVCT) is associated with improvement in HIV testing outcomes compared to facility-based models. SEARCH STRATEGY We searched online for published and unpublished studies in MEDLINE (February 2007), EMBASE (February 2007), CENTRAL (February 2007). We also searched databases listing conference proceedings and abstracts; AIDSearch (February 2007), The Cochrane Library (Issue 2, 2007), LILACS, CINAHL and Sociofile. We also contacted authors who have published on the subject of review. SELECTION CRITERIA We searched for randomized controlled trials (RCTs) and non-randomized trials (e.g., cohort, pre/post-intervention and other observational studies) comparing home-based HIV VCT against other testing models. DATA COLLECTION AND ANALYSIS We independently selected studies, assessed study quality and extracted data. We expressed findings as odds ratios (OR), and relative Risk (RR) together with their 95% confidence intervals (CI). MAIN RESULTS We identified one cluster-randomized trial and one pre/post-intervention (cohort) study, which were included in the review. An additional two ongoing RCTs were identified. All identified studies were conducted in developing countries. The two included studies comprised one cluster-randomized trial conducted in an urban area in Lusaka, Zambia and one pre/post-intervention (cohort) study, part of a rural community cohort in Southwestern Uganda. The two studies, while differing in methodology, found very high acceptability and uptake of VCT when testing and or results were offered at home, compared to the standard (facility-based testing and results). In the cluster-randomized trial (n=849), subjects randomized to an optional testing location (including home-based testing) were 4.6 times more likely to accept VCT than those in the facility arm (RR 4.6, 95% CI 3.6-6.2). Similarly, in the pre/post study (n=1868) offering participants the option of home delivery of results increased VCT uptake. In the intervention year (home delivery) participants were 5.23 times more likely to receive their results than during the year when results were available only at the facility. (OR 5.23 95% CI 4.02-6.8). AUTHORS' CONCLUSIONS Home-based testing and/or delivery of HIV test results at home, rather than in clinics, appears to lead to higher uptake in testing. However, given the limited extant literature and the limitations in the included existing studies, there is not sufficient evidence to recommend large-scale implementation of the home-based testing model.
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Affiliation(s)
- M H Bateganya
- University of Medicine and Dentistry of New Jersey, Francois Xavier Bagnoud Ctr-Guyana Care and Treatment Network, 110 Duke and Barrack Street, Kingston, Georgetown, Guyana.
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Sahasrabuddhe VV, Vermund SH. The future of HIV prevention: control of sexually transmitted infections and circumcision interventions. Infect Dis Clin North Am 2007; 21:241-57, xi. [PMID: 17502238 PMCID: PMC2700301 DOI: 10.1016/j.idc.2007.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Prevention and control of sexually transmitted infections (STIs) has proven effective in reducing HIV infection when treatment is available promptly for symptomatic persons in conditions of an emerging epidemic. Biologically, it is assumed that reduced genital tract inflammation reduces infectiousness for HIV as well as reducing susceptibility in HIV-uninfected persons. Male circumcision has been demonstrated effective in reducing risk for HIV infection in three separate trials from South Africa, Kenya, and Uganda. Global expansion of STI treatment and male circumcision programs are vital tools for control of HIV infection; current evidence is reviewed and research priorities are presented.
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Affiliation(s)
- Vikrant V Sahasrabuddhe
- Department of Pediatrics, Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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