African American patient experiences with a rapid HIV testing program in an urban public clinic

Association of social network characteristics with HIV knowledge, stigma, and testing: findings from a study of racial and ethnic minority women in a small Western city

Black and Latina women are disproportionately impacted by HIV/AIDS. Despite existing research linking social networks and HIV risk among men who have sex with men (MSM) and other high-risk populations, little research has examined how ethnic/racial minority women's social networks shape HIV prevention and intervention targets. Using interviews with a sample of 165 predominantly Black and Latina-identifying women from a small city in the Western U.S., this research examines the relationship between egocentric network characteristics and HIV knowledge, attitudes, and testing history. Results reveal that network characteristics play a significant role in shaping HIV-related knowledge, prejudice, and testing intention but not HIV testing history. Individual-level factors like homelessness and perceptions of testing barriers are more salient for explaining testing behaviors than network characteristics. Intervention efforts to improve knowledge and reduce prejudice among Black and Latina women may benefit from mobilizing network ties.

Acceptance of Opt-Out HIV Screening in Outpatient Settings in the United States: A Systematic Review and Meta-Analysis

OBJECTIVES

In the United States, about 15% of persons living with HIV infection do not know they are infected. Opt-out HIV screening aims to normalize HIV testing by performing an HIV test during routine medical care unless the patient declines. The primary objective of this systematic review and meta-analysis was to assess the acceptance of opt-out HIV screening in outpatient settings in the United States.

METHODS

We searched in PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published from January 1, 2006, through December 31, 2018, of opt-out HIV screening in outpatient settings. We collected data from selected studies and calculated for each study (1) the percentage of persons who were offered HIV testing, (2) the percentage of persons who accepted the test, and (3) the percentage of new HIV diagnoses among persons tested. We also collected information on the reasons given by patients for opting out. The meta-analysis used a random-effects model to estimate the average percentages of HIV testing offered, HIV testing accepted, and new HIV diagnoses.

RESULTS

We initially identified 6986 studies; the final analysis comprised 14 studies. Among the 8 studies that reported the size of the study population eligible for HIV screening, 71.4% (95% confidence interval [CI], 53.9%-89.0%) of the population was offered an HIV test on an opt-out basis. The test was accepted by 58.7% (95% CI, 47.2%-70.2%) of persons offered the test. Among 9 studies that reported data on new HIV diagnoses, 0.18% (95% CI, 0.08%-0.26%) of the persons tested had a new HIV diagnosis. Patients' most frequently cited reasons for refusal of HIV screening were that they perceived a low risk of having HIV or had previously been tested.

CONCLUSIONS

The rates of offering and accepting an HIV test on an opt-out basis could be improved by addressing health system and patient-related factors. Setting a working target for these rates would be useful for measuring the success of opt-out HIV screening programs.

HIV Testing Among Heterosexual Hispanic Women in South Florida

PURPOSE

The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women.

DESIGN

This study utilizes a cross-sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self-Care. The Social Cognitive Model (SCM) guided this study.

METHODS

Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression.

FINDINGS

The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it.

CONCLUSIONS

Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women.

CLINICAL RELEVANCE

Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women.

Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men

The present study examined how three psychosocial barriers-anticipated HIV stigma, HIV infectiousness-reduction beliefs, and optimism about available HIV treatments-related to HIV testing history and acceptance of an at-home HIV test among men who have sex with men. We also examined the mediating role of a variable that affects medical screening for other health conditions but has not yet been investigated in HIV contexts: the tendency to avoid psychologically threatening information. Volunteers completed a paper and pencil survey and were offered a free at-home HIV test during the 2015 Atlanta Pride Festival in Atlanta, GA. Anticipated HIV stigma, infectiousness beliefs, and treatment optimism were inconsistently related to HIV testing history and acceptance of an at-home HIV test, but all had direct effects on the desire to avoid HIV information. In a mediation model, each of these psychosocial barriers had indirect effects on both HIV testing outcomes via information avoidance. These findings suggest that information avoidance is an important proximal HIV testing barrier, thus providing a novel target for interventions and information campaigns.

Barriers and Facilitators to Interventions Improving Retention in HIV Care: A Qualitative Evidence Meta-Synthesis

Retention in HIV care is vital to the HIV care continuum. The current review aimed to synthesize qualitative research to identify facilitators and barriers to HIV retention in care interventions. A qualitative evidence meta-synthesis utilizing thematic analysis. Prospective review registration was made in PROSPERO and review procedures adhered to PRISMA guidelines. Nineteen databases were searched to identify qualitative research conducted with individuals living with HIV and their caregivers. Quality assessment was conducted using CASP and the certainty of the evidence was evaluated using CERQual. A total of 4419 citations were evaluated and 11 were included in the final meta-synthesis. Two studies were from high-income countries, 3 from middle-income countries, and 6 from low-income countries. A total of eight themes were identified as facilitators or barriers for retention in HIV care intervention: (1) Stigma and discrimination, (2) Fear of HIV status disclosure, (3) task shifting to lay health workers, (4) Human resource and institutional challenges, (5) Mobile Health (mHealth), (6) Family and friend support, (7) Intensive case management, and, (8) Relationships with caregivers. The current review suggests that task shifting interventions with lay health workers were feasible and acceptable. mHealth interventions and stigma reduction interventions appear to be promising interventions aimed at improving retention in HIV care. Future studies should focus on improving the evidence base for these interventions. Additional research is needed among women and adolescents who were under-represented in retention interventions.

Trends in HIV Testing among Adults in Georgia: Analysis of the 2011-2015 BRFSS Data

Georgia is ranked fifth highest among states for rates of human immunodeficiency virus (HIV) diagnosis. About 4% of persons living with HIV infection in the United States reside in Georgia, and almost 19% of these people do not know their HIV status. The present study examined the trends and associated factors of HIV testing among adults in Georgia between 2011 and 2015 by analyzing data of the Behavioral Risk Factor Surveillance System (BRFSS). A total of 31,094 persons aged ≥18 years were identified who responded to the question "Have you ever been tested for HIV?" Overall, there were 11,286 (44.2%) respondents who had been tested for HIV, compared to 19,808 (55.8%) who had not. There was a slight decrease in the percentage of respondents who have ever tested for HIV, from 45.6% in 2011 to 43.7% in 2015 (APC (annual percent change) = -0.98, not significant). Factors associated with HIV testing were being female (p = 0.004), black (p < 0.001), younger than 55 years (p < 0.001), single (p < 0.001), attaining education level above high school (p < 0.001), and earning annual income of $50,000 or less (p = 0.028). Overall in Georgia, there has been a slight decline in the temporal trend of HIV testing, and more than half of adults have never been tested for HIV. For reducing HIV transmission in Georgia, enhancing access and utilization of HIV testing should be a public health priority.

Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review

OBJECTIVE

To synthesize qualitative evidence on linkage to care interventions for people living with HIV.

DESIGN

Systematic literature review.

METHODS

We searched 19 databases for studies reporting qualitative evidence on linkage interventions. Data extraction and thematic analysis were used to synthesize findings. Quality was assessed using the Critical Appraisal Skills Programme tool and certainty of evidence was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach.

RESULTS

Twenty-five studies from 11 countries focused on adults (24 studies), adolescents (eight studies), and pregnant women (four studies). Facilitators included community-level factors (i.e., task shifting, mobile outreach, integrated HIV, and primary services, supportive cessation programs for substance users, active referrals, and dedicated case management teams), and individual-level factors (encouragement of peers/family and positive interactions with healthcare providers in transitioning into care). One key barrier for people living with HIV was perceived inability of providers to ensure confidentiality as part of linkage to care interventions. Providers reported difficulties navigating procedures across disparate facilities and having limited resources for linkage to care interventions.

CONCLUSION

Our findings extend the literature by highlighting the importance of task-shifting, mobile outreach, integrated HIV, and primary care services. Both community and individual-level factors may increase the feasibility and acceptability of HIV linkage to care interventions. These findings may inform policies to increase the reach of HIV services available in communities.

Routine HIV Screening in an Urban Community Health Center: Results from a Geographically Focused Implementation Science Program

OBJECTIVE

CDC has recommended routine HIV screening since 2006. However, few community health centers (CHCs) routinely offer HIV screening. Research is needed to understand how to implement routine HIV screening programs, particularly in medically underserved neighborhoods with high rates of HIV infection. A routine HIV screening program was implemented and evaluated in a Philadelphia, Pennsylvania, neighborhood with high rates of HIV infection.

METHODS

Implementation science is the study of methods to promote the integration of research findings and evidence into health-care policy and practice. Using an implementation science approach, the results of the program were evaluated by measuring acceptability, adoption, and penetration of routine HIV screening.

RESULTS

A total of 5,878 individuals were screened during the program. HIV screening was highly accepted among clinic patients. In an initial needs assessment of 516 patients, 362 (70.2%) patients reported that they would accept testing if offered. Routine screening policies were adopted clinic-wide. Staff trainings, new electronic medical records that prompted staff members to offer screening and evaluate screening rates, and other continuing quality-improvement policies helped promote screenings. HIV screening offer rates improved from an estimated 5.0% of eligible patients at baseline in March 2012 to an estimated 59.3% of eligible patients in December 2014. However, only 5,878 of 13,827 (42.5%) patients who were offered screening accepted it, culminating in a 25.2% overall screening rate. Seventeen of the 5,878 patients tested positive, for a seropositivity rate of 0.3%.

CONCLUSION

Routine HIV screening at CHCs in neighborhoods with high rates of HIV infection is feasible. Routine screening is an important tool to improve HIV care continuum outcomes and to address racial and geographic disparities in HIV infection.

Does the Centers for Disease Control and Prevention's Recommendation of Opt-Out HIV Screening Impact the Effect of Stigma on HIV Test Acceptance?

HIV/AIDS-related stigma is a key factor impeding patient utilization of HIV testing services. To destigmatize HIV testing, the Centers for Disease Control and Prevention recommended an 'opt-out' screening strategy aimed at all patients in all clinical settings, regardless of HIV risk. This study assessed whether opt-out screening as compared to opt-in screening was associated with increased uptake of HIV testing among patients with HIV/AIDS-related stigma concerns. This study included 374 patients attending two Los Angeles ambulatory care clinics. Stigma items were grouped into three constructs: Blame/isolation, abandonment, and contagion. Individuals endorsing the blame/isolation subscale (AOR = 0.52; 95 % CI 0.29-0.92; p\0.05) and abandonment subscale (AOR = 0.27; 95 % CI 0.13-0.59; p\0.01) were significantly less likely to accept an HIV test. Additionally, the opt-out model did not counter the negative effects of stigma on HIV test acceptance. These findings indicate that stigma remains a barrier to HIV testing, regardless of the opt-out screening approach.

Correlates of HIV testing among African American and Latino church congregants: the role of HIV stigmatizing attitudes and discussions about HIV

Faith-based organizations can be key settings in which to reach African Americans and Latinos for HIV prevention, but little is known regarding factors that predict congregants' HIV testing behaviors. We examined the extent to which sociodemographic factors, HIV-related cues to action (e.g., knowing someone who is HIV-positive), and the social climate surrounding HIV (stigma toward a hypothetical HIV-positive congregant, HIV-related discussions at church about abstinence, condoms, and testing) were associated with willingness to be tested in church and with ever having been tested among 1211 African American and Latino congregants. Multivariate analyses indicated that congregants were more open to church-based testing if they were younger and had discussed condoms at church. They were less open if they expressed stigmatizing attitudes toward a hypothetical congregant. Foreign-born Latinos with low English proficiency were more willing to be tested at church than were African Americans. Congregants were more likely to have ever been tested if they were younger, African American, female, or married; if they knew someone who was HIV-positive; and if they had discussed testing and condoms at church. They were less likely if they had discussed abstinence. Open dialogue around HIV may activate congregants to be more receptive to church-based prevention.

Oral rapid test: an alternative to traditional HIV screening in Chile

OBJECTIVE

To compare the sensitivity and specificity of an Oral Rapid Test (ORT) to that of the Enzyme-Linked Immunosorbent Assay (ELISA) for HIV testing in Santiago, Chile; to track the number of study participants returning for ELISA testing results; and to analyze the participants' perceptions of the ORT compared to the ELISA.

METHODS

A total of 497 people were recruited in Santiago, Chile: 153 had previously tested positive for HIV, and 344 were of unknown status. Participants were tested for HIV using both the ELISA and the ORT to examine and compare specificity and sensitivity. Qualitative data were collected from 22 participants to compare perceptions of the testing experience with ORT versus ELISA.

RESULTS

The ELISA reported 184 (37%) of the 497 participants as being "positive" for HIV antibodies; the ORT showed 181 (36.4%) as being "reactive" for HIV. The ORT showed a sensitivity of 98.4% (95.7%-99.9%, 95% Confidence Interval) and specificity of 100%. The Kappa test produced K = 0.983 (P < 0.0001). Of the 344 participants whose HIV status was unknown at the start of the study, 55 failed to return for their ELISA results. Participants positively perceived ORT as having reduced both waiting time and anxiety over obtaining their test results. ORT oral swabbing appeared more practical and less invasive than drawing blood for the ELISA.

CONCLUSIONS

The ORT and ELISA were statistically equal in specificity and sensitivity. ORT provides quicker results, potentially ensuring that more people receive them, and does not require handling of or exposure to potentially hazardous blood products.

Faith-based HIV prevention and counseling programs: findings from the Cincinnati census of religious congregations

Congregations are well positioned to address HIV in their communities, but their response to HIV has been mixed. An emerging literature describes HIV programming in urban, predominantly black congregations, but population-based data remain limited. This study examined the levels of HIV prevention and counseling programs and associated factors (e.g., religious, organizational) by using data from a phone census of congregations in the Greater Cincinnati area (N = 447). Over 10 % of congregations (36 % of Black Protestant and 5-18 % of other types of congregations) offered HIV education/prevention alone or in combination with counseling or with counseling and testing. Path analysis results showed notable significant (p < 0.05) total effects of theology-polity on HIV prevention/counseling programs, but these effects were fully mediated by other factors, including other community work and racial composition. The levels of HIV programming in this study were high by national standards, but further outreach is needed in high-risk African American communities.

What's God got to do with it? Engaging African-American faith-based institutions in HIV prevention

African-Americans are disproportionately infected and affected by HIV/AIDS. Although faith-based institutions play critical leadership roles in the African-American community, the faith-based response to HIV/AIDS has historically been lacking. We explore recent successful strategies of a citywide HIV/AIDS awareness and testing campaign developed in partnership with 40 African-American faith-based institutions in Philadelphia, Pennsylvania, a city with some of the USA's highest HIV infection rates. Drawing on important lessons from the campaign and subsequent efforts to sustain the campaign's momentum with a citywide HIV testing, treatment and awareness programme, we provide a road map for engaging African-American faith communities in HIV prevention that includes partnering with faith leaders, engaging the media to raise awareness, destigmatising HIV/AIDS and encouraging HIV testing, and conducting educational and HIV testing events at houses of worship. African-American faith-based institutions have a critical role to play in raising awareness about the HIV/AIDS epidemic and reducing racial disparities in HIV infection.

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.