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Jansen van Vuuren CJ, Lewis L, Harkoo I, Dawood H, Mansoor LE. Experience with Contraceptive Dosage Forms and Interest in Novel PrEP Technologies in Women. AIDS Behav 2023; 27:3596-3602. [PMID: 37221330 PMCID: PMC10589132 DOI: 10.1007/s10461-023-04072-6] [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: 04/26/2023] [Indexed: 05/25/2023]
Abstract
New pre-exposure prophylaxis (PrEP) strategies tailored to the needs and expectations of individuals at risk of HIV acquisition are needed. In the CAPRISA 082 prospective cohort study in KwaZulu-Natal, South Africa, sexually active women aged 18 to 30 reported, through interviewer-administered questionnaires, on their prior contraceptive experience and interest in both approved and potential future PrEP dosage forms (oral PrEP, long-acting injectable PrEP, and PrEP implants) between March 2016 and February 2018. Univariable and multivariable Poisson regression models with robust standard errors were used to detect associations between women's prior and current contraceptive use and interest in PrEP options. Of 425 women enrolled, 381 (89.6%) had used at least one modern female contraceptive method previously, with injectable depot medroxyprogesterone acetate (DMPA) being used by 79.8% (n = 339). Women were more likely to show interest in a future PrEP implant if they were currently using (aRR 2.1, CI 1.43-3.07, p = 0.0001) or had ever used (aRR 1.65, CI 1.14-2.40, p = 0.0087) a contraceptive implant, and were more likely to choose an implant as their first choice method than the implant-naïve (current users aRR 3.2, CI 1.79-5.73, p < 0.0001; "ever" users aRR 2.12, CI 1.16-3.86, p = 0.0142). Women were more interested in injectable PrEP if they had used injectable contraceptives (current users aRR 1.24, CI 1.06-1.46, p = 0.0088; "ever" users aRR 1.72, CI 1.20-2.48, p = 0.0033); and were more interested in oral PrEP if they had ever used oral contraceptives (aRR 1.3, CI 1.06-1.59, p = 0.0114). This apparent relationship between women's contraceptive experience and their interest in novel forms of PrEP in an equivalent dosage form may play a future role in strengthening HIV prevention efforts in women at high risk of HIV acquisition.
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Affiliation(s)
- Claudia J Jansen van Vuuren
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ishana Harkoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Halima Dawood
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Leila E Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Mkopi A, Korte JE, Lesslie V, diNapoli M, Mutiso F, Mwajubwa S, Kassim I, Conserve DF, Juma O. Acceptability and uptake of oral HIV self-testing among rural community members in Tanzania: a pilot study. AIDS Care 2023:1-8. [PMID: 37245239 DOI: 10.1080/09540121.2023.2217376] [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: 12/17/2022] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
New strategies are needed to improve HIV testing rates in Tanzania, particularly among adult men. We sought to investigate if HIV oral self-testing would increase HIV testing uptake in Tanzanian rural community homes. The study design was a prospective community-randomized pilot study, in two matched villages with similar characteristics (intervention and control villages) Before data collection, we trained village health workers and research assistants for one week. We recruited male and female adults from 50 representative households in each of two villages in eastern Tanzania. We collected data at baseline and we followed-up the enrolled households after a one-month period. There was a high interest in testing for HIV, with all participants from both arms (100%; n = 259) reporting that they would like to test for HIV. After the one-month follow-up, overall, 66.1% (162/245) of study participants reported to have tested for HIV in both arms. In the intervention arm, 97.6% (124/127) reported that they tested for HIV versus in the control arm, 32.2% (38/118) tested for HIV, p-value < 0.001. In Tanzania, we found that availability of HIV self-testing was associated with an enormous increase in HIV testing uptake in a rural population.
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Affiliation(s)
| | | | | | | | - Fedelis Mutiso
- Medical University of South Carolina, Charleston SC, USA
| | | | - Irabi Kassim
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Donaldson F Conserve
- Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, Washington DC, USA
| | - Omar Juma
- Ifakara Health Institute, Dar es Salaam, Tanzania
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Jairoun AA, Al-Hemyari SS, Abdulla NM, Al Ani M, Habeb M, Shahwan M, Jaber AAS, El-Dahiyat F, Jairoun M. Knowledge about, acceptance of and willingness to use over-the-counter COVID-19 self-testing kits. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Objectives
Early investments in new diagnostic technologies that allow for rapid and decentralized testing were critical in reducing SARS-CoV-2’s detrimental health and economic effects. This study evaluates public knowledge about, acceptance of and willingness to use COVID-19 self-testing kits.
Methods
An online descriptive cross-sectional questionnaire was used in this study. The final study population included all contacted national and resident adults, age 18 and over, who were willing to engage in the study. The survey was divided according to participants’ demographic information and 11 questions assessed the respondents’ understanding of and willingness to use COVID-19 self-testing kits. The statistical analysis was carried out using SPSS version 24. Multivariate linear regression models were used to identify the factors influencing respondents’ knowledge of and attitudes toward the acceptability of self-testing kits for COVID-19 and their willingness to use these kits.
Key findings
A total of 876 respondents participated in the study and completed the whole questionnaire. The average knowledge score on the acceptability of and willingness to use self-testing kits for COVID-19 was 70.2%, with a 95% confidence interval (CI) [69.1%, 71.4%]. Participants who were postgraduate, female and vaccinated against COVID-19, as well as employees and older participants, were jointly highly associated with higher levels of knowledge about, acceptance of and willingness to use self-testing kits for COVID-19. Moreover, participants who had been infected with COVID-19, were vaccinated against COVID-19 or were female, employees, older, Western or Arabic were jointly highly associated with positive attitudes about the acceptability of and willingness to use self-testing kits for COVID-19.
Conclusions
The majority of the respondents have acceptable levels of knowledge about, acceptance of and willingness to use self-testing kits for COVID-19. Nonetheless, future studies should consider the issues of pre- and post-test counselling, false negative results and the sale of unregulated testing kits. Additional information should be communicated so that people can make informed decisions and be protected from possible abuse of COVID-19 self-testing kits when they become available in pharmacies.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- Health and Safety Department, Dubai Municipality , Dubai , UAE
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM) , Pulau Pinang , Malaysia
| | - Sabaa Saleh Al-Hemyari
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM) , Pulau Pinang , Malaysia
- Pharmacy Department, Emirates Health Services , Dubai , UAE
| | - Naseem Mohammed Abdulla
- Health and Safety Department, Dubai Municipality , Dubai , UAE
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University (HBMSU) , Dubai , UAE
- Department of Environmental Health Sciences, Canadian University Dubai , Dubai , UAE
| | - Mena Al Ani
- Developmental Biology & Cancer Department, University College London, UCL Great Ormond Street Institute of Child Health , London , UK
| | - Mustafa Habeb
- Edgware Community Hospital Barnet, Enfield and Haringey Mental Health NHS Trust , London , UK
| | - Moyad Shahwan
- College of Pharmacy and Health Science, Ajman University , Ajman , UAE
- Center of Medical and Bio-allied Health Sciences Research, Ajman University , Ajman , UAE
| | - Ammar Ali Saleh Jaber
- Department of Clinical Pharmacy & Pharmacotherapeutics, Dubai Pharmacy College for Girls , Al Muhaisanah 1, Al mizhar Dubai , UAE
| | - Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University , Al Ain , UAE
- AAU Health and Biomedical Research Center, Al Ain University , Abu Dhabi , UAE
| | - Maimona Jairoun
- College of Pharmacy and Health Science, Ajman University , Ajman , UAE
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Medina‐Marino A, Bezuidenhout D, Ngwepe P, Bezuidenhout C, Facente SN, Mabandla S, Hosek S, Little F, Celum CL, Bekker L. Acceptability and feasibility of leveraging community-based HIV counselling and testing platforms for same-day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa. J Int AIDS Soc 2022; 25:e25968. [PMID: 35872602 PMCID: PMC9309460 DOI: 10.1002/jia2.25968] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/06/2022] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Community-based delivery of HIV pre-exposure prophylaxis (PrEP) to South African adolescent girls and young women's (AGYW) could increase access but needs evaluation. We integrated PrEP services via home-based services and pop-up tents into existing community-based HIV testing services (CB-HTS) in Eastern Cape Province, South Africa. METHODS After accessing CB-HTS via a "pop-up" tent or home-based services, HIV-negative AGYW aged 16-25 years were invited to complete a baseline questionnaire and referred for PrEP services at a community-based PrEP site co-located with pop-up HTS tents. A 30-day supply of PrEP was dispensed. PrEP uptake, time-to-initiation, cohort characteristics and first medication refill within 90 days were measured using descriptive statistics. RESULTS Of the 1164 AGYW who tested for HIV, 825 (74.3%) completed a questionnaire and 806 (97.7%) were referred for community-based PrEP. Of those, 624 (77.4%) presented for PrEP (482/483 [99.8%] from pop-up HTS and 142/323 [44.0%] from home-based HTS), of which 603 (96.6%) initiated PrEP. Of those initiating PrEP following home-based HTS, 59.1% initiated within 0-3 days, 25.6% within 4-14 days and 15.3% took ≥15 days to initiate; 100% of AGYW who used pop-up HTS initiated PrEP the same day. Among AGWY initiating PrEP, 37.5% had a detectable sexually transmitted infection (STI). Although AGYW reported a low self-perception of HIV risk, post-hoc application of HIV risk assessment measures to available data classified most study participants as high risk for HIV acquisition. Cumulatively, 329 (54.6%) AGYW presented for a first medication refill within 90 days of accepting their first bottle of PrEP. CONCLUSIONS Leveraging CB-HTS platforms to provide same-day PrEP initiation and refill services was acceptable to AGYW. A higher proportion of AGYW initiated PrEP when co-located with CB-HTS sites compared to those referred following home-based HTS, suggesting that proximity of CB-HTS and PrEP services facilitates PrEP uptake among AGYW. The high prevalence of STIs among those initiating PrEP necessitates the integration of STI and HIV prevention programs for AGYW. Eligibility for PrEP initiation should not be required among AHYW in high HIV burden communities. Community-based service delivery will be crucial to maintaining access to PrEP services during the COVID-19 pandemic and future health and humanitarian emergencies.
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Affiliation(s)
- Andrew Medina‐Marino
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- Research UnitFoundation for Professional Development, Buffalo City MetroEastern Cape ProvinceSouth Africa
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dana Bezuidenhout
- Research UnitFoundation for Professional Development, Buffalo City MetroEastern Cape ProvinceSouth Africa
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
| | - Phuti Ngwepe
- Research UnitFoundation for Professional Development, Buffalo City MetroEastern Cape ProvinceSouth Africa
- Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
| | - Charl Bezuidenhout
- Research UnitFoundation for Professional Development, Buffalo City MetroEastern Cape ProvinceSouth Africa
- School of Public HealthBoston UniversityBostonMassachusettsUSA
| | | | - Selly Mabandla
- HIV/AIDSSTIs and TB ProgramBuffalo City Metro Health DistrictEastern Cape Province Department of HealthBhishoSouth Africa
| | - Sybil Hosek
- Departments of Psychiatry and Infectious DiseaseStroger Hospital of Cook CountyChicagoIllinoisUSA
| | - Francesca Little
- Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
| | - Connie L. Celum
- Department of Global Health, Medicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
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Mason S, Ezechi OC, Obiezu-Umeh C, Nwaozuru U, BeLue R, Airhihenbuwa C, Gbaja-Biamila T, Oladele D, Musa AZ, Modi K, Parker J, Uzoaru F, Engelhart A, Tucker J, Iwelunmor J. Understanding factors that promote uptake of HIV self-testing among young people in Nigeria: Framing youth narratives using the PEN-3 cultural model. PLoS One 2022; 17:e0268945. [PMID: 35657809 PMCID: PMC9165856 DOI: 10.1371/journal.pone.0268945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
It is important to understand how to frame the formats for promoting HIV self-testing to increase uptake among young people. In this study, we used a culture-centered model to understand the narratives of HIV self-testing preferences among young people in Nigeria. We conducted a crowdsourcing contest to solicit ideas surrounding HIV self-testing promotion among young people (10–24 years) in Nigeria from October to November 2018 as part of the 2018 World AIDS Day event. We received 903 submissions and employed thematic content analysis to evaluate 769 eligible youth narratives. Thematic content analysis of the statements from the youth narratives was guided by the PEN-3 cultural model to examine the positive, existential, and negative perceptions (beliefs and values), enablers (resources), and nurturers (roles of friends and family) of HIV self-testing promotion among young people in Nigeria. Several themes emerged as factors that influence the uptake of HIV self-testing among young people in Nigeria. Specifically, seven themes emerged as perceptions: HIV testing accessibility, stigma reduction, and autonomy (positive); HIV self-testing kit packaging and advertisements (existential); lack of knowledge and increased stigma (negative). Seven themes emerged as enablers: social media, school, and government promotion (positive); gamification and animation (existential); high cost and access to linkage to care services (negative); And seven themes emerged as nurturers: peer, families, and faith-based communities (positive); parents and family-centered approach (existential); and partners and family (negative). Our data suggests that increased awareness around HIV self-testing on current youth-friendly platforms, de-stigmatization of HIV and HIV self-testing, decreased prices for HIV self-testing kits, reliability of testing kits, increased linkage to care services, and promotion of self-testing among family members and the community will be beneficial for HIV self-testing scale-up measures among young people in Nigeria.
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Affiliation(s)
- Stacey Mason
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
- * E-mail:
| | - Oliver C. Ezechi
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Rhonda BeLue
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Collins Airhihenbuwa
- Global Research Against Noncommunicable Diseases (GRAND), Georgia State University, School of Public Health, Atlanta, Georgia, United States of America
| | - Titilola Gbaja-Biamila
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - David Oladele
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Adesola Z. Musa
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, Lagos, Nigeria
| | - Karan Modi
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Jessica Parker
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Florida Uzoaru
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Alexis Engelhart
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Joseph Tucker
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
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Watson-Grant S, Reynolds Z, Lee D, Mufeti J, Mungunda H, Mswia R. Where are the men in HIV testing and prevention in Namibia? J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Medina-Marino A, Bezuidenhout D, Hosek S, Barnabas RV, Atujuna M, Bezuidenhout C, Ngwepe P, Peters RPH, Little F, Celum CL, Daniels J, Bekker LG. The Community PrEP Study: a randomized control trial leveraging community-based platforms to improve access and adherence to pre-exposure prophylaxis to prevent HIV among adolescent girls and young women in South Africa-study protocol. Trials 2021; 22:489. [PMID: 34311754 PMCID: PMC8314507 DOI: 10.1186/s13063-021-05402-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND HIV incidence among South African adolescent girls and young women (AGYW) remains high, but could be reduced by highly effective pre-exposure prophylaxis (PrEP). Unfortunately, AGYW report significant barriers to clinic-based sexual and reproductive health services. Even when AGYW access PrEP as an HIV prevention method, poor prevention-effective use was a serious barrier to achieving its optimal HIV prevention benefits. Determining the acceptability and feasibility of community-based platforms to increase AGYW's access to PrEP, and evaluating behavioural interventions to improve prevention-effective use of PrEP are needed. METHODS We propose a mixed-methods study among AGYW aged 16-25 years in Eastern Cape Province, South Africa. In the first component, a cross-sectional study will assess the acceptability and feasibility of leveraging community-based HIV counselling and testing (CBCT) platforms to refer HIV-negative, at-risk AGYW to non-clinic-based, same-day PrEP initiation services. In the second component, we will enrol 480 AGYW initiating PrEP via our CBCT platforms into a three-armed (1:1:1) randomized control trial (RCT) that will evaluate the effectiveness of adherence support interventions to improve the prevention-effective use of PrEP. Adherence will be measured over 24 months via tenofovir-diphosphate blood concentration levels. Qualitative investigations will explore participant, staff, and community experiences associated with community-based PrEP services, adherence support activities, study implementation, and community awareness. Costs and scalability of service platforms and interventions will be evaluated. DISCUSSION This will be the first study to assess the acceptability and feasibility of leveraging CBCT platforms to identify and refer at-risk AGYW to community-based, same-day PrEP initiation services. It will also provide quantitative and qualitative results to inform adherence support activities and services that promote the prevention-effective use of PrEP among AGYW. By applying principles of implementation science, behavioural science, and health economics research, we aim to inform strategies to improve access to and prevention-effective use of PrEP by AGYW. TRIAL REGISTRATION ClinicalTrials.gov NCT03977181 . Registered on 6 June 2019-retrospectively registered.
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Affiliation(s)
- Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa.
- The Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dana Bezuidenhout
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Sybil Hosek
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Millicent Atujuna
- The Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Phuti Ngwepe
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, 10 Rochester Rd, Vincent, East London, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Connie L Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Joseph Daniels
- Department of Psychiatry and Human Behaviors, Charles R. Drew University of Medicine and Science, Los Angeles, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
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Giguère K, Eaton JW, Marsh K, Johnson LF, Johnson CC, Ehui E, Jahn A, Wanyeki I, Mbofana F, Bakiono F, Mahy M, Maheu-Giroux M. Trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa, 2000-20: a modelling study using survey and HIV testing programme data. Lancet HIV 2021; 8:e284-e293. [PMID: 33667411 PMCID: PMC8097636 DOI: 10.1016/s2352-3018(20)30315-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Monitoring knowledge of HIV status among people living with HIV is essential for an effective national HIV response. This study estimates progress and gaps in reaching the UNAIDS 2020 target of 90% knowledge of status, and the efficiency of HIV testing services in sub-Saharan Africa, where two thirds of all people living with HIV reside. METHODS For this modelling study, we used data from 183 population-based surveys (including more than 2·7 million participants) and national HIV testing programme reports (315 country-years) from 40 countries in sub-Saharan Africa as inputs into a mathematical model to examine trends in knowledge of status among people living with HIV, median time from HIV infection to diagnosis, HIV testing positivity, and proportion of new diagnoses among all positive tests, adjusting for retesting. We included data from 2000 to 2019, and projected results to 2020. FINDINGS Across sub-Saharan Africa, knowledge of status steadily increased from 5·7% (95% credible interval [CrI] 4·6-7·0) in 2000 to 84% (82-86) in 2020. 12 countries and one region, southern Africa, reached the 90% target. In 2020, knowledge of status was lower among men (79%, 95% CrI 76-81) than women (87%, 85-89) across sub-Saharan Africa. People living with HIV aged 15-24 years were the least likely to know their status (65%, 62-69), but the largest gap in terms of absolute numbers was among men aged 35-49 years, with 701 000 (95% CrI 611 000-788 000) remaining undiagnosed. As knowledge of status increased from 2000 to 2020, the median time to diagnosis decreased from 9·6 years (9·1-10) to 2·6 years (1·8-3·5), HIV testing positivity declined from 9·0% (7·7-10) to 2·8% (2·1-3·9), and the proportion of first-time diagnoses among all positive tests dropped from 89% (77-96) to 42% (30-55). INTERPRETATION On the path towards the next UNAIDS target of 95% diagnostic coverage by 2025, and in a context of declining positivity and yield of first-time diagnoses, disparities in knowledge of status must be addressed. Increasing knowledge of status and treatment coverage among older men could be crucial to reducing HIV incidence among women in sub-Saharan Africa, and by extension, reducing mother-to-child transmission. FUNDING Steinberg Fund for Interdisciplinary Global Health Research (McGill University); Canadian Institutes of Health Research; Bill & Melinda Gates Foundation; Fonds the recherche du Québec-Santé; UNAIDS; UK Medical Research Council; MRC Centre for Global Infectious Disease Analysis; UK Foreign, Commonwealth & Development Office.
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Affiliation(s)
- Katia Giguère
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada
| | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Kimberly Marsh
- Strategic Information Department, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Cheryl C Johnson
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Eboi Ehui
- Programme National de Lutte contre le Sida, Abidjan, Côte d'Ivoire
| | - Andreas Jahn
- Department for HIV and AIDS, Ministry of Health and Population, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi and I-TECH, Department of Global Health, University of Washington, Seattle, USA
| | - Ian Wanyeki
- Strategic Information Department, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | | | - Fidèle Bakiono
- Conseil National de Lutte contre le Sida et les Infections Sexuellement Transmissibles (CNLS-IST), Ouagadougou, Burkina Faso
| | - Mary Mahy
- Strategic Information Department, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada.
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9
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Medina‐Marino A, Daniels J, Bezuidenhout D, Peters R, Farirai T, Slabbert J, Guloba G, Johnson S, Bekker L, Nkhwashu N. Outcomes from a multimodal, at-scale community-based HIV counselling and testing programme in twelve high HIV burden districts in South Africa. J Int AIDS Soc 2021; 24:e25678. [PMID: 33709542 PMCID: PMC7952633 DOI: 10.1002/jia2.25678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/23/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Facility-based HIV testing services (HTS) have been less acceptable and accessible by adolescents, men and key populations in South Africa. Community-based HIV counselling and testing (CBCT) modalities, including mobile unit and home-based testing, have been proposed to decrease barriers to HIV testing uptake. CBCT modalities and approaches may be differentially acceptable to men and women based on age. Implementation of multimodal CBCT services may improve HIV testing rates among adolescents and men, and support the roll-out of prevention services. METHODS A cross-sectional analysis was conducted using aggregate, routine programmatic data collected from 1 October 2015 through 31 March 2017 from a multimodal, at-scale CBCT programme implemented in 12 high-burden districts throughout South Africa. Data collection tools were aligned to reporting standards for the National Department of Health and donor requirements. HIV testing rates (i.e. number of tests performed per 100,000 population using South African census data) and testing proportions by modality were stratified by sex, age groups and heath districts. Descriptive statistics were performed using STATA 13.0. RESULTS Overall, 944,487 tests were performed during the 1.5-year testing period reported. More tests were conducted among females than males (53.6% vs. 46.4%). Overall, 8206 tests per 100,000 population (95% CI: 8190.2 to 8221.9) were performed; female-to-male (F:M) testing ratio was 1.11. Testing rates were highest among young women age 20 to 24 years (16,328.4; 95% CI: 16,237.9 to 16,419.1) and adolescent girls aged 15 to 19 years (12,817.0; 95% CI: 12,727.9 to 12,906.6). Home-based testing accounted for 61.3% of HIV tests, followed by near-home mobile unit testing (30.2%) and workplace mobile unit testing (4.7%). More women received HTS via home-based testing (F:M ratio = 1.29), whereas more men accessed work-place mobile testing (M:F ratio = 1.35). No sex differential was observed among those accessing near-home mobile testing (F:M ratio = 0.98). CONCLUSIONS Concurrent implementation of multiple, targeted CBCT modalities can reduce sex disparities in HIV testing in South Africa. Given the acceptability and accessibility of these CBCT services to adolescent girls and young women, evident from their high testing rates, leveraging community-based services delivery platforms to increase access to HIV prevention services, including pre-exposure prophylaxis (PrEP), should be considered.
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Affiliation(s)
- Andrew Medina‐Marino
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
| | - Joseph Daniels
- Department of Psychiatry and Human BehaviorsCharles R. Drew University of Medicine and ScienceLos AngelesCAUSA
| | - Dana Bezuidenhout
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
| | - Remco Peters
- Research UnitFoundation for Professional DevelopmentEast LondonSouth Africa
| | - Thato Farirai
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Jean Slabbert
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Geoffrey Guloba
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Suzanne Johnson
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
| | - Linda‐Gail Bekker
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | - Nkhensani Nkhwashu
- Community‐based HIV Counselling and Testing ProgramFoundation for Professional DevelopmentPretoriaSouth Africa
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10
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Ostermann J, Njau B, Hobbie A, Mtuy T, Masaki ML, Shayo A, van Zwetselaar M, Masnick M, Flaherty B, Brown DS, Mühlbacher AC, Thielman NM. Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations. BMJ Open 2020; 10:e039313. [PMID: 33158826 PMCID: PMC7651730 DOI: 10.1136/bmjopen-2020-039313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Approximately one million undiagnosed persons living with HIV in Southern and Eastern Africa need to test for HIV. Novel approaches are necessary to identify HIV testing options that match the heterogeneous testing preferences of high-risk populations. This pragmatic randomised controlled trial (PRCT) will evaluate the efficacy of a preference-informed, heterogeneity-focused HIV counselling and testing (HCT) offer, for improving rates of HIV testing in two high-risk populations. METHODS AND ANALYSIS The study will be conducted in Moshi, Tanzania. The PRCT will randomise 600 female barworkers and 600 male Kilimanjaro mountain porters across three study arms. All participants will receive an HIV testing offer comprised of four preference-informed testing options, including one 'common' option-comprising features that are commonly available in the area and, on average, most preferred among study participants-and three options that are specific to the study arm. Options will be identified using mixed logit and latent class analyses of data from a discrete choice experiment (DCE). Participants in Arm 1 will be offered the common option and three 'targeted' options that are predicted to be more preferred than the common option and combine features widely available in the study area. Participants in Arm 2 will be offered the common option and three 'enhanced' options, which also include HCT features that are not yet widely available in the study area. Participants in Arm 3, an active control arm, will be offered the common option and three predicted 'less preferred' options. The primary outcome will be uptake of HIV testing. ETHICS AND DISSEMINATION Ethical approval was obtained from the Duke University Health System IRB, the University of South Carolina IRB, the Ethics Review Committee at Kilimanjaro Christian Medical University College, Tanzania's National Institute for Medical Research, and the Tanzania Food & Drugs Authority (now Tanzania Medicines & Medical Devices Authority). Findings will be published in peer-reviewed journals. The use of rigorous DCE methods for the preference-based design and tailoring of interventions could lead to novel policy options and implementation science approaches. TRIAL REGISTRATION NUMBER NCT02714140.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Carolina, South Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy & Inequalities Research, Duke University, Durham, North Carolina, USA
| | - Bernard Njau
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Amy Hobbie
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy & Inequalities Research, Duke University, Durham, North Carolina, USA
| | - Tara Mtuy
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Aisa Shayo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Max Masnick
- Selway Labs, LLC, Barrington, Rhode Island, USA
| | - Brian Flaherty
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Axel C Mühlbacher
- Center for Health Policy & Inequalities Research, Duke University, Durham, North Carolina, USA
- Institut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Health Policy & Inequalities Research, Duke University, Durham, North Carolina, USA
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11
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Mlughu TS, Anaeli A, Joseph R, Sirili N. Voluntary HIV Counseling and Testing Among Commercial Motorcyclist Youths: An Exploration of Ethical Challenges and Coping Mechanisms in Dar es Salaam. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:675-685. [PMID: 33177884 PMCID: PMC7650004 DOI: 10.2147/hiv.s259997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022]
Abstract
Background Regardless, the known benefits of voluntary testing and counseling (VCT) in the fight against HIV/AIDS, its uptake is still low among youth. This study explored ethical challenges facing voluntary counseling and testing for HIV/AIDS among youth engaged in commercial motorcycling in Kinondoni municipality, Dar es Salaam city. Methods Qualitative exploratory study was carried out to 35 people using key informants’ interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). Key informants were purposefully selected based on their roles in VCT services, while the FGD participants and in-depth interview respondents were purposefully selected among youth commercial motorcyclists. Qualitative content data analysis was used to analyze the gathered information. Findings Results of this study show that lack of privacy during counseling and treatment, fear of HIV status disclosure to others by counselors and difficulties in counseling are the main ethical challenges facing VCT services among youth in Kinondoni municipality. Shortage of counselors to match the number of VCT services’ clients and lack of on-job training on HIV/AIDS testing and counseling among counselors partly contributed to the revealed ethical challenges. In an attempt to address the ethical challenges, youth peer educators and routine supervision were the available initiatives on improving VCT services among youth. Conclusion VCT services face ethical challenges which are either health facility-based, community-based or are at the national level. Addressing the ethical challenges is necessary in order to improve the uptake of VCT services and thus strengthen the fight against HIV/AIDS. Deployment of enough counselors, refresher training to counselors, and raising community awareness on HIV/AIDS and the negative impacts of stigma are among the initial strategies for remedying the situation.
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Affiliation(s)
- Thadei S Mlughu
- Department of Bioethics and Health Professionalism, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amani Anaeli
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Renatha Joseph
- Department of Bioethics and Health Professionalism, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nathanael Sirili
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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12
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Ondoa P, Ndlovu N, Keita MS, Massinga-Loembe M, Kebede Y, Odhiambo C, Mekonen T, Ashenafi A, Kebede A, Nkengasong J. Preparing national tiered laboratory systems and networks to advance diagnostics in Africa and meet the continent's health agenda: Insights into priority areas for improvement. Afr J Lab Med 2020; 9:1103. [PMID: 33102173 PMCID: PMC7565058 DOI: 10.4102/ajlm.v9i2.1103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/29/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Amsterdam Institute for Global Health and Development, Academic Medical Centre, Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
| | - Nqobile Ndlovu
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Mah-Sere Keita
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | | | - Yenew Kebede
- Africa Centres for Disease, Control and Prevention, Addis Ababa, Ethiopia
| | | | - Teferi Mekonen
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Aytenew Ashenafi
- Africa Centres for Disease, Control and Prevention, Addis Ababa, Ethiopia
| | - Amha Kebede
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - John Nkengasong
- Africa Centres for Disease, Control and Prevention, Addis Ababa, Ethiopia
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13
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Choko AT, Roshandel G, Conserve DF, Corbett EL, Fielding K, Hemming K, Malekzadeh R, Weijer C. Ethical issues in cluster randomized trials conducted in low- and middle-income countries: an analysis of two case studies. Trials 2020; 21:314. [PMID: 32295604 PMCID: PMC7161096 DOI: 10.1186/s13063-020-04269-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cluster randomized trials are common in health research in low- and middle-income countries raising issues that challenge interpretation of standard ethical guidelines. While the Ottawa Statement on the ethical design and conduct of cluster randomized trials provides guidance for researchers and research ethics committees, it does not explicitly focus on low- and middle-income settings. MAIN BODY In this paper, we use the lens of the Ottawa Statement to analyze two cluster randomized trials conducted in low- and middle-income settings in order to identify gaps or ethical issues requiring further analysis and guidance. The PolyIran trial was a parallel-arm, cluster trial examining the effectiveness of a polypill for prevention of cardiovascular disease in Golestan province, Iran. The PASTAL trial was an adaptive, multistage, parallel-arm, cluster trial evaluating the effect of incentives for human immunodeficiency virus self-testing and follow-up on male partners of pregnant women in Malawi. Through an in-depth case analysis of these two studies we highlight several issues in need of further exploration. First, standards for verbal consent and waivers of consent require methods for operationalization if they are to be employed consistently. Second, the appropriate choice of a control arm remains contentious. Particularly in the case of implementation interventions, locally available care is required as the comparator to address questions of comparative effectiveness. However, locally available care might be lower than standards set out in national guidelines. Third, while the need for access to effective interventions post-trial is widely recognized, it is often not possible to guarantee this upfront. Clarity on what is required of researchers and sponsors is needed. Fourth, there is a pressing need for ethics education and capacity building regarding cluster randomized trials in these settings. CONCLUSION We identify four issues in cluster randomized trials conducted in low- and middle-income countries for which further ethical analysis and guidance is required.
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Affiliation(s)
- Augustine T Choko
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Donaldson F Conserve
- Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, USA
| | - Elizabeth L Corbett
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Charles Weijer
- Rotman Institute of Philosophy, Western University, London, Canada.
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14
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Cheruiyot C, Magu D, Mburugu P, Sagwe D. Uptake and utilization of institutional voluntary HIV testing and counseling services among students aged 18-24 in Kenya's public Universities. Afr Health Sci 2019; 19:3190-3199. [PMID: 32127896 PMCID: PMC7040318 DOI: 10.4314/ahs.v19i4.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Kenya is home to an estimated 1.7 million people living with HIV/AIDS. According to the Kenya AIDS Indicator survey KAIS 2012, HIV prevalence in the age group 15-24 stood at 2.2%. Globally, young people aged 15-24 are a highly vulnerable population with respect to HIV/AIDS infection and transmission. HIV testing and counseling services play a critical role as an entry point to care and treatment. However, uptake of HIV testing and counseling services among the youth in Kenya has been reportedly low. Youths at Universities are among the priority populations in HIV/AIDS programs. OBJECTIVES This study aimed to determine the barriers to uptake and utilization of institution-based voluntary counseling and testing VCT services among students aged 18-24 in selected public universities in Kenya. The specific objectives were to determine the factors associated with uptake and utilization and the association between various socio-demographic factors and service uptake in institutional VCT facilities. METHODS This research utilized a descriptive cross-sectional study design where primarily, data was collected using semi-structured questionnaires and through focus group discussions held with the students in the sampled Universities. Data available at Jomo Kenyatta University of Agriculture and Technology JKUAT Hospital VCT were reviewed for the period 2010 and 2016 to give an insight into service utilization rates among students. Multi-stage sampling technique was utilized to reach a student sample size of 305 from the selected public Universities in Kenya. RESULTS Uptake of institutional VCT services among University students sampled stood at 45% from a population where 84.4% were aware of the presence of these services on their campuses. More males than females utilized the services. Emerging themes from the study indicated that participants utilized the services for different reasons. Accessibility to test site, testing hours, fear to be seen at site and fear of test result were also identified as factors affecting service uptake. These factors also were also reported when students were asked about their desired characteristics of a VCT facility on campus. CONCLUSION This study has unraveled the factors that are associated with testing and counseling in institutional facilities. University students seem to seek and utilize VCT services for different reasons. It is also clear that patterns of services utilization vary from group to another as observed in the case of year of study, gender and age category. RECOMMENDATIONS It is necessary for policy makers in institutions of higher learning together with those tasked with managing healthcare services in these institutions to adopt approaches that will overcome the barriers to utilization of VCT services among students. With knowledge of the factors associated with uptake and utilization of VCT services in institutional facilities, efforts to tackle the barriers and maximize on enhancers should be utilized fully in order to improve uptake and utilization of services. More research should also focus on the persisting risky sexual behaviors among University students despite the high knowledge they have on HIV/AIDS.
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Affiliation(s)
- Caliph Cheruiyot
- Jomo Kenyatta University of Agriculture and Technology, Environmental health and Disease control
| | - Dennis Magu
- Jomo Kenyatta University of Agriculture and Technology, Environmental health and Disease control
| | - Patrick Mburugu
- Jomo Kenyatta University of Agriculture and Technology, Paediatrics and Child Health
| | - Daniel Sagwe
- Jomo Kenyatta University of Agriculture and Technology, Rehabilitative Sciences
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15
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He X, Feng X, Liu P, Lyu Y, Lu H, Ma Y, Liang S, Liu F, Jiang Y. An innovative vending machine-based HIV testing and intervention service in China: anonymous urine collection kits distributed at universities. AIDS Care 2019; 31:1319-1322. [PMID: 31088155 DOI: 10.1080/09540121.2019.1612012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To find more effective test and intervention measures, and to achieve the first 90 of the 90-90-90 target, this study was conducted for the first time to develop and assess an innovative HIV anonymous urine test service-based vending machine and Internet at universities of China. From June to December 2016, 11 vending machines were placed in 7 pilot universities in Beijing, Sichuan, Yunnan and Heilongjiang provinces. A total of 957 HIV urine collection kits were dispensed free and also through vending machines and 378 (39.5%) urine samples were returned and 376 (99.5%) of them were qualified to be tested for HIV antibody in professional laboratories. Participants searched for confidential test results using an ID code online. Only seven (1.86%) urine samples were positive. Monitoring data showed 67.8% (255/376) participants searched for test results online, 72.2% of kits were purchased in dormitory buildings and 27.8% were purchased in teaching buildings and 88.9% were purchased between 21:00 and 24:00. In conclusion, this study analyzes the acceptability, feasibility and effectiveness of HIV testing and intervention service.
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Affiliation(s)
- Xiaoxia He
- a National HIV/HCV Reference Laboratory, National Center for AIDS/STD Control and Prevention, China CDC , Beijing , People's Republic of China
| | - Xia Feng
- b Department of Clinical Laboratory, Beijing Youan Hospital, Capital Medical University , Beijing , People's Republic of China
| | - Peng Liu
- c China Association of STD & AIDS Prevention , Beijing , People's Republic of China
| | - Yi Lyu
- a National HIV/HCV Reference Laboratory, National Center for AIDS/STD Control and Prevention, China CDC , Beijing , People's Republic of China
| | - Hongyan Lu
- d Beijing Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Yanling Ma
- e Yunnan Center for Disease Control and Prevention , Kunming , People's Republic of China
| | - Shu Liang
- f Sichuan Center for Disease Control and Prevention , Chengdu , People's Republic of China
| | - Fei Liu
- g Heilongjiang Center for Disease Control and Prevention , Harbin , People's Republic of China
| | - Yan Jiang
- a National HIV/HCV Reference Laboratory, National Center for AIDS/STD Control and Prevention, China CDC , Beijing , People's Republic of China
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16
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Devillé W, Tempelman H. Feasibility and robustness of an oral HIV self-test in a rural community in South-Africa: An observational diagnostic study. PLoS One 2019; 14:e0215353. [PMID: 30986228 PMCID: PMC6464222 DOI: 10.1371/journal.pone.0215353] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/02/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND HIV-self-testing (HIVST) could be a strategy to get more people tested for HIV in resource limited settings. One of the prerequisites of a successful HIVST programme is the availability of an easy to use, valid HIV-test which is robust against field conditions and procedural errors by untrained lay users. METHODS AND FINDINGS The primary objective of this study was to evaluate the ability of untrained persons to correctly interpret the OraQuick HIV Self-Test results with oral fluid compared with results obtained by trained users using the matched lot OraQuick Rapid HIV-1/2 Antibody Test and blinded to the results of the Self-Test. Sensitivity of the OraQuick HIV Self-Test in untrained users was 101 in 102 (99.02%; 95%CI = 93.88-99.95%)-and specificity- 1,241 in 1,241 (100.0%; 95%CI = 99.62-100.0%). Forty-eight Self-Tests were excluded in the accuracy analysis (due to a result read as invalid, not sure or ambiguous) resulting in a test system failure rate of 3.45% (95% CI 2.56%-4.55%). At least one observation of difficulty or error with one or more of the test steps were seen in 1,193 (84.6%) participants. Age, education and health literacy were independently associated with the sum score of procedural errors and difficulties. Four tests did not provide a valid result as determined by the trained user's interpretation of the Self-Test. CONCLUSIONS The OraQuick HIV Self-Test provides reliable and repeatable results in a rural field environment in spite of procedural errors.
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Affiliation(s)
- Walter Devillé
- Ndlovu Care Group, Groblersdal, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Schatz E, Houle B, Mojola SA, Angotti N, Williams J. How to "Live a Good Life": Aging and HIV Testing in Rural South Africa. J Aging Health 2019; 31:709-732. [PMID: 29318924 PMCID: PMC6027599 DOI: 10.1177/0898264317751945] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The African HIV epidemic is aging, yet HIV testing behavior studies either exclude older persons or include too few to say much about age differences. METHOD Strategically combining focus group interviews (participants in 40s/50s/60s-plus age groups) and survey data from rural South Africa (where HIV prevalence peaks in the late 30s, but continues to be over 10% into the late 60s), we examine gender and life course variation, motivations, and barriers in HIV testing. RESULTS We find significant gender differences-Women test at higher rates at younger ages, men at older ages. Our qualitative data not only highlight recognition of testing importance but also suggest gendered motivations and perceptions of testing. Men and women report similar barriers, however, including fear of finding out their (positive) HIV status, limited confidentiality, and partner nondisclosure. DISCUSSION We conclude with recommendations to increase HIV testing uptake among older adults including home testing, couples testing, and HIV testing concurrently with noncommunicable diseases.
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Affiliation(s)
- Enid Schatz
- Department of Health Sciences, University of Missouri
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
- School of Demography, The Australian National University, Australia
| | - Sanyu A. Mojola
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
- Department of Sociology, University of Colorado, Boulder, Boulder, CO, USA
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
- Department of Sociology, American University, Washington, D.C., USA
| | - Jill Williams
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
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Anglewicz P, Akilimali P, Eitmann LP, Hernandez J, Kayembe P. The relationship between interviewer-respondent familiarity and family planning outcomes in the Democratic Republic of Congo: a repeat cross-sectional analysis. BMJ Open 2019; 9:e023069. [PMID: 30670510 PMCID: PMC6348299 DOI: 10.1136/bmjopen-2018-023069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The typical approach of survey data collection is to use interviewers who are not from the study site and do not know the participants, yet the implications of this approach on data quality have seldom been investigated. We examine the relationship between interviewer-respondent familiarity and selected family planning outcomes, and whether this relationship changes over time between 2015 and 2016. SETTING We use data from the Performance Monitoring and Accountability 2020 Project in Kongo Central Province, Democratic Republic of Congo. PARTICIPANTS Participants include representative samples of women of reproductive ages (15 to 49), 1565 interviewed in 2015 and 1668 in 2016. The study used a two-stage cluster design: first randomly selecting enumeration areas (EAs), then randomly selecting households within each EA. DESIGN We first identify individual characteristics associated with familiarity between RE and respondent. Next, we examine the relationship between RE-respondent acquaintance and family planning outcomes. Finally, we use two waves of data to examine whether this relationship changes over time between 2015 and 2016. RESULTS In multivariate analysis, interviewer-respondent acquaintance is significantly associated with last birth unintended (OR 1.91, 95% CI 1.17 to 3.13) and reported infertility in 2015 (OR 2.26, 95% CI 1.03 to 4.95); and any contraceptive use (OR 1.51, 95% CI 1.01 to 2.28), traditional contraceptive use (OR 1.79, 95% CI 1.10 to 2.89), reported infidelity (OR 1.89, 95% CI 1.02 to 3.49) and age at first sex (coefficient -0.48, 95% CI -0.96 to -0.01) in 2016. The impact of acquaintance on survey responses changed over time for any contraceptive use (OR 2.09, 95% CI 1.33 to 3.30). CONCLUSIONS The standard in many large-scale surveys is to use interviewers from outside the community. Our results show that interviewer-respondent acquaintance is associated with a range of family planning outcomes; therefore, we recommend that the approach to hiring interviewers be examined and reconsidered in survey data collection efforts.
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Affiliation(s)
- Philip Anglewicz
- Department of Global Community Health and Behavioral Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Pierre Akilimali
- Faculty of Medicine, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Linnea Perry Eitmann
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Julie Hernandez
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Patrick Kayembe
- Division of Epidemiology and Biostatistics School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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Smith P, Clayton J, Pike C, Bekker LG. A review of the atomoRapid HIV self-testing device: an acceptable and easy alternative to facilitate HIV testing. Expert Rev Mol Diagn 2019; 19:9-14. [PMID: 30570364 DOI: 10.1080/14737159.2019.1561286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction:HIV testing is the gateway to both HIV prevention and treatment, and increased HIV testing and linkage to services is vital for an effective HIV response. HIV testing has progressed significantly from a lengthy laboratory process conducted by specialist medical staff to rapid point of care testing performed by trained lay staff. Despite HIV testing services being widely available, testing rates remain suboptimal among young people and men. Alternative delivery strategies that complement conventional testing services are needed to reach these priority groups. Areas covered:This article reviewed the AtomoRapid HIV self-testing (HIVST) device as an innovative alternative to conventional testing. Expert commentary:HIVST complements traditional HIV testing options and can be used to overcome major barriers to testing by catering for testing outside of conventional settings and by allowing individuals to test themselves privately, and at their own discretion and frequency. We conclude that the high sensitivity, specificity, acceptability, usability, and fidelity of this device makes it an appropriate option for the enhancement of HIV testing strategies for harder to reach populations, such as young people and men.
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Affiliation(s)
- Philip Smith
- a The Desmond Tutu HIV Centre , University of Cape Town , Cape Town , South Africa
| | - Janine Clayton
- a The Desmond Tutu HIV Centre , University of Cape Town , Cape Town , South Africa
| | - Carey Pike
- a The Desmond Tutu HIV Centre , University of Cape Town , Cape Town , South Africa
| | - Linda-Gail Bekker
- a The Desmond Tutu HIV Centre , University of Cape Town , Cape Town , South Africa
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20
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Sande L, Maheswaran H, Mangenah C, Mwenge L, Indravudh P, Mkandawire P, Ahmed N, d’Elbee M, Johnson C, Hatzold K, Corbett EL, Neuman M, Terris-Prestholt F. Costs of accessing HIV testing services among rural Malawi communities. AIDS Care 2018. [PMCID: PMC6050712 DOI: 10.1080/09540121.2018.1479032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV testing is free in Malawi, but users may still incur costs that can deter or delay them accessing these services. We sought to identify and quantify these costs among HIV testing service clients in Malawi. We asked residents of communities participating in a cluster randomised trial investigating the impact of HIV self-testing about their past HIV testing experiences and the direct non-medical and indirect costs incurred to access HIV testing. We recruited 749 participants whose most recent HIV test was within the past 12 months. The mean total cost to access testing was US$2.45 (95%CI: US$2.11–US$2.70). Men incurred higher costs (US$3.81; 95%CI: US$2.91–US$4.50) than women (US$1.83; 95%CI: US$1.61–US$2.00). Results from a two-part multivariable regression analysis suggest that age, testing location, time taken to test, visiting a facility specifically for an HIV test and district of residence significantly affected the odds of incurring costs to testing. In addition, gender, wealth, age, education and district of residence were associated with significant user costs.
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Affiliation(s)
- Linda Sande
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Collin Mangenah
- The Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
| | | | - Pitchaya Indravudh
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Nurilign Ahmed
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Marc d’Elbee
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organisation, Geneva, Switzerland
| | | | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa Neuman
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Fern Terris-Prestholt
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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21
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Huang X, Liu X, Chen J, Bao Y, Hou J, Lu X, Xia W, Xia H, Song A, Liu Z, Su B, Chen H, Chen Y, Wu H. Evaluation of Blood-Based Antibody Rapid Testing for HIV Early Therapy: A Meta-Analysis of the Evidence. Front Immunol 2018; 9:1458. [PMID: 30013552 PMCID: PMC6036269 DOI: 10.3389/fimmu.2018.01458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background Western blot (WB) assay is considered the gold standard test for HIV infection confirmation. However, it requires technical expertise and is quite time-consuming. WHO recommends blood-based rapid diagnosis to achieve same-day test and treatment. However, this rapid testing strategy has not been promoted worldwide due to inadequate research evaluating the effectiveness of rapid tests (RTs) as an alternative confirmatory HIV test for WB. This study aims to compare the diagnostic performance of rapid HIV tests compared with WB. Methods PubMed and Web of Science were searched for publications on rapid HIV tests using blood specimen. A meta-analysis was performed to quantitatively evaluate the diagnostic performance of rapid HIV tests compared with the WB assay in terms of pooled sensitivity, specificity, area under summary receiver operating characteristic (SROC) curve, and diagnostic odds ratio (DOR). Results Twenty articles involving 27,343 fresh specimens for rapid HIV tests were included in the meta-analysis. Regarding Capillus HIV-1/HIV-2, the pooled sensitivity, specificity, area under SROC curve, and DOR derived from six studies were 0.999 (95% CI, 0.956-1.000), 0.999 (95% CI, 0.991-1.00), 1.00 (95% CI, 0.99-1.00), and 1.0 × 106 (95% CI, 2.6 × 104-3.9 × 107) compared with the WB assay, respectively. With respect to Determine HIV-1/2, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 1.00 (95% CI, 0.789-1.000), 0.992 (95% CI, 0.985-0.996), 1.00 (95% CI, 0.99-1.00), and 1.8 × 106 (95% CI 406.049-7.8 × 109) compared with the WB assay, respectively. Regarding two-step serial RTs, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 0.998 (95% CI, 0.991-1.000), 0.998 (95% CI, 0.994-0.999), and 1.00 (95% CI 0.99-1.00) compared with the WB assay, respectively. Conclusion Our meta-analysis results may provide evidenced-based support for substituting RT for WB. Blood-based rapid HIV tests have comparable sensitivity and specificity to WB for HIV early therapy.
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Affiliation(s)
- Xiaojie Huang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Xinchao Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Jieqing Chen
- Department of Information Technology, Peking Union Medical College Hospital, Beijing, China
| | - Yugang Bao
- AIDS Healthcare Foundation, Beijing, China
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Xiaofan Lu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Wei Xia
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Huan Xia
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Aixin Song
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Zhiying Liu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China.,Zunyi Medical University, Zunyi, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
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22
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Abstract
This study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women's economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community. Important individual-level enabling and perceived need factors included high socioeconomic status, not having observed HIV-related stigma and knowledge of HIV status (based on a previous HIV test), such that these groups of individuals had a significantly higher likelihood of being tested for HIV during pregnancy than their counterparts of lower socioeconomic status, and who had observed HIV-related stigma or did not know their HIV status. The results further revealed that community HIV awareness is important for improving antenatal HIV testing, while stigma is associated with reduced testing uptake. Most contextual community-level factors were not found to have much effect on the uptake of antenatal HIV testing. Therefore, policies should focus on individual-level predisposing and enabling factors to improve the uptake of antenatal HIV testing in Zimbabwe.
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23
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Angotti N, Mojola SA, Schatz E, Williams JR, Gómez-Olivé FX. 'Taking care' in the age of AIDS: older rural South Africans' strategies for surviving the HIV epidemic. CULTURE, HEALTH & SEXUALITY 2018; 20:262-275. [PMID: 28741983 PMCID: PMC5985658 DOI: 10.1080/13691058.2017.1340670] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Older adults have been largely overlooked in community studies of HIV in highly endemic African countries. In our rural study site in Mpumalanga Province, South Africa, HIV prevalence among those aged 50 and older is 16.5%, suggesting that older adults are at risk of both acquiring and transmitting HIV. This paper utilises community-based focus-group interviews with older rural South African men and women to better understand the normative environment in which they come to understand and make decisions about their health as they age in an HIV endemic setting. We analyse the dimensions of an inductively emerging theme: ku ti hlayisa (to take care of yourself). For older adults, 'taking care' in an age of AIDS represented: (1) an individualised pathway to achieving old-age respectability through the taking up of responsibilities and behaviours that characterise being an older person, (2) a set of gendered norms and strategies for reducing one's HIV risk, and (3) a shared responsibility for attenuating the impact of the HIV epidemic in the local community. Findings reflect the individual, interdependent and communal ways in which older rural South Africans understand HIV risk and prevention, ways that also map onto current epidemiological thinking for improving HIV-related outcomes in high-prevalence settings.
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Affiliation(s)
- Nicole Angotti
- Department of Sociology, American University, Washington DC, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Sanyu A. Mojola
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
- Departments of Health Sciences and Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - Jill R. Williams
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
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24
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McGovern ME, Herbst K, Tanser F, Mutevedzi T, Canning D, Gareta D, Pillay D, Bärnighausen T. Do gifts increase consent to home-based HIV testing? A difference-in-differences study in rural KwaZulu-Natal, South Africa. Int J Epidemiol 2018; 45:2100-2109. [PMID: 27940483 PMCID: PMC5841834 DOI: 10.1093/ije/dyw122] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/12/2022] Open
Abstract
Background Despite the importance of HIV testing for controlling the HIV epidemic, testing rates remain low. Efforts to scale up testing coverage and frequency in hard-to-reach and at-risk populations commonly focus on home-based HIV testing. This study evaluates the effect of a gift (a US$5 food voucher for families) on consent rates for home-based HIV testing. Methods We use data on 18 478 individuals (6 418 men and 12 060 women) who were successfully contacted to participate in the 2009 and 2010 population-based HIV surveillance carried out by the Wellcome Trust's Africa Health Research Institute in rural KwaZulu-Natal, South Africa. Of 18 478 potential participants contacted in both years, 35% (6 518) consented to test in 2009, and 41% (7 533) consented to test in 2010. Our quasi-experimental difference-in-differences approach controls for unobserved confounding in estimating the causal effect of the intervention on HIV-testing consent rates. Results Allocation of the gift to a family in 2010 increased the probability of family members consenting to test in the same year by 25 percentage points [95% confidence interval (CI) 21-30 percentage points; P < 0.001]. The intervention effect persisted, slightly attenuated, in the year following the intervention (2011). Conclusions In HIV hyperendemic settings, a gift can be highly effective at increasing consent rates for home-based HIV testing. Given the importance of HIV testing for treatment uptake and individual health, as well as for HIV treatment-as-prevention strategies and for monitoring the population impact of the HIV response, gifts should be considered as a supportive intervention for HIV-testing initiatives where consent rates have been low.
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Affiliation(s)
- Mark E McGovern
- CHaRMS - Centre for Health Research at the Management School, Queen's University Belfast, Northern Ireland.,Africa Health Research Institute, Mtubatuba, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Frank Tanser
- Africa Health Research Institute, Mtubatuba, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - David Canning
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston 02115, MA, USA.,Harvard Center for Population and Development Studies, Cambridge 02144, MA, USA
| | - Dickman Gareta
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Deenan Pillay
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, Mtubatuba, South Africa.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston 02115, MA, USA.,Harvard Center for Population and Development Studies, Cambridge 02144, MA, USA.,Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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25
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Kelvin EA, George G, Mwai E, Nyaga EN, Mantell JE, Romo ML, Odhiambo JO, Govender K. Offering Self-administered Oral HIV Testing as a Choice to Truck Drivers in Kenya: Predictors of Uptake and Need for Guidance While Self-testing. AIDS Behav 2018; 22:580-592. [PMID: 28540563 PMCID: PMC5818565 DOI: 10.1007/s10461-017-1783-9] [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] [Indexed: 11/25/2022]
Abstract
We assessed predictors of choosing self-administered oral HIV testing in the clinic with supervision versus the standard provider-administered blood test when offered the choice among 149 Kenyan truck drivers, described the types of guidance participants needed during self-testing and predictors of needing guidance. Overall, 56.38% of participants chose the self-test, 23.49% the provider-administered test, and 20.13% refused testing. In the adjusted regression models, each additional unit on the fatalism and self-efficacy scales was associated with 0.97 (p = 0.003) and 0.83 (p = 0.008) times lower odds of choosing the self-test, respectively. Overall, 52.38% of self-testers did so correctly without questions, 47.61% asked questions, and 13.10% required unsolicited correction from the provider. Each additional unit on the fatalism scale was associated with 1.07 times higher odds of asking for guidance when self-testing (p < 0.001). Self-administered oral HIV testing seems to be acceptable and feasible among Kenyan truck drivers, especially if given the opportunity to ask questions.
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26
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Kranzer K, Simms V, Bandason T, Dauya E, McHugh G, Munyati S, Chonzi P, Dakshina S, Mujuru H, Weiss HA, Ferrand RA. Economic incentives for HIV testing by adolescents in Zimbabwe: a randomised controlled trial. Lancet HIV 2018; 5:e79-e86. [PMID: 29170030 PMCID: PMC5809636 DOI: 10.1016/s2352-3018(17)30176-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/20/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND HIV testing is the important entry point for HIV care and prevention service, but uptake of HIV testing and thus coverage of antiretroviral therapy are much lower in older children and adolescents than in adults. We investigated the effect of economic incentives provided to caregivers of children aged 8-17 years on uptake of HIV testing and counselling in Harare, Zimbabwe. METHODS This randomised controlled trial was nested within a household HIV prevalence survey of children aged 8-17 years in Harare. Households with one or more survey participants whose HIV status was unknown were eligible to participate in the trial. Eligible households were randomly assigned (1:1:1) to either receive no incentive, receive a fixed US$2 incentive, or participate in a lottery for $5 or $10 if the participant presented for HIV testing and counselling at a local primary health-care centre. The survey fieldworkers who enrolled participants were not blinded to trial arm allocation, but the statistician was blinded for analysis of outcome. The primary outcome was the proportion of households in which at least one child had an HIV test within 4 weeks of enrolment. HIV test uptake in the incentivised groups was compared with uptake in the non-incentivised group using logistic regression, adjusting for community and number of children as fixed effects and research assistant as a random effect. All analyses were by intention to treat. The trial is registered with the Pan African Clinical Trials Registry, number PACTR201605001615280. FINDINGS Between Aug 4, and Dec 18, 2015, 2050 eligible households were enrolled in the prevalence survey. 649 (32%) households were assigned no incentive, 740 (34%) households were assigned a $2 incentive, and 661 (32%) households were assigned to lottery participation. Children were unavailable in 148 households in the no-incentive group, 63 households in the $2 incentive group, and 81 households in the lottery group. 1688 households had at least one child with unknown HIV status and were enrolled into the trial. 22 households had no undiagnosed child, and one household refused consent. The primary outcome of HIV testing was assessed in 472 (28%) households in the no-incentive group, 654 (39%) households in the $2 incentive group, and 562 (33%) households in the lottery group. At least one child was HIV tested in 93 (20%) households in the no-incentive group, in 316 (48%) households in the $2 incentive group (adjusted odds ratio 3·67, 95% CI 2·77-4·85; p<0·0001), and in 223 (40%) of 562 households in the lottery group (2·66, 2·00-3·55; p<0·0001). No adverse events were reported. INTERPRETATION Fixed incentives and lottery-based incentives increased the uptake of HIV testing by older children and adolescents, a key hard-to-reach population. This strategy would be sustainable in the context of vertical HIV infection as repeated testing would not be necessary until sexual debut. FUNDING Wellcome Trust.
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Affiliation(s)
- Katharina Kranzer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; National and Supranational Tuberculosis Reference Laboratory, Leibniz Research Centre Borstel, Borstel, Germany.
| | - Victoria Simms
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Suba Dakshina
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
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27
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Kim HB, Haile B, Lee T. Promotion and Persistence of HIV Testing and HIV/AIDS Knowledge: Evidence From a Randomized Controlled Trial in Ethiopia. HEALTH ECONOMICS 2017; 26:1394-1411. [PMID: 27671119 DOI: 10.1002/hec.3425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 06/28/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
We use data from a randomized controlled trial in Ethiopia and examine the causal effects of HIV/AIDS education, home-based voluntary HIV counseling and testing (VCT), and conditional cash transfers (CCT) for facility-based VCT on HIV/AIDS knowledge and demand for HIV testing. HIV/AIDS education significantly increases HIV/AIDS knowledge but has a limited effect on testing take-up. However, when HIV/AIDS education is combined with either home-based VCT or CCT for facility-based VCT, take-up increases substantially by about 63 and 57 percentage points, respectively. We also demonstrate evidence of persistence in test-taking behavior, where past HIV testing does not dampen demand for testing. Lastly, we find suggestive evidence that home-based VCT could be more effective at detecting HIV-positive cases relative to CCT for facility-based VCT. Our findings highlight the importance of geographic accessibility in the testing decision and persistence in demand for HIV testing. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hyuncheol Bryant Kim
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Beliyou Haile
- International Food Policy Research Institute (IFPRI), Washington, D.C., USA
| | - Taewha Lee
- College of Nursing, Yonsei University, Seoul, South Korea
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28
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Mwenge L, Sande L, Mangenah C, Ahmed N, Kanema S, d’Elbée M, Sibanda E, Kalua T, Ncube G, Johnson CC, Hatzold K, Cowan FM, Corbett EL, Ayles H, Maheswaran H, Terris-Prestholt F. Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe. PLoS One 2017; 12:e0185740. [PMID: 29036171 PMCID: PMC5642898 DOI: 10.1371/journal.pone.0185740] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/14/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Providing HIV testing at health facilities remains the most common approach to ensuring access to HIV treatment and prevention services for the millions of undiagnosed HIV-infected individuals in sub-Saharan Africa. We sought to explore the costs of providing these services across three southern African countries with high HIV burden. METHODS Primary costing studies were undertaken in 54 health facilities providing HIV testing services (HTS) in Malawi, Zambia and Zimbabwe. Routinely collected monitoring and evaluation data for the health facilities were extracted to estimate the costs per individual tested and costs per HIV-positive individual identified. Costs are presented in 2016 US dollars. Sensitivity analysis explored key drivers of costs. RESULTS Health facilities were testing on average 2290 individuals annually, albeit with wide variations. The mean cost per individual tested was US$5.03.9 in Malawi, US$4.24 in Zambia and US$8.79 in Zimbabwe. The mean cost per HIV-positive individual identified was US$79.58, US$73.63 and US$178.92 in Malawi, Zambia and Zimbabwe respectively. Both cost estimates were sensitive to scale of testing, facility staffing levels and the costs of HIV test kits. CONCLUSIONS Health facility based HIV testing remains an essential service to meet HIV universal access goals. The low costs and potential for economies of scale suggests an opportunity for further scale-up. However low uptake in many settings suggests that demand creation or alternative testing models may be needed to achieve economies of scale and reach populations less willing to attend facility based services.
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Affiliation(s)
| | - Linda Sande
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Collin Mangenah
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | - Nurilign Ahmed
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Marc d’Elbée
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Euphemia Sibanda
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | - Thokozani Kalua
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | | | - Cheryl C. Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Frances M. Cowan
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Fern Terris-Prestholt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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29
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Brooks C, D'Ambruoso L, Kazimierczak K, Ngobeni S, Twine R, Tollman S, Kahn K, Byass P. Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa. BMJ Glob Health 2017; 2:e000231. [PMID: 29071128 PMCID: PMC5640027 DOI: 10.1136/bmjgh-2016-000231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 06/08/2017] [Accepted: 07/02/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION South Africa is a country faced with complex health and social inequalities, in which HIV/AIDS has had devastating impacts. The study aimed to gain insights into the perspectives of rural communities on HIV-related mortality. METHODS A participatory action research (PAR) process, inclusive of a visual participatory method (Photovoice), was initiated to elicit and organise local knowledge and to identify priorities for action in a rural subdistrict underpinned by the Agincourt Health and Socio-Demographic Surveillance System (HDSS). We convened three village-based discussion groups, presented HDSS data on HIV-related mortality, elicited subjective perspectives on HIV/AIDS, systematised these into collective accounts and identified priorities for action. Framework analysis was performed on narrative and visual data, and practice theory was used to interpret the findings. FINDINGS A range of social and health systems factors were identified as causes and contributors of HIV mortality. These included alcohol use/abuse, gender inequalities, stigma around disclosure of HIV status, problems with informal care, poor sanitation, harmful traditional practices, delays in treatment, problems with medications and problematic staff-patient relationships. To address these issues, developing youth facilities in communities, improving employment opportunities, timely treatment and extending community outreach for health education and health promotion were identified. DISCUSSION Addressing social practices of blame, stigma and mistrust around HIV-related mortality may be a useful focus for policy and planning. Research that engages communities and authorities to coproduce evidence can capture these practices, improve communication and build trust. CONCLUSION Actions to reduce HIV should go beyond individual agency and structural forces to focus on how social practices embody these elements. Initiating PAR inclusive of visual methods can build shared understandings of disease burdens in social and health systems contexts. This can develop shared accountability and improve staff-patient relationships, which, over time, may address the issues identified, here related to stigma and blame.
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Affiliation(s)
- Chloe Brooks
- Department for International Development, London, UK.,Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Lucia D'Ambruoso
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK.,Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/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
| | | | - Sizzy Ngobeni
- MRC/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.,INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Rhian Twine
- MRC/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
| | - Stephen Tollman
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/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.,INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Kathleen Kahn
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/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.,INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Peter Byass
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK.,Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/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
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Abstract
Supplemental Digital Content is Available in the Text. Background: As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum. Conceptual Framework: This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social–ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters. Discussion: The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.
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Geoffroy E, Schell E, Jere J, Khozomba N. Going door-to-door to reach men and young people with HIV testing services to achieve the 90-90-90 treatment targets. Public Health Action 2017; 7:95-99. [PMID: 28695081 DOI: 10.5588/pha.16.0121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Mulanje District, Malawi. Objective: To examine the effectiveness of door-to-door (DtD) testing in reaching young people and men in a remote, rural area with a high prevalence of human immunodeficiency virus (HIV) infection. Design: This was a retrospective analysis of data collected for a pilot DtD program. HIV testing services (HTS) visited targeted villages for 1-2 weeks. All current residents aged ⩾2 years not known to be HIV-positive were offered testing. Results: Ninety per cent (13 783/15 391) of individuals eligible for testing accepted. Forty-one per cent (n = 5693) of those tested were males and 56% (n = 7752) were aged <20 years. The overall proportion who tested positive was 4% (n = 524), with half as many males as females testing positive (OR 0.49, 95%CI 0.40-0.60, P < 0.001). There was a higher positive yield rate for those aged ⩾20 years (6% for men and 8% for women). Two thirds were first-time testers; males were half as likely as females to have been previously tested (OR 0.43, 95%CI 0.40-0.47, P < 0.001). Conclusion: DtD-HTS can be an effective way to reach populations in remote, rural high-prevalence areas where access to fixed facilities is inadequate. It has the potential to reach young people and men better than facility-based testing or other community strategies, and can identify young HIV-positive children who may have been missed by other methods.
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Affiliation(s)
- E Geoffroy
- Global AIDS Interfaith Alliance, San Rafael, California, USA
| | - E Schell
- Global AIDS Interfaith Alliance, San Rafael, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - J Jere
- Global AIDS Interfaith Alliance, Limbe, Malawi
| | - N Khozomba
- Global AIDS Interfaith Alliance, Limbe, Malawi
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Gwadz M, Cleland CM, Perlman DC, Hagan H, Jenness SM, Leonard NR, Ritchie AS, Kutnick A. Public Health Benefit of Peer-Referral Strategies for Detecting Undiagnosed HIV Infection Among High-Risk Heterosexuals in New York City. J Acquir Immune Defic Syndr 2017; 74:499-507. [PMID: 28267698 PMCID: PMC5341134 DOI: 10.1097/qai.0000000000001257] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Identifying undiagnosed HIV infection is necessary for the elimination of HIV transmission in the United States. The present study evaluated the efficacy of 3 community-based approaches for uncovering undiagnosed HIV among heterosexuals at high-risk (HHR), who are mainly African American/Black and Hispanic. Heterosexuals comprise 24% of newly reported HIV infections in the United States, but experience complex multilevel barriers to HIV testing. We recruited African American/Black and Hispanic HHR in a discrete urban area with both elevated HIV prevalence and poverty rates. Approaches tested were (1) respondent-driven sampling (RDS) and confidential HIV testing in 2 sessions (n = 3116); (2) RDS and anonymous HIV testing in one session (n = 498); and (3) venue-based sampling (VBS) and HIV testing in a single session (n = 403). The main outcome was newly diagnosed HIV infection. RDS with anonymous testing and one session reached HHR with less HIV testing experience and more risk factors than the other approaches. Furthermore, RDS with anonymous (4.0%) and confidential (1.0%) testing yielded significantly higher rates of newly diagnosed HIV than VBS (0.3%). Thus peer-referral approaches were more efficacious than VBS for uncovering HHR with undiagnosed HIV, particularly a single-session/anonymous strategy, and have a vital role to play in efforts to eliminate HIV transmission.
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Affiliation(s)
- Marya Gwadz
- *Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY;†Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; and‡Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Mokgatle MM, Madiba S. High Acceptability of HIV Self-Testing among Technical Vocational Education and Training College Students in Gauteng and North West Province: What Are the Implications for the Scale Up in South Africa? PLoS One 2017; 12:e0169765. [PMID: 28141858 PMCID: PMC5283675 DOI: 10.1371/journal.pone.0169765] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022] Open
Abstract
Background Although HIV self-testing (HIVST) is globally accepted as an important complement to existing HIV testing approaches, South Africa has lagged behind in its adoption. As a result, data on the acceptability and uptake of HIVST testing is limited. The study investigated the acceptability of HIVST among students in Technical Vocational Education and Training (TVET) colleges in two provinces in South Africa. Methods A cross-sectional survey using a self-administered structured questionnaire was used to collect data among 3,662 students recruited from 13 TVET colleges. Results The mean age of the students was 21.9 years. The majority (80.9%) were sexually active; while 66.1% reported that they had one sexual partner, and 33.9% had two or more sexual partners in the past year, and66.5% used condoms during the last sexual act. Three-quarters tested for HIV in the past year but less than half knew about HIVST prior to the survey. The acceptability of HIVST was high; about three-quarters showed a willingness to purchase a self-test kit and a majority would self-test with partners. Acceptability of HIVST was associated with being sexually active (OR = 1.73, p = 0.02, confidence interval (CI): 1.08–2.75), having ever been tested for HIV (OR = 1.74, p = 0.001, CI: 1.26–2.38), and having multiple sexual partners (OR = 0.61, p = 0.01, CI: 0.42–0.88). Three-quarters would confirm test results at a local health facility. In terms of counselling, telephone hotlines were acceptable to only 39.9%, and less than half felt that test-kit leaflets would provide sufficient information to self-test. Interpretations The high acceptability of HIVST among the students calls for extensive planning and preparation for the scaling up of HIVST in South Africa. In addition, campaigns similar to those conducted to promote HIV counselling and testing (HCT) should be considered to educate communities about HIVST.
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Affiliation(s)
- Mathildah Mpata Mokgatle
- School of Public Health, Department of Biostatistics, Sefako Makgatho Health Sciences University, South Africa
- * E-mail:
| | - Sphiwe Madiba
- School of Public Health, Department of Environmental and Occupational Health, Sefako Makgatho Health Sciences University, South Africa
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HIV Testing Preferences Among MSM Members of an LGBT Community Organization in Los Angeles. J Assoc Nurses AIDS Care 2017; 28:363-371. [PMID: 28185723 DOI: 10.1016/j.jana.2017.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/04/2017] [Indexed: 11/23/2022]
Abstract
Lack of regular HIV testing puts African American, Asian, and Latino men who have sex with men (MSM) at high risk for HIV infection. Rapid self-testing may be an effective option for these men. We explored acceptability, preferences, and usability of HIV self-test kits with MSM of color using semi-structured focus groups to discuss HIV testing history, reasons for testing, and self-testing preferences. Participants (n = 21) lived in Los Angeles, identified as MSM of color, and were 18-35 years of age. Discussions were audio-recorded, transcribed, and analyzed using grounded theory. Participants expressed needs for (a) accessibility, (b) privacy, (c) local support, and (d) access to testing professionals. Self-testing for HIV infection may be an effective method for high-risk MSM. Effective self-testing programs need to consider accessibility, confidentiality, and support to increase routine testing. Community-based organizations have an opportunity to increase HIV testing for MSM of color.
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35
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Maksut JL, Eaton LA, Siembida EJ, Driffin DD, Baldwin R. A Test of Concept Study of At-Home, Self-Administered HIV Testing With Web-Based Peer Counseling Via Video Chat for Men Who Have Sex With Men. JMIR Public Health Surveill 2016; 2:e170. [PMID: 27974287 PMCID: PMC5196490 DOI: 10.2196/publichealth.6377] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/18/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023] Open
Abstract
Background Men who have sex with men (MSM), particularly MSM who identify as African-American or Black (BMSM), are the sociodemographic group that is most heavily burdened by the human immunodeficiency virus (HIV) epidemic in the United States. To meet national HIV testing goals, there must be a greater emphasis on novel ways to promote and deliver HIV testing to MSM. Obstacles to standard, clinic-based HIV testing include concerns about stigmatization or recognition at in-person testing sites, as well as the inability to access a testing site due to logistical barriers. Objective This study examined the feasibility of self-administered, at-home HIV testing with Web-based peer counseling to MSM by using an interactive video chatting method. The aims of this study were to (1) determine whether individuals would participate in at-home HIV testing with video chat–based test counseling with a peer counselor, (2) address logistical barriers to HIV testing that individuals who report risk for HIV transmission may experience, and (3) reduce anticipated HIV stigma, a primary psychosocial barrier to HIV testing. Methods In response to the gap in HIV testing, a pilot study was developed and implemented via mailed, at-home HIV test kits, accompanied by HIV counseling with a peer counselor via video chat. A total of 20 MSM were enrolled in this test of concept study, 80% of whom identified as BMSM. Results All participants reported that at-home HIV testing with a peer counseling via video chat was a satisfying experience. The majority of participants (13/18, 72%) said they would prefer for their next HIV testing and counseling experience to be at home with Web-based video chat peer counseling, as opposed to testing in an office or clinic setting. Participants were less likely to report logistical and emotional barriers to HIV testing at the 6-week and 3-month follow-ups. Conclusions The results of this study suggest that self-administered HIV testing with Web-based peer counseling is feasible and that MSM find it to be a satisfactory means by which they can access their test results. This study can serve as a general guideline for future, larger-scale studies of Web-based HIV test counseling for MSM.
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Affiliation(s)
- Jessica L Maksut
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT, United States
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT, United States
| | - Elizabeth J Siembida
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT, United States
| | - Daniel D Driffin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs Mansfield, CT, United States
| | - Robert Baldwin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs Mansfield, CT, United States
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36
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Barriers and facilitators associated with HIV testing uptake in South African health facilities offering HIV Counselling and Testing. Health SA 2016. [DOI: 10.1016/j.hsag.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Madiba S, Mokgatle M. Parents Support Implementation of HIV Testing and Counseling at School: Cross-Sectional Study with Parents of Adolescent Attending High School in Gauteng and North West Provinces, South Africa. AIDS Res Treat 2016; 2016:4842814. [PMID: 27807481 PMCID: PMC5078638 DOI: 10.1155/2016/4842814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/30/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background. A formative assessment of the implementation of HIV testing and counseling (HTC) at school showed high acceptability and willingness to test among learners. However, the success of the proposed HTC depends on the support and acceptability of key stakeholders, including the parents. The aim of the study was to assess the opinions and acceptability of the implementation of HTC at school among parents of adolescents in high school. Methods. This was a cross-sectional household survey conducted with parents of adolescents attending high schools in educational districts in North West and Gauteng provinces, South Africa. Results. A total of 804 parents participated, and 548 (68.3%) were biological mothers, 85 (10.6%) were fathers, and the remaining were other relatives including grandmothers. Almost all (n = 742, 92.9%) parents were in support of implementation and provision of HTC at school, 701 (87.7%) would allow their children to be tested at school, 365 (46%) felt that parental consent was not needed to test at school, and 39.4% preferred to receive the HIV test results with their children. Conclusion. Parents accept the roll-out of an HTC program at school and have a role to play in supporting children who test positive for HIV.
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Affiliation(s)
- Sphiwe Madiba
- School of Public Health, Department of Environmental and Occupational Heath, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mathildah Mokgatle
- School of Public Health, Department of Biostatistics, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Musheke M, Merten S, Bond V. Why do marital partners of people living with HIV not test for HIV? A qualitative study in Lusaka, Zambia. BMC Public Health 2016; 16:882. [PMID: 27561332 PMCID: PMC5000425 DOI: 10.1186/s12889-016-3396-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of HIV status is crucial for HIV prevention and management in marital relationships. Yet some marital partners of people living with HIV decline HIV testing despite knowing the HIV-positive status of their partners. To date, little research has explored the reasons for this. METHODS An exploratory qualitative study was undertaken in Lusaka, Zambia, between March 2010 and September 2011, nested within a larger ethnographic study. In-depth interviews were held with individuals who knew the HIV-positive status of their marital partners but never sought HIV testing (n = 30) and HIV service providers of a public sector clinic (n = 10). A focus group discussion was also conducted with eight (8) lay HIV counsellors. Data was transcribed, coded and managed using ATLAS.ti and analysed using latent content analysis. RESULTS The overarching barrier to uptake of HIV testing was study participants' perception of their physical health, reinforced by uptake of herbal remedies and conventional non-HIV medication to mitigate perceived HIV-related symptoms. They indicated willingness to test for HIV if they noticed a decline in physical health and other alternative forms of care became ineffective. Also, some study participants viewed themselves as already infected with HIV on account of the HIV-positive status of their marital partners, with some opting for faith healing to get 'cured'. Other barriers were the perceived psychological burden of living with HIV, modulated by lay belief that knowledge of HIV-positive status led to rapid physical deterioration of health. Perceived inability to sustain uptake of life-long treatment - influenced by a negative attitude towards treatment - further undermined uptake of HIV testing. Self-stigma, which manifested itself through fear of blame and a need to maintain moral credibility in marital relationships, also undermined uptake of HIV testing. CONCLUSIONS Improving uptake of HIV testing requires a multi-pronged approach that addresses self-stigma, lay risk perceptions, negative treatment and health beliefs and the perceived psychological burden of living with HIV. Strengthening couple HIV testing services, including addressing conflict and addressing gendered power relationships are also warranted to facilitate joint knowledge, acceptance and management of HIV status in marital relationships.
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Affiliation(s)
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4002, Basel, Switzerland.,University of Basel, Petersplatz 1, CH-4003, Basel, Switzerland
| | - Virginia Bond
- Zambart Project, University of Zambia, P.O. Box 50697, Lusaka, Zambia.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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"They are looking just the same": Antiretroviral treatment as social danger in rural Malawi. Soc Sci Med 2016; 167:71-8. [PMID: 27608050 DOI: 10.1016/j.socscimed.2016.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/27/2016] [Accepted: 08/16/2016] [Indexed: 11/21/2022]
Abstract
Research on the social impact of ART pivots on questions of individual adherence and community acceptability of treatment programmes. In this paper we examine unexpected and unintended consequences of the scale-up of treatment in rural Malawi, using a unique dataset of more than 150 observational journals from three sites, spanning 2010 to 2013, focusing on men's everyday conversations. Through thematic content analysis, we explore the emerging perception that the widespread availability of ART constitutes a form of social danger, as treatment makes it difficult to tell who does or does not have AIDS. This ambiguity introduced through ART is interpreted as putting individuals at risk, because it is no longer possible to tell who might be infected - indeed, the sick now look healthier and "plumper" than the well. This ambivalence over the social impact of ART co-exists with individual demand for and appreciation of the benefits of treatment.
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Dai L, Sweat MD, Gebregziabher M. Modeling excess zeros and heterogeneity in count data from a complex survey design with application to the demographic health survey in sub-Saharan Africa. Stat Methods Med Res 2016; 27:208-220. [PMID: 28034169 DOI: 10.1177/0962280215626608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To show a novel application of a weighted zero-inflated negative binomial model in modeling count data with excess zeros and heterogeneity to quantify the regional variation in HIV-AIDS prevalence in sub-Saharan African countries. Methods Data come from latest round of the Demographic and Health Survey (DHS) conducted in three countries (Ethiopia-2011, Kenya-2009 and Rwanda-2010) using a two-stage cluster sampling design. The outcome is an aggregate count of HIV cases in each census enumeration area of each country. The outcome data are characterized by excess zeros and heterogeneity due to clustering. We compare scale weighted zero-inflated negative binomial models with and without random effects to account for zero-inflation, complex survey design and clustering. Finally, we provide marginalized rate ratio estimates from the best zero-inflated negative binomial model. Results The best fitting zero-inflated negative binomial model is scale weighted and with a common random intercept for the three countries. Rate ratio estimates from the final model show that HIV prevalence is associated with age and gender distribution, HIV acceptance, HIV knowledge, and its regional variation is associated with divorce rate, burden of sexually transmitted diseases and rural residence. Conclusions Scale weighted zero-inflated negative binomial with proper modeling of random effects is shown to be the best model for count data from a complex survey design characterized by excess zeros and extra heterogeneity. In our data example, the final rate ratio estimates show significant regional variation in the factors associated with HIV prevalence indicating that HIV intervention strategies should be tailored to the unique factors found in each country.
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Affiliation(s)
- Lin Dai
- 1 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael D Sweat
- 2 Center for Global Health, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mulugeta Gebregziabher
- 1 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,2 Center for Global Health, Medical University of South Carolina, Charleston, South Carolina, USA
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Kelvin EA, Cheruvillil S, Christian S, Mantell JE, Milford C, Rambally-Greener L, Mosery N, Greener R, Smit JA. Choice in HIV testing: the acceptability and anticipated use of a self-administered at-home oral HIV test among South Africans. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2016; 15:99-108. [PMID: 27399040 PMCID: PMC5453183 DOI: 10.2989/16085906.2016.1189442] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Combination HIV prevention is being widely promoted by funders. This strategy aims to offer HIV prevention choices that can be selected and combined to decrease HIV risk in ways that fit with each individual's situation. Treatment as prevention and pre-exposure prophylaxis are two new evidence-based strategies to decrease HIV incidence, both of which require high HIV testing rates to be effective, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a goal of 90% of HIV-positive individuals knowing their status by 2030. However, HIV testing rates in many countries remain suboptimal. Just as no single HIV prevention method is ideal for all people in all situations, no single HIV testing modality is likely to be acceptable to everyone. By offering HIV testing choices, we may be able to increase testing rates. However, many low-resourced countries have been slow to take up new HIV testing options such as the self-administered at-home oral HIV test that is currently available in the United States. In this paper, we present findings from 20 in-depth interviews, conducted in 2010, documenting opinions about self-administered at-home oral HIV testing, a testing modality still largely unavailable in Africa. Participants were clients of three primary healthcare clinics in South Africa. Self-testing was seen as enabling confidentiality/privacy, saving time, and facilitating testing together with partners. However, concerns were raised about psychological distress when testing at home without a counsellor. Some suggested this concern could be minimised by having experienced clinic-based HIV testing and counselling before getting self-testing kits for home use. Thus, self-administered HIV testing could be an option added to the current testing modalities to address some important barriers to testing.
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Affiliation(s)
- Elizabeth A Kelvin
- City University New York Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
- Doctor of Public Health Program, The Graduate Center, City University of New York, New York, New York, USA
| | - Sonia Cheruvillil
- City University New York Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
- Doctor of Public Health Program, The Graduate Center, City University of New York, New York, New York, USA
| | - Stephanie Christian
- City University New York Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
- School of Urban Public Health, Hunter College, City University of New York, New York, USA
| | - Joanne E Mantell
- Division of Gender, Health and Sexuality, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, New York, USA
| | - Cecilia Milford
- MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Letitia Rambally-Greener
- MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ross Greener
- MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Jennifer A Smit
- MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- Pharmaceutical Sciences, School of Health Science, University of KwaZulu-Natal, South Africa
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Bateganya MH, Sileo KM, Wanyenze RK, Kiene SM. Strategies for delivery of HIV test results in population-based HIV seroprevalence surveys: a review of the evidence. Public Health 2016; 135:3-13. [PMID: 26947313 PMCID: PMC4893974 DOI: 10.1016/j.puhe.2016.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Many population-based demographic surveys assess local and national HIV prevalence in developing countries through home-based HIV testing and counselling (HBHTC), but results are rarely returned to participants. This review gathered evidence on the feasibility and best practices of providing HIV test results during such surveys by reviewing population-based surveys that provided test results. STUDY DESIGN Literature review. METHODS This review was conducted as part of a broader literature review related to HBHTC. We present results from population-based HIV seroprevalence surveys conducted between January 1984 and June 2013. RESULTS We identified eighteen population-based surveys describing uptake of results when testing or results were offered in the home, four of which compare home uptake to facility-based testing. All were from Sub-Saharan Africa. More people tested and received results in HBHTC compared to facility-based testing. Uptake of test results (72%) and the percentage of the population tested (59%) was highest when testing and the provision of results were provided in the home compared to the provision of results elsewhere (41% uptake; 37% population coverage), as well as mobile/facility-based testing and the provision of results (15% uptake; 13% population coverage). Providing results the same day as testing in HBHTC produces higher uptake (97% uptake; 74% population coverage) than delayed results. CONCLUSIONS Inclusion of home testing and provision of HIV results to participants in national population-based surveys in Sub-Saharan Africa is possible and should be prioritized. The timing and location of testing and the provision of results during HBHTC as part of population-based surveys affects uptake of testing and population coverage.
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Affiliation(s)
- M H Bateganya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - K M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - R K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - S M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
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Préau M, Lorente N, Sagaon-Teyssier L, Champenois K, Gall JML, Mabire X, Spire B, Mora M, Yazdanpanah Y, Suzan M. Factors associated with satisfaction with community-based non-medicalized counseling and testing using HIV rapid tests among MSM in France. AIDS Care 2016; 28:1240-8. [DOI: 10.1080/09540121.2016.1173636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brunie A, Wamala-Mucheri P, Akol A, Mercer S, Chen M. Expanding HIV testing and counselling into communities: Feasibility, acceptability, and effects of an integrated family planning/HTC service delivery model by Village Health Teams in Uganda. Health Policy Plan 2016; 31:1050-7. [PMID: 27045002 DOI: 10.1093/heapol/czw035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/13/2022] Open
Abstract
Improving HIV testing and counselling (HTC) requires a range of strategies. This article reports on HTC service delivery by Village Health Teams (VHTs) in Uganda in the context of a model integrating this new component into pre-existing family planning services. Eight health centres from matched pairs were randomly allocated to intervention or control. After being trained, 36 VHTs reporting to selected facilities in the intervention group started offering HTC along with family planning, while VHTs in the control group provided family planning only. Proficiency testing was conducted as external quality assurance. A survey of all 36 VHTs and 137 family planning clients in the intervention group and 119 clients in the control group and a review of record data were conducted after 10 months. Survey responses by VHTs and their clients in the intervention group demonstrate knowledge of counselling messages and safe testing. External quality assessment results provide additional evidence of competency. Eighty per cent of the family planning clients surveyed in the intervention group received an HIV test during the intervention; 27% of those were first-time testers. More clients had ever tested for HIV in the intervention group compared with the control; clients also retested more often. Findings indicate that this model is feasible and acceptable for expanding quality HTC into communities. This study was registered with ClinicalTrials.gov, number [NCT02244398].
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Affiliation(s)
- Aurélie Brunie
- FHI 360, 1825 Connecticut Ave NW, Washington, DC 20009, USA
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Osborn M, Obermeyer CM. Understanding client satisfaction with HIV testing and counseling services: a mixed-methods study in four African countries. AIDS Care 2016; 28:689-94. [PMID: 26872848 DOI: 10.1080/09540121.2016.1140889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper uses mixed methods to provide comparative evidence across four African countries and identify those aspects of the testing experience that are the most important components of clients' satisfaction with services. We analyze data from three sources: a survey of clients at health facilities that included closed-ended questions about specific services and interactions around testing; responses to open-ended questions about testing experiences that were part of the same survey; and semi-structured interviews with a subsample of respondents who described their experience of testing and being diagnosed with HIV. High levels of reported satisfaction are found in both the survey and interview. The critical factors contributing to client satisfaction included: the three C's of testing-counseling, consent, and confidentiality, client-provider interactions, convenience of location, "good services", and reliable test results.
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Affiliation(s)
- Michelle Osborn
- a Department of Anthropology , Union College , Schenectady , NY , USA
| | - Carla Makhlouf Obermeyer
- b Department of Epidemiology and Population Health , American University of Beirut , Beirut , Lebanon
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Evans C, Nalubega S, McLuskey J, Darlington N, Croston M, Bath-Hextall F. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2016; 13:130-286. [PMID: 26767819 DOI: 10.11124/jbisrir-2015-2345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/25/2015] [Accepted: 10/22/2015] [Indexed: 10/31/2022]
Abstract
BACKGROUND Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. OBJECTIVES The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. INCLUSION CRITERIA TYPES OF PARTICIPANTS All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). CONTEXT The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. SEARCH STRATEGY A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. METHODOLOGICAL QUALITY Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. DATA EXTRACTION Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. RESULTS This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues. CONCLUSIONS This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling. IMPLICATIONS FOR PRACTICE The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework. Nurses/midwives undertaking provider-initiated HIV testing and counseling require management support, ongoing training and adequate infrastructure/resources. Additional guidance is required on legal/ethical issues in testing of children and in third party disclosure. IMPLICATIONS FOR RESEARCH Operational research is required to determine an optimal skill mix and optimal methods of integrating provider-initiated HIV testing and counseling into existing work routines.
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Affiliation(s)
- Catrin Evans
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - Sylivia Nalubega
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - John McLuskey
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - Nicola Darlington
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | | | - Fiona Bath-Hextall
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
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Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature 2015; 528:S77-85. [PMID: 26633769 DOI: 10.1038/nature16044] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing modalities, characterizing community (home, mobile, index, key populations, campaign, workplace and self-testing) and facility approaches by population reached, HIV positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing and counselling had high coverage and uptake and identified HIV-positive people at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% confidence interval (CI) = 47-54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65-67%). Few studies evaluated HIV testing for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19-62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63-88%), indicating service gaps. Community testing with facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87-98%) and antiretroviral initiation (75%, 95% CI = 68-82%). Expanding home and mobile testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention, and decrease HIV burden.
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Ostermann J, Brown DS, Mühlbacher A, Njau B, Thielman N. Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania. HEALTH ECONOMICS REVIEW 2015; 5:60. [PMID: 26285777 PMCID: PMC4540717 DOI: 10.1186/s13561-015-0060-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/03/2015] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with individuals' willingness-to-accept (WTA) an HIV test in a general population sample and among two high-risk populations in Moshi, Tanzania. METHODS In total, 721 individuals, including randomly selected community members (N = 402), female barworkers (N = 135), and male Kilimanjaro mountain porters (N = 184), were asked in a double-bounded contingent valuation format if they would test for HIV in exchange for 2000, 5000 or 10,000 Shillings (approximately $1.30, $3.20, and $6.40, respectively). The study was conducted between September 2012 and February 2013. RESULTS More than one quarter of participants (196; 27 %) stated they would be willing to test for Tanzania Shilling (TSH) 2000, whereas one in seven (98; 13.6 %) required more than TSH 10,000. The average WTA estimate was TSH 4564 (95 % Confidence Interval: TSH 4201 to 4927). Significant variation in WTA estimates by gender, HIV risk factors and other characteristics plausibly reflects variation in individuals' valuations of benefits of and barriers to testing. WTA estimates were higher among males than females. Among males, WTA was nearly one-third lower for those who reported symptoms of HIV than those who did not. Among females, WTA estimates varied with respondents' education, own and partners' HIV testing history, and lifetime reports of transactional sex. For both genders, the most significant association was observed with respondents' perception of the accuracy of the HIV test; those believing HIV tests to be completely accurate were willing to test for approximately one third less than their counterparts. The mean WTA estimates identified in this study suggest that within the study population, incentivized universal HIV testing could potentially identify undiagnosed HIV infections at an incentive cost of $150 per prevalent infection and $1400 per incident infection, with corresponding costs per quality adjusted life year (QALY) gained of $70 for prevalent and $620 for incident HIV infections. CONCLUSIONS The results support the value of information about the accuracy of HIV testing, and suggest that relatively modest amounts of money may be sufficient to incentivize at-risk populations to test.
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Affiliation(s)
- Jan Ostermann
- Duke Global Health Institute, Duke University, Box 90392, 310 Trent Drive, Durham, NC 27701 USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC USA
- Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Derek S. Brown
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC USA
- Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Axel Mühlbacher
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC USA
- Institut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Bernard Njau
- Community Health Department, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Nathan Thielman
- Duke Global Health Institute, Duke University, Box 90392, 310 Trent Drive, Durham, NC 27701 USA
- School of Medicine, Duke University, Durham, NC USA
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McGovern ME, Marra G, Radice R, Canning D, Newell ML, Bärnighausen T. Adjusting HIV prevalence estimates for non-participation: an application to demographic surveillance. J Int AIDS Soc 2015; 18:19954. [PMID: 26613900 PMCID: PMC4662682 DOI: 10.7448/ias.18.1.19954] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/27/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION HIV testing is a cornerstone of efforts to combat the HIV epidemic, and testing conducted as part of surveillance provides invaluable data on the spread of infection and the effectiveness of campaigns to reduce the transmission of HIV. However, participation in HIV testing can be low, and if respondents systematically select not to be tested because they know or suspect they are HIV positive (and fear disclosure), standard approaches to deal with missing data will fail to remove selection bias. We implemented Heckman-type selection models, which can be used to adjust for missing data that are not missing at random, and established the extent of selection bias in a population-based HIV survey in an HIV hyperendemic community in rural South Africa. METHODS We used data from a population-based HIV survey carried out in 2009 in rural KwaZulu-Natal, South Africa. In this survey, 5565 women (35%) and 2567 men (27%) provided blood for an HIV test. We accounted for missing data using interviewer identity as a selection variable which predicted consent to HIV testing but was unlikely to be independently associated with HIV status. Our approach involved using this selection variable to examine the HIV status of residents who would ordinarily refuse to test, except that they were allocated a persuasive interviewer. Our copula model allows for flexibility when modelling the dependence structure between HIV survey participation and HIV status. RESULTS For women, our selection model generated an HIV prevalence estimate of 33% (95% CI 27-40) for all people eligible to consent to HIV testing in the survey. This estimate is higher than the estimate of 24% generated when only information from respondents who participated in testing is used in the analysis, and the estimate of 27% when imputation analysis is used to predict missing data on HIV status. For men, we found an HIV prevalence of 25% (95% CI 15-35) using the selection model, compared to 16% among those who participated in testing, and 18% estimated with imputation. We provide new confidence intervals that correct for the fact that the relationship between testing and HIV status is unknown and requires estimation. CONCLUSIONS We confirm the feasibility and value of adopting selection models to account for missing data in population-based HIV surveys and surveillance systems. Elements of survey design, such as interviewer identity, present the opportunity to adopt this approach in routine applications. Where non-participation is high, true confidence intervals are much wider than those generated by standard approaches to dealing with missing data suggest.
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Affiliation(s)
- Mark E McGovern
- Queen's Management School, Queen's University Belfast, Belfast, Northern Ireland, UK
- UKCRC Centre of Excellence for Public Health (NI), Belfast, UK
- Wellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa;
| | - Giampiero Marra
- Department of Statistical Science, University College London, London, UK
| | - Rosalba Radice
- Department of Economics, Mathematics and Statistics, Birkbeck, University of London, London, UK
| | - David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-Louise Newell
- Wellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Till Bärnighausen
- Wellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Moyer E. The Anthropology of Life After AIDS: Epistemological Continuities in the Age of Antiretroviral Treatment. ANNUAL REVIEW OF ANTHROPOLOGY 2015. [DOI: 10.1146/annurev-anthro-102214-014235] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Anthropologists working on HIV are increasingly reframing their research as taking place in “the age of treatment,” marking a shift from “the age of AIDS.” The age of treatment is characterized by the increasing biomedicalization of HIV, which has come about as a result of improved pharmaceutical and surveillance technologies and the presumption by international experts in global health that HIV could be eradicated in the near future through biomedical interventions. Despite this radical transformation, I argue that there are many important epistemological continuities for anthropologists researching HIV/AIDS in the twenty-first century. This review identifies such continuities between anthropological research conducted prior to and that conducted since the availability of life-saving treatment for HIV.
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Affiliation(s)
- Eileen Moyer
- Department of Anthropology, University of Amsterdam, 1001 NA Amsterdam, The Netherlands
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