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Khan AA, Abdullah M, Khan R, Kazmi T, Sultan F, Aamir S, Khawaja AA, Khan A. Pakistan's national COVID-19 response: lessons from an emergent response to the pandemic. Front Public Health 2024; 12:1379867. [PMID: 39161854 PMCID: PMC11330871 DOI: 10.3389/fpubh.2024.1379867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/15/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction In 2020, Pakistan faced the formidable challenge of the COVID-19 pandemic with an existing yet disjointed healthcare infrastructure, that included by over 18,000 public and an estimated 75,000 private health facilities and some elements of an epidemic surveillance and response system. This descriptive study examines how Pakistan developed a COVID-19 response, driven by establishing a central coordination and decision-making mechanism to overcome these systemic challenges. Methods The study is based on interviews and interactions of the many actors in the response by the authors, who also participated in nearly all proceedings of the National Command and Operation Centre (NCOC) and many of the National Coordination Committee (NCC). This information is supplemented by reviewing documents, reports, news items, media and social media, and journal articles. Results The study highlights the critical role of political arrangement, where the NCC, comprising of ministers, bureaucrats, and military personnel, facilitated federal and provincial integration. The NCC found resources and set policy. Its direction was implemented by the NCOC, a top-down yet inclusive platform, integrated political, military, and civil society actors, to ensure cohesive decision-making and implementation. It provided technical guidance, harnessed data for strategic decisions and held implementers accountable. At its peak, the NCOC boasted nearly 300 personnel, including high-ranking military officers, a stark contrast to the limited staffing in most ministries. In addition, the response's success is attributed to the perception of COVID-19 as an existential threat, leading to unprecedented collaboration and decisive actions that were enforced authoritatively. Conclusion Pakistan's experience offers valuable insights for proactive management of health emergencies in resource-limited settings. It underscores the necessity for inter-sectoral dialog and data-driven policy implementation, especially in the context of political economies where activity-driven governance often overshadows objective-driven policy execution. However, the lessons from the COVID-19 response, including a blueprint for future epidemic responses and lessons for use of data and evidence in developing country health systems, if not institutionalized, risk being lost in the post-pandemic era.
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Affiliation(s)
- Adnan Ahmad Khan
- Research and Development Solutions (RADS), Islamabad, Pakistan
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | | | - Romesa Khan
- Research and Development Solutions (RADS), Islamabad, Pakistan
| | | | - Faisal Sultan
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | | | - Aamir Ashraf Khawaja
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Ayesha Khan
- Akhter Hameed Khan Foundation, Islamabad, Pakistan
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Starks TJ, Kyre K, Castiblanco J, Parker JN, Kahle E, Stephenson R, Cain D. Comparing Repeated (Annual) Couples HIV Testing and Counseling to Individual HIV Testing and Counseling Among Male Couples at High Risk of HIV Infection: Protocol for a Randomized Control Trial. JMIR Res Protoc 2024; 13:e53023. [PMID: 38349737 PMCID: PMC10900088 DOI: 10.2196/53023] [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: 09/22/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Couples HIV testing and counseling (CHTC) is now a standard of care prevention strategy recommended by the Centers for Disease Control and Prevention for sexual minority men (SMM) in relationships. Despite standard recommendations that couples complete CHTC every 6-12 months, no study has empirically evaluated the effects associated with CHTC retesting. OBJECTIVE This study aims to understand the benefits associated with continued dyadic engagement in the HIV prevention continuum through routine CHTC retesting, which is of particular importance for emerging-adult SMM in relationships who use drugs. METHODS Eligible couples for this CHTC retesting trial must already be enrolled in the 4Us trial, where they completed a CHTC session after their baseline survey. The purpose of the original 4Us trial was to test the efficacy of 2 intervention components for CHTC: a communication skills training video and a substance use module. Couples were eligible for the original 4Us trial if they identified as cisgender male, were in a relationship for 3 months or longer, were aged 17 years or older, and communicated in English. At least 1 partner had to be aged 17-29 years, report HIV negative or unknown serostatus, report use of at least 1 drug (cannabis, cocaine or crack, crystal methamphetamine, ketamine, gamma-hydroxybuterate [GHB], psychedelics, ecstasy, prescription medication misuse, opiates, and nitrates) use, and engage in condomless anal sex (CAS) acts with a casual partner or have a main partner who is nonmonogamous or serodiscordant. Those who complete the 4Us 12-month follow-up and remain in a relationship with the partner they participated in 4Us with are offered the opportunity to participate in this CHTC retesting trial. Those consenting are randomized to either CHTC retesting or individual HIV testing. Follow-up assessments are conducted 3 and 6 months after randomization to evaluate the effects of repeat CHTC on 2 primary outcomes: (1) CAS with a casual partner in the absence of preexposure prophylaxis (PrEP), and (2) CAS with a serodiscordant main partner who is not virally suppressed or concurrent CAS between main and casual partners in the absence of PrEP. RESULTS The CHTC retesting trial launched in January 2023, and enrollment is ongoing. As of February 2024, the study had enrolled 106 eligible participants (n=53 couples). CONCLUSIONS Findings from this CHTC retesting study will contribute to knowledge about the benefits associated with regular (repeated) CHTC testing versus routine individual HIV testing for SMM in relationships. The results of this trial will inform CHTC retesting guidance. TRIAL REGISTRATION ClinicalTrials.gov NCT05833074; htps://www.clinicaltrials.gov/study/NCT05833074. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53023.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
- Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, New York, NY, United States
| | - Kory Kyre
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Juan Castiblanco
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Jayelin N Parker
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Erin Kahle
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
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Khan AA, Khan R, Khawaja Z, Ibrahim M, Shaheen Z, Khan A. Exploring the typology of decision-makers, institutions, and incentives that shape health decisions in Pakistan and insulate decision makers from citizens feedback. Front Public Health 2023; 11:1253798. [PMID: 38145073 PMCID: PMC10748403 DOI: 10.3389/fpubh.2023.1253798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction In developing countries such as Pakistan, program and policies underperform in providing public good as weak institutions lead to decisions that are unresponsive to citizens and are driven by personal motivations of the incumbents. We describe the decision-making processes in the health sector through the framework of "Public Choice" theory which posits how individual motives shape institutional performance and direction. Methods We conducted 84 qualitative interviews with five types of stakeholders: politicians, senior and mid-level bureaucrats, donors, public health experts and media personnel spanning 2 periods over a decade. The initial interviews were conducted during 2013-2015 period and a case study on decision-making during the COVID-19 response was added in 2020-2022 period. Findings Most new ideas originate from top political leadership, guided by personal agendas or political expediency. Senior bureaucrats implement politicians' agenda and mid-level officials maintain the status quo and follow established "authority." Since officials' performance, promotions, transfers, and the rare dismissals are based on tenure deviations rather than work performance, individuals and institutions are reluctant to take initiative without "consensus" among their colleagues often leading to inaction or delays that obviate initiative and reform. The public sector lacks institutional memory, formal information gathering, and citizen engagement, impacting public goods, health services, and policies. Media and donor personnel are important influencers. However, media mostly report only "hot issues" in health, with short publication and reader attention cycles. Donor personnel are the most likely to follow evidence for decision making, albeit while following their institutional priorities determined centrally. The COVID-19 response is presented as a contrast from usual practices, where evidence was used to guide decisions, as the pandemic was perceived as a national threat by the highest leadership. Conclusion Absence of citizen feedback and formal systems for evidence gathering and processing leads to decisions that neglect the needs of those they serve, prioritizing personal or political gains and perpetuating the status quo. However, the COVID-19 pandemic emphasized the importance of evidence-based decision-making and offers valuable lessons for reforming decision-making processes.
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Affiliation(s)
- Adnan A. Khan
- Research and Development Solutions, Islamabad, Pakistan
- Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Romesa Khan
- Research and Development Solutions, Islamabad, Pakistan
| | | | | | | | - Ayesha Khan
- Akhter Hameed Khan Foundation, Islamabad, Pakistan
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Borgstede SJ, Elly A, Helova A, Kwena Z, Darbes LA, Hatcher A, Thirumurthy H, Owino G, Pisu M, Owuor K, Braun T, Turan JM, Bukusi EA, Nghiem VT. Cost of Home-Based Couples Human Immunodeficiency Virus Counseling and Testing and Human Immunodeficiency Virus Self-Testing During Pregnancy and Postpartum in Southwestern Kenya. Value Health Reg Issues 2023; 34:125-132. [PMID: 36709657 PMCID: PMC9992305 DOI: 10.1016/j.vhri.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/05/2022] [Accepted: 11/30/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Home-based couples HIV testing and counseling and HIV self-testing (HIVST) for pregnant women can promote HIV status disclosure and male partner testing; however, cost data are lacking. We examined a home-based couples intervention (HBCI) and HIVST intervention costs per couple (unit cost) during pregnancy and postpartum in Kenya. METHODS This randomized controlled trial is comparing HBCI and HIVST for couples among pregnant women attending antenatal care clinics in two counties in southwestern Kenya. We used micro-costing to estimate the unit cost per couple receiving the intervention as the total of direct and indirect costs for each study arm in 2019 US$. We used a one-month window to conduct a time and motion study to determine personnel effort and resources. We then compared the unit cost by arm, identified key cost drivers, and conducted sensitivity analyses for cost uncertainties. RESULTS At base-case, the unit cost was $129.01 and $41.99, respectively, for HBCI and HIVST. Personnel comprised half of the unit cost for both arms. Staff spent more time on activities related to participant engagement in HBCI (accounting for 6.4% of the unit cost) than in HIVST (2.3%). Staff training was another key cost driver in HBCI (20.1% of the unit cost compared to 12.5% in HIVST). Sensitivity analyses revealed that the unit cost ranges were $104.64-$154.54 for HBCI and $30.49-$56.59 for HIVST. CONCLUSIONS Our findings may guide spending decisions for future HIV prevention and treatment programs for pregnant couples in resource-limited settings such as Kenya.
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Affiliation(s)
- Seth J Borgstede
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Assurah Elly
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anna Helova
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary Kwena
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lynae A Darbes
- Center for Sexuality and Health Disparities, and Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Abigail Hatcher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Owino
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maria Pisu
- Department of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin Owuor
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Bukusi
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Van T Nghiem
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
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Ahmed M, Seid S, Yimer A, Seid A, Ahmed O. Uptake of premarital HIV testing and associated factors among women who had autonomous versus non autonomous marriage in Ethiopia: A nationwide study. PLoS One 2022; 17:e0271879. [PMID: 35980877 PMCID: PMC9387857 DOI: 10.1371/journal.pone.0271879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Premarital HIV testing offers an opportunity where prospective couples can know their HIV status before marriage to prevent both heterosexual and vertical transmission of HIV. Therefore, this study aimed to determine whether there is any significant difference in the prevalence of premarital HIV testing among women who had autonomous versus non-autonomous marriage, and to investigate the factors associated with premarital HIV testing among women who had autonomous versus non-autonomous marriage in Ethiopia. Methods Data were extracted from 2016 Ethiopia Demographic and Health Survey dataset and analyzed by using SPSS version 20. Frequencies and weighted percentage of the variables, and second-order Rao-Scott statistic were computed. Multivariable logistic regression analysis was used to identify factors between the two groups. An adjusted odds ratio with 95% confidence interval was considered to state statistically significant associations. Result From 9602 included sample, 4,043 (42.1%) of the women had autonomous marriage, and 5,559(57.9%) of the women had non-autonomous marriage. The prevalence of premarital HIV testing in Ethiopia among women who had autonomous marriage was 30.5% (95% CI: 27.7–33.4%) compared to 20.6% (95% CI: 18.5–22.8) among women who had a non-autonomous marriage. No differences in associated factors were found between women who had autonomous versus non autonomous marriage to uptake HIV testing. In both groups, residence in rural area, education attainment (primary, secondary, higher), media access, being rich and richest, knowing the places for HIV testing, chewing chat, and drinking alcohol were significantly predicts premarital HIV testing. Conclusion The study indicated that 10% more women in autonomous marriage tested for HIV relative to non-autonomous women whilst being an urban resident, educated, having access to media, household wealth and knowledge of testing facilities significantly predict HIV testing among women in Ethiopia. The paper recommends the Ethiopian government shall expand access to education among women while improving their access to media to enhance their socioeconomic wellbeing and health. Furthermore, it is better to inspire women to undergo autonomous marriage by fostering education in the community to enhance premarital HIV testing.
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Affiliation(s)
- Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
- * E-mail:
| | - Seada Seid
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Ali Yimer
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abdu Seid
- Department of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Ousman Ahmed
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Abdool Karim SS, Baxter C, Abdool Karim Q. Advancing HIV prevention using tenofovir-based pre-exposure prophylaxis. Antivir Ther 2022; 27:13596535211067589. [DOI: 10.1177/13596535211067589] [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
Tenofovir-based pre-exposure prophylaxis (PrEP) revolutionized the global HIV prevention landscape. Prior to the proof-of concept trial in 2010, which demonstrated that tenofovir (TFV) could prevent sexual transmission of HIV, prevention options were largely limited to behavior change, condoms, and circumcision. Several subsequent studies evaluating oral tenofovir disoproxil fumarate (TDF) or the TDF/emtricitabine (FTC) combination as PrEP for HIV prevention provided evidence for regulatory approval and inclusion in national and international guidelines. By 2021, 1.5 million people had initiated oral tenofovir-based PrEP, contributing to declines in HIV incidence in some regions. Here we reflect on how oral tenofovir-based PrEP became an important component of combination HIV prevention programs across the globe.
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Affiliation(s)
- Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Pan Y, Metsch LR, Gooden LK, Mantero AMA, Feaster DJ. The Disaggregated Repeated Measures Design: A Novel Approach to Assess Sexual Risk Behaviors. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:311-322. [PMID: 32458301 PMCID: PMC7688506 DOI: 10.1007/s10508-019-01582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 09/27/2019] [Accepted: 10/31/2019] [Indexed: 06/11/2023]
Abstract
Although numerous studies have examined sexual and substance use behaviors that put people at risk for sexually transmitted infections including HIV, most focus on an overall measure of aggregate risk or a few simple and particular subtypes of sexual acts assessed in separate analyses. In this article, we introduce a more sensitive approach to assess how the relative characteristics of sex acts may determine the level of risk in which an individual chooses to engage. Project AWARE, a randomized clinical trial conducted among 5012 patients in nine STD clinics across the U.S., is used to illustrate the approach. Our study was guided by two aims: (1) describe a new approach to examine the count of sexual acts using a disaggregated repeated measures design and (2) show how this new approach can be used to evaluate interactions among different categories of sexual risk behaviors and other predictors of interest (such as gender/sexual orientation). Profiles of different subtypes of sexual acts in the past 6 months were assessed. Potential interactions of the characteristics associated with each subtype which resulted in up to 48 distinct subtypes of sexual risk behaviors-sex with a primary/non-primary partner; partner's HIV status; vaginal/anal sex; condom use; and substance use before or during sex act-can be examined. Specifically, we chose condom use and primary and non-primary status of partner as an application in this paper to illustrate our method. There were significantly more condomless sex acts (M = 23, SE = 0.9) and sex acts with primary partners (M = 27.1, SE = 0.9) compared to sex acts with condoms (M = 10.9, SE = 0.4, IRR = 2.10, 95% CI 1.91-2.32, p < .001) and sex acts with non-primary partner (M = 10.9, SE = 0.5, IRR = 2.5, 95% CI 2.33-2.78, p < .001). In addition, there were significant differences for the count of sexual risk behaviors among women who have sex with men (WSM), men who have sex with women (MSW) and men who have sex with men (MSM) for sex acts with and without condom use, primary and non-primary partner, and their interaction (ps = .03, < .0001, and .001, respectively). This approach extends our understanding of how people make choices among sexual behaviors and may be useful in future research on disaggregated characteristics of sex acts.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th St., Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alejandro Max Antonio Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th St., Miami, FL, 33136, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th St., Miami, FL, 33136, USA
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Factors associated with premarital HIV testing among married women in Ethiopia. PLoS One 2020; 15:e0235830. [PMID: 32745083 PMCID: PMC7398550 DOI: 10.1371/journal.pone.0235830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/24/2020] [Indexed: 01/07/2023] Open
Abstract
Background Premarital HIV testing is the key entry point in prevention, care, treatment, and support services, in which people learn their HIV status and its implications to make informed decisions about their health. This study was, therefore, conducted to identify factors associated with premarital HIV testing among married women in Ethiopia. Methods A cross-sectional study design was used, and secondary data analysis was done using 2016 Ethiopian demographic health survey (EDHS). Two-stage stratified cluster sampling technique was used. The data were analyzed by using SPSS version 20. Frequencies and weighted percentage of the variables, and second-order Rao-Scott statistic were computed. Multivariate logistic regression analysis was performed to control confounders and to identify predictors of premarital HIV testing. Adjusted odds ratio with 95% confidence interval was considered to declare statistically significant associations. Result The total sample comprised 9602 married women. In this study, the odds of premarital HIV testing were associated with being urban residents (AOR: 1.81; 95% CI: 2.74–5.20), attended primary education (AOR:1.54; 95%:1.27–1.87), secondary education (AOR:2.34; 95% CI:1.70–3.23), higher education (AOR:2.92; 95% CI:1.90–4.50), access to media (AOR: 1.44; 95% CI:1.20–1.76), being rich (AOR: 1.52; 95%CI:1.12–2.07), andrichest (AOR: 1.67;95%CI:1.15–2.44), known the place of HIV testing (AOR: 4.95; 95% CI:3.44–7.11), discriminatory attitude to PLHIV (AOR: 1.47; 95%CI:1.23–1.76), being khat chewer(AOR: 1.60;95%CI:1.11–2.31), and alcohol drinker (AOR: 1.55; 95% CI:1.27–1.90). Conclusion It is possible to conclude that being urban resident, attending education (primary, secondary, higher), media access, improved wealth index, knowing the places for HIV testing, chewing khat, drinking alcohol, and having discriminatory attitude towards PLHIV were positively associated with premarital HIV testing. The Ethiopian government needs to step up efforts to expand education for all Women. Advancing access to HIV testing for rural women may also increase premarital HIV testing services uptake. Further qualitative researches need to be done to assess the relationship between discriminatory attitude towards PLHIV and premarital HIV testing.
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Lott BE, Trejo MJ, Baum C, McClelland DJ, Adsul P, Madhivanan P, Carvajal S, Ernst K, Ehiri J. Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC Public Health 2020; 20:654. [PMID: 32393218 PMCID: PMC7216595 DOI: 10.1186/s12889-020-08777-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work. METHODS A systematic search of literature was conducted in PubMed, Web of Science, Embase, and CINAHL databases through May 2019. Screening and data charting were performed by two independent reviewers. Intervention studies measuring changes to uptake in screening among women in SSA were included, with no restriction to intervention type, study setting or date, or participant characteristics. Intervention type and implementation strategies were described using behavioral constructs from the IBM. RESULTS Of the 3704 citations the search produced, 19 studies were selected for inclusion. Most studies were published between 2014 and 2019 (78.9%) and were set in Nigeria (47.4%) and South Africa (26.3%). Studies most often assessed screening with Pap smears (31.6%) and measured uptake as ever screened (42.1%) or screened during the study period (36.8%). Education-based interventions were most common (57.9%) and the IBM construct of knowledge/skills to perform screening was targeted most frequently (68.4%). Willingness to screen was high, before and after intervention. Screening coverage ranged from 1.7 to 99.2% post-intervention, with six studies (31.6%) reporting a significant improvement in screening that achieved ≥60% coverage. CONCLUSIONS Educational interventions were largely ineffective, except those that utilized peer or community health educators and mHealth implementation strategies. Two economic incentivization interventions were moderately effective, by acting on participants' instrumental attitudes, but resulted in screening coverage less than 20%. Innovative service delivery, including community-based self-sampling, acted on environmental constraints, striving to make services more available, accessible, and appropriate to women, and were the most effective. This review demonstrates that intent to perform screening may not be the major determinant of screening behavior, suggesting other theoretical frameworks may be needed to more fully understand uptake of cervical screening in sub-Saharan Africa, particularly for health systems change interventions.
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Affiliation(s)
- Breanne E Lott
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
| | - Mario J Trejo
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Christina Baum
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - D Jean McClelland
- Health Sciences Library, University of Arizona, 1501 N Campbell Ave Ward 6, Tucson, AZ, 85724, USA
| | - Prajakta Adsul
- School of Medicine and Cancer Center, University of New Mexico, MSC08 4720, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.,College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.,Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore, 560021, India
| | - Scott Carvajal
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Kacey Ernst
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - John Ehiri
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
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HIV Prevalence and Factors Influencing the Uptake of Voluntary HIV Counseling and Testing among Older Clients of Female Sex Workers in Liuzhou and Fuyang Cities, China, 2016-2017: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9634328. [PMID: 32185227 PMCID: PMC7060410 DOI: 10.1155/2020/9634328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/22/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022]
Abstract
Objective To compare the prevalence of HIV and associated factors for participating HIV voluntary counseling and testing (VCT) among older clients of female sex workers (CFSWs) in Liuzhou City and Fuyang City in China. Methods A cross-sectional study was conducted and the study employed 978 male CFSWs, aged 50 years and above from October 2016 to December 2017. All participants were required to complete a questionnaire and provide blood samples for HIV testing. Multivariate logistic regression analysis was used to analyze the influential factors of using VCT program and tested for HIV. Results The HIV infection prevalence rate was 1.2% and 0.5%, while 52.3% and 54.6% participants had ever utilized VCT service and tested for HIV in Liuzhou City and Fuyang City, respectively. The older CFSWs who ever heard of VCT program were more likely to uptake VCT program in both cities (ORLiuzhou = 2.224, ORFuyang = 2.421). Participants, whose marital status was married or cohabiting (ORLiuzhou = 0.548, ORFuyang = 0.495), who have stigma against individuals who are living with HIV/AIDS (ORLiuzhou = 0.273, ORFuyang = 0.371), whose monthly income is more than 500 yuan (ORLiuzhou = 0.622, ORFuyang = 0.600), and whose age is more than 60 years old (ORLiuzhou = 0.639, ORFuyang = 0.554), were less likely to visit VCT clinics. Those who are worried about HIV-infected participants were more likely to utilize VCT services in Fuyang City (AOR = 1.838, 95%CI : 1.146‐2.948). Conclusion Combine strategy will be needed to promote the utilization of VCT service, based on the socioeconomic characteristics of older male CFSWs in different cities of China.
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Mugabe D, Bhatt N, Carlucci JG, Gudo ES, Gong W, Sidat M, Moon TD. Self-reported non-receipt of HIV test results: A silent barrier to HIV epidemic control in Mozambique. PLoS One 2019; 14:e0224102. [PMID: 31639164 PMCID: PMC6804976 DOI: 10.1371/journal.pone.0224102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/05/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction People living with HIV (PLHIV) and who are aware of their HIV status can access and benefit from antiretroviral therapy (ART) with subsequent individual and public health benefits; however, many PLHIV are unaware of their HIV status. We assessed the magnitude and determinants of self-reported non-receipt of HIV test results in adults aged 15–59 years old in Mozambique. Methods We performed a secondary analysis of data from the 2015 Mozambique Immunization indicators, Malaria and HIV/AIDS (IMASIDA 2015). Eligible adults (15–59 years) from each selected household were interviewed and data on sociodemographic characteristics, HIV knowledge, attitudes and behaviors, and HIV testing history were collected. Multivariable logistic regression assessed factors associated with self-reported non-receipt of HIV test results. Population representative estimates were calculated. Results 13,028 (90.8%) of 14,343 eligible participants were interviewed. A total of 6,654 (51.1%) respondents had previously been tested for HIV and were included in the analysis. Of these, 308 (4.6%; 95% CI: 3.70–5.77) self-reported not having received HIV test results. In the multivariable analysis, previous sexually transmitted infection (aOR: 2.76; 95% CI: 1.44–5.31), HIV stigmatizing attitudes (aOR: 1.96; 95% CI: 1.14–3.37), and lack of decision-making power towards health care seeking (aOR: 2.51; 95% CI: 1.39–4.52) were associated with non-receipt of HIV test results. Whereas, secondary or higher education (aOR: 0.25; 95% CI: 0.12–0.54), higher HIV knowledge (aOR: 0.47; 95% CI: 0.26–0.86), and age between 30–34 and 35–39 years old (aOR 0.47; 95% CI: 0.28–0.80; and aOR: 0.49; 95% CI: 0.27–0.90, respectively), were associated with receipt of HIV test results. Conclusions In this nationally representative survey, self-reported non-receipt of HIV test results was high and of public health relevance. These findings suggest adaptation of HIV counseling and testing programs emphasizing individualized approaches that target the youngest, least educated and the poorest individuals, especially those living in rural areas.
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Affiliation(s)
- Didier Mugabe
- National Institute of Health of Mozambique, Marracuene, Maputo, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Nilesh Bhatt
- National Institute of Health of Mozambique, Marracuene, Maputo, Mozambique
| | - James G. Carlucci
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Eduardo S. Gudo
- National Institute of Health of Mozambique, Marracuene, Maputo, Mozambique
| | - Wu Gong
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Troy D. Moon
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Gong E, de Walque D, Dow WH. Coping with risk: Negative shocks, transactional sex, and the limitations of conditional cash transfers. JOURNAL OF HEALTH ECONOMICS 2019; 67:102219. [PMID: 31437666 DOI: 10.1016/j.jhealeco.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 05/31/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
Transactional sex is an important risk-coping mechanism and a leading contributor to the HIV/AIDS epidemic in sub-Saharan Africa. We use data from a conditional cash transfer (CCT) experiment in rural Tanzania designed to incentivize safer sexual behavior by conditioning transfers on testing negative for sexually transmitted infections (STIs). For women, we find that negative shocks measured by food insecurity lead to a 36% increase in STIs and increases in self-reported risky sexual behavior. We find no significant effects of negative shocks on either STIs or self-reported sexual behavior for men. This CCT design did not appear to mitigate the behavioral response to shocks that we document in women. We propose that this finding can be explained by binding credit constraints and the relatively infrequent timing of the CCTs. When women experience a negative shock, cash needs are immediate, while transfers linked to a CCT are paid out in a specific point in time. If women are unable to access credit during a shock, they may resort to transactional sex even if they face monetary incentives to do otherwise.
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Abstract
Voluntary counselling and testing (VCT) for HIV has been promoted as a strategy to prevent HIV pandemics by changing sexual behaviour. Despite the provision of VCT in countries with generalized or high-burden epidemics, including Nigeria, the extent of its influence on behavioural change remains a conjecture. The main objective of this study was to examine the influence of HIV VCT on sexual behaviour changes among youths in Nigeria. The study utilized 2013 Nigeria Demographic and Health Survey (NDHS) data. Data were analysed from a nationally representative sample drawn from 8046 females and 6031 males aged 15-24 giving a total sample of 14,077 never-married youths. Descriptive and analytical analyses were carried out, including multivariate logistic regression. The study found a low uptake of HIV VCT and regional variation in behavioural changes between female and male youths. Voluntary HIV counselling and testing was found to be a protective factor for condom use at last sex for female youths, but significantly reduced the likelihood of primary sexual abstinence for both females and males, as well as having a single sexual partner for female youths. After controlling HIV VCT with other variables, certain socioeconomic factors were found to be significantly associated with behavioural changes. Thus, the attitudes of most Nigerian youths towards voluntary HIV counselling and testing needs to be improved through socioeconomic factors for healthy sexual activity. To achieve this, government and non-governmental organizations, as well as religious leaders and policymakers, should engage in appropriate and long-term activities directed at the sexual health needs of never-married youths, through voluntary HIV counselling and testing, to encourage them to change their sexual behaviour.
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Duflo E, Dupas P, Ginn T, Barasa GM, Baraza M, Pouliquen V, Sharma V. HIV prevention among youth: A randomized controlled trial of voluntary counseling and testing for HIV and male condom distribution in rural Kenya. PLoS One 2019; 14:e0219535. [PMID: 31361767 PMCID: PMC6667138 DOI: 10.1371/journal.pone.0219535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Voluntary Counseling and Testing for HIV (VCT) and increasing access to male condoms are common strategies to respond to the HIV/AIDS pandemic. Using biological and behavioral outcomes, we compared programs to increase access to VCT, male condoms or both among youth in Western Kenya with the standard available HIV prevention services within this setting. DESIGN A four arm, unblinded randomized controlled trial. METHODS The sample includes 10,245 youth aged 17 to 24 randomly assigned to receive community-based VCT, 150 male condoms, both VCT and condoms, or neither program. All had access to standard HIV services available within their communities. Surveys and blood samples for HSV-2 testing were collected at baseline (2009-2010) and at follow up (2011-2013). VCT was offered to all participants at follow up. HSV-2 prevalence, the primary outcome, was assessed using weighted logistic regressions in an intention-to-treat analysis. RESULTS For the 7,565 respondents surveyed at follow up, (effective tracking rate = 91%), the weighted HSV-2 prevalence was similar across groups (control group = 10.8%, condoms only group = 9.1%, VCT only group = 10.2%, VCT and condoms group = 11.5%). None of the interventions significantly reduced HSV-2 prevalence; the adjusted odds ratios were 0.87 (95% CI: 0.61-1.25) for condoms only, 0.94 (95% CI: 0.64-1.38) for VCT only, and 1.12 (95% CI: 0.79-1.58) for both interventions. The VCT intervention significantly increased HIV testing (adj OR: 3.54, 95% CI: 2.32-5.41 for VCT only, and adj OR: 5.52, 95% CI: 3.90-7.81 for condoms and VCT group). There were no statistically significant effects on risk of HIV, or on other behavioral or knowledge outcomes including self-reported pregnancy rates. CONCLUSION This study suggests that systematic community-based VCT campaigns (in addition to VCT availability at local health clinics) and condom distribution are unlikely on their own to significantly reduce the prevalence of HSV-2 among youth.
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Affiliation(s)
- Esther Duflo
- Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | | | - Thomas Ginn
- Stanford University, Stanford, CA, United States of America
| | | | | | | | - Vandana Sharma
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Narin P, Yamamoto E, Saw YM, Net N, Inthaphatha S, Kariya T, Hamajima N. Factors associated with HIV testing among the general male population in Cambodia: A secondary data analysis of the Demographic Health Survey in 2005, 2010, and 2014. PLoS One 2019; 14:e0219820. [PMID: 31318928 PMCID: PMC6638958 DOI: 10.1371/journal.pone.0219820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 07/02/2019] [Indexed: 12/28/2022] Open
Abstract
In Cambodia, the human immunodeficiency virus (HIV) is predominantly transmitted between spouses and casual partners, with men having higher mortality and morbidity from HIV infection than women due to lesser access to healthcare services and antiretroviral therapy. This study aimed to identify the rate of HIV testing and barriers to HIV testing among the general male population in Cambodia. We analyzed secondary data of men who underwent HIV testing at Voluntary Confidential Counseling and Testing (VCCT) sites in 2006–2017 and of male participants in the Cambodia Demographic and Health Survey (CDHS) in 2005, 2010, and 2014. The number of men who underwent HIV testing at the VCCT sites increased during 2006–2010 and decreased during 2012–2015. CDHS data showed that the lifetime prevalence of HIV testing among men aged 15–49 years gradually increased from 14.7% in 2005 to 36.4% in 2014. Multivariate analysis revealed nine factors associated with a higher lifetime prevalence of HIV testing including: seven sociodemographic factors, namely CDHS year (2010 and 2014), age groups (20–35 and 36–49 years), urban residence, higher education, higher wealth index, having occupations other than agriculture, ever-married status (married and widowed/divorced); and two factors of HIV risk behavior, namely two or more lifetime sexual partners and condom use during the last sexual intercourse. To our knowledge, this is the first study that assessed factors associated with the lifetime prevalence of HIV testing among the general male population in Cambodia. The factors were mostly sociodemographic factors, and no factors were related to condom use, or the diagnosis or symptoms of sexually transmitted infections (STIs). These results suggest that reproductive health education at primary schools and strengthening of healthcare provider-initiated testing and counseling for patients with STIs are highly needed in Cambodia.
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Affiliation(s)
- Piseth Narin
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- National AIDS Authority, Phnom Penh, Cambodia
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ny Net
- Department of International Cooperation, Ministry of Health, Phnom Penh, Cambodia
| | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Masyuko SJ, Cherutich PK, Contesse MG, Maingi PM, Wamuti BM, Macharia PM, Bukusi DE, Otieno FA, Spiegel HML, Dunbar MD, Golden MR, Richardson BA, Farquhar C. Index participant characteristics and HIV assisted partner services efficacy in Kenya: results of a cluster randomized trial. J Int AIDS Soc 2019; 22 Suppl 3:e25305. [PMID: 31321887 PMCID: PMC6639668 DOI: 10.1002/jia2.25305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/09/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION We have previously demonstrated that assisted partner services (aPS) increases HIV testing and case finding among partners of persons living with HIV (PLHIV) in a cluster randomized trial in Kenya. However, the efficacy of aPS may vary across populations. In this analysis, we explore differences in aPS efficacy by characteristics of index participants. METHODS Eighteen HIV testing sites were randomized to immediate versus 6-week delayed aPS. Participants were PLHIV (or index participants) and their sexual partners. Partners of index participants were contacted for HIV testing and linked to care if HIV positive. Primary outcomes were the number of partners per index participant who: 1) tested for HIV, 2) tested HIV positive and 3) enrolled in HIV care. We used generalized estimating equations to assess differences in aPS efficacy by region, testing location, gender, age and knowledge of HIV status. RESULTS From 2013 to 2015, the study enrolled 1119 index participants, 625 of whom were in the immediate group. These index participants named 1286 sexual partners. Immediate aPS was more efficacious than delayed aPS in promoting HIV testing among partners in high compared to low HIV prevalence regions (Nyanza incidence rate ratio (IRR) 7.2; 95% confidence interval (CI) 5.4, 9.6 vs. Nairobi/Central IRR 3.4 95% CI 2.3, 4.8). Higher rates of partner HIV testing were also observed for index participants in rural/peri-urban compared to urban sites (IRR 6.6; 95% CI 4.5, 9.6 vs. IRR 3.5 95% CI 2.5, 5.0 respectively), for female versus male index participants (IRR 5.8 95% CI 4.2, 7.9 vs. IRR 3.7; 95% CI 2.4, 5.8 respectively) and for newly diagnosed versus known HIV-positive index participants (IRR 6.0 95% CI 4.2, 8.7 vs. IRR 3.3; 95% CI 2.0, 7.7 respectively). Providing aPS to female versus male index participants also had a significantly higher HIV case finding rate (IRR 9.1; 95% CI 4.0, 20.9 vs. IRR 3.2 95% CI 1.7, 6.0 respectively.) CONCLUSIONS: While it is known that aPS promotes increases in HIV testing and case finding, this is the first study to demonstrate significant differences in aPS efficacy across characteristics of the index participant. Understanding these differences and their drivers will be critical as aPS is brought to scale in order to ensure all PLHIV have access to these services.
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Affiliation(s)
- Sarah J Masyuko
- National AIDS and STI Control ProgramMinistry of HealthNairobiKenya
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Peter K Cherutich
- Department of Preventive and Promotive Health ServicesMinistry of HealthNairobiKenya
| | | | - Peter M Maingi
- VCT and HIV Prevention UnitKenyatta National HospitalNairobiKenya
| | - Beatrice M Wamuti
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Paul M Macharia
- National AIDS and STI Control ProgramMinistry of HealthNairobiKenya
| | - David E Bukusi
- VCT and HIV Prevention UnitKenyatta National HospitalNairobiKenya
| | - Felix A Otieno
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Hans ML Spiegel
- Department of Health and Human ServicesKelly Government SolutionsContractor to National Institute of Allergy and Infectious DiseasesNational Institutes of HealthRockvilleMDUSA
| | - Matthew D Dunbar
- Department of Computer Science and DemographyUniversity of WashingtonSeattleWAUSA
| | | | - Barbra A Richardson
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of BiostatisticsUniversity of WashingtonSeattleWAUSA
| | - Carey Farquhar
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
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Azuogu BN, Ogbonnaya LU, Umeokonkwo CD, Alo C, Ifebunandu NA, Obionu CN, Agu AP, Azuogu VC, Oyari FOO, Okedo-Alex IN, Okafor IM, Madubueze UC. Effect of multiple intervention models on uptake of HIV testing services and sexual behaviour among residents of military cantonments in south-east Nigeria. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:89-94. [PMID: 30987539 DOI: 10.2989/16085906.2019.1586738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: HIV testing and counselling (HTC) has been a viable tool in controlling the spread of HIV/AIDS, and serves as the entry point in the HIV care and treatment cascade. In Africa, HIV-related morbidity and mortality are high with thousands still unaware of their HIV status. This study assessed the effect of on-site multiple HIV control interventions on the uptake of HTC services, knowledge and sexual behaviour among residents of two military cantonments [barracks] in south-east Nigeria. Methods: A quasi-experimental study was conducted among residents of cantonments in two states in Nigeria. A multistage sampling technique was used to select 350 respondents each at intervention and control sites. A pre-tested interviewer-administered questionnaire was used to collect information. On-site HTC services were established, with the training of HTC counsellors and peer educators. HIV awareness carnivals, with information, education and communication activities were conducted. Data were analysed with SPSS software and statistical tests carried out at 5% level of significance. Results: There was a statistically significant increase in the uptake of HTC services from 41.1% pre-intervention to 81.1% post-intervention (χ2 = 113.8, p < 0.001). Also, knowledge about HIV improved significantly from 35.4% to 98.8% (p < 0.001) in the intervention group, together with avoidance of risky sexual behaviour. Conclusion: The study demonstrated the effectiveness of multiple on-site intervention models in improving HIV knowledge, uptake of HTC services, and sexual behaviour among diverse cantonment residents. Establishing on-site HTC services and a constellation of awareness events will contribute significantly towards HIV prevention and control among high-risk populations.
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Affiliation(s)
- Benedict N Azuogu
- a Department of Community Medicine , Federal Teaching Hospital Abakaliki , Nigeria.,b Department of Community Medicine , Ebonyi State University , Abakaliki , Nigeria
| | - Lawrence U Ogbonnaya
- b Department of Community Medicine , Ebonyi State University , Abakaliki , Nigeria
| | | | - Chihurumnanya Alo
- a Department of Community Medicine , Federal Teaching Hospital Abakaliki , Nigeria.,b Department of Community Medicine , Ebonyi State University , Abakaliki , Nigeria
| | - Ngozi A Ifebunandu
- c Department of Internal Medicine , Ebonyi State University/Federal Teaching Hospital , Abakaliki , Nigeria
| | - Christopher N Obionu
- d Department of Community Medicine , University of Nigeria , Enugu Campus, Nigeria
| | - Adaoha P Agu
- b Department of Community Medicine , Ebonyi State University , Abakaliki , Nigeria
| | - Victoria C Azuogu
- e Department of Health Education , Ebonyi State University , Abakaliki , Nigeria
| | - Felix O-O Oyari
- a Department of Community Medicine , Federal Teaching Hospital Abakaliki , Nigeria
| | - Ijeoma N Okedo-Alex
- a Department of Community Medicine , Federal Teaching Hospital Abakaliki , Nigeria
| | - Ifenyinwa M Okafor
- a Department of Community Medicine , Federal Teaching Hospital Abakaliki , Nigeria
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Nabukenya AM, Matovu JKB. Correlates of HIV status awareness among older adults in Uganda: results from a nationally representative survey. BMC Public Health 2018; 18:1128. [PMID: 30223821 PMCID: PMC6142637 DOI: 10.1186/s12889-018-6027-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/09/2018] [Indexed: 11/16/2022] Open
Abstract
Background Recent evidence suggests that HIV prevalence is generally higher among older than younger persons. However, few studies have explored issues regarding HIV testing and awareness of HIV status among older persons. We explored the correlates of HIV status awareness among older adults (aged 45+ years) in Uganda. Methods This paper is based on secondary analysis of existing data on persons aged between 45 and 59 years from a nationally representative Uganda AIDS Indicator Survey which was conducted between February and September 2011. Records on the socio-demographics and HIV/AIDS-specific indicators for 2472 persons were extracted for analysis. Individuals were considered to be aware of their HIV status if they reported that they had tested and received their HIV test results within the past 12 months. Data analyses were done using the sample survey procedures to take into account the sampling structure of the data. Odds ratios were used to quantify the associations between receipt of HIV test results and potential factors. Results Of the 2472 respondents, 48% had ever tested and received their HIV test results while 23% tested and received their HIV results in the past 12 months or already knew that they are HIV positive. Individuals with the following characteristics had higher odds of being aware of their HIV status: being female (adjusted Odds Ratio (AOR) = 1.26; 95% CI: (1.04, 1.53), having high comprehensive knowledge of HIV/AIDS (AOR = 1.28; 95% CI: 1.04, 1.58), having attended secondary school education (AOR = 2.10; 95% CI: 1.47, 2.99) and engagement in high risk sexual behaviors (AOR = 1.53; 95% CI: (1.11, 2.10). A high level of stigma (holding at least three stigmatizing attitudes toward people living with HIV) was negatively correlated with awareness of HIV status (AOR =0.60; 95% CI: (0.45, 0.78). Conclusion Less than a quarter of older Ugandans are aware of their current HIV status. High levels of stigma and low comprehensive knowledge of HIV/AIDS remained critical barriers to HIV testing and awareness of HIV status. These findings suggest a need for innovative HIV testing strategies to increase HIV status awareness among older adults in Uganda.
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Affiliation(s)
- Anne M Nabukenya
- MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph K B Matovu
- MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda. .,Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
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Sosa-Rubí SG, Salinas-Rodríguez A, Montoya-Rodríguez AA, Galárraga O. The Relationship Between Psychological Temporal Perspective and HIV/STI Risk Behaviors Among Male Sex Workers in Mexico City. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1551-1563. [PMID: 29380090 PMCID: PMC5955784 DOI: 10.1007/s10508-017-1123-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 05/17/2023]
Abstract
Men who have sex with men (MSM) face a disproportionate burden of HIV incidence and HIV prevalence, particularly young men who have sex with men. The aim of this article was to analyze the relation between a psychological temporal perspective and HIV/sexually transmitted infection (STI) risk behaviors among male sex workers (MSWs), a potentially highly present-oriented group of MSM. A total sample of 326 MSWs were included and responded to a validated psychological scale: the Zimbardo's Time Perspective Inventory; they also reported how frequently they engaged in protective behaviors against HIV and other STI risks behaviors, including condom use with casual and regular partners, as well as prior HIV testing. We adjusted structural equation models to analyze the relation between a psychological temporal perspective and HIV/STI risk behaviors. We found that orientation toward the past was correlated with decreased condom use with casual partners (β = - 0.18; CI95% - 0.23, - 0.12). Future orientation was not associated with condom use with casual partners. Regarding condom use with regular partners, past and present orientation were related to lower likelihood of condom use (β = - 0.23; CI95% - 0.29, - 0.17; β = - 0.11; CI95% - 0.19, - 0.02), whereas future orientation increased the likelihood of condom use with regular partners (β = 0.40; CI95% 0.31, 0.50). Time orientation (past, present, or future) did not predict the probability of having an HIV test. The design of HIV/STI prevention programs among vulnerable populations, such as MSM and MSWs, should consider specific time-frame mechanisms that can importantly affect sexual risk behavior decisions.
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Affiliation(s)
- Sandra G Sosa-Rubí
- National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Aarón Salinas-Rodríguez
- National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
| | | | - Omar Galárraga
- Brown University School of Public Health, Providence, RI, USA
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Mashaphu S, Burns JK, Wyatt GE, Vawda NB. Psychosocial and behavioural interventions towards HIV risk reduction for serodiscordant couples in Africa: A systematic review. S Afr J Psychiatr 2018; 24:1136. [PMID: 30263215 PMCID: PMC6138108 DOI: 10.4102/sajpsychiatry.v24i0.1136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 04/19/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sexual transmission of HIV frequently occurs in the context of a primary relationship between two partners; however, HIV prevention interventions generally focus on individuals at risk, rather than specifying couples as a unit of change and analysis, neglecting the crucial role that partners may play in sexual behaviour. This article reviews published scientific literature addressing couple-oriented HIV counselling and testing and other behavioural interventions using an online search for peer-reviewed papers. METHODS A systematic review was conducted to evaluate what has been published on psychosocial interventions in HIV serodiscordant couples in Africa. Electronic databases were searched from January 1990 to December 2015. Quality assessment of included studies was conducted using the Systematic Appraisal of Quality in Observational Research tool. RESULTS The electronic database searches initially retrieved 493 records; after cross-referencing, removing duplicates and applying strict inclusion and exclusion criteria, only eight papers were included in this review. All the studies under review showed that couples-focused counselling and educational programmes were associated with positive outcomes including reduced HIV transmission, reduced unprotected sex, increased rates of status disclosure and high levels of treatment adherence. CONCLUSIONS The literature on interventions for HIV serodiscordant couples is sparse. However, most interventions indicate that couples-focused interventions are effective in HIV risk reduction. In spite of the limited available data and repeated recommendations by different health authorities, couple-centred approaches to HIV prevention have not been implemented on a large scale.
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Affiliation(s)
| | | | - Gail E. Wyatt
- Department of Psychiatry and Bio-behavioural Sciences, University of California Los Angeles, United States
| | - Naseema B. Vawda
- Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa
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Sibanda EL, Tumushime M, Mufuka J, Mavedzenge SN, Gudukeya S, Bautista-Arredondo S, Hatzold K, Thirumurthy H, McCoy SI, Padian N, Copas A, Cowan FM. Effect of non-monetary incentives on uptake of couples' counselling and testing among clients attending mobile HIV services in rural Zimbabwe: a cluster-randomised trial. LANCET GLOBAL HEALTH 2018; 5:e907-e915. [PMID: 28807189 DOI: 10.1016/s2214-109x(17)30296-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/23/2017] [Accepted: 07/05/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Couples' HIV testing and counselling (CHTC) is associated with greater engagement with HIV prevention and care than individual testing and is cost-effective, but uptake remains suboptimal. Initiating discussion of CHTC might result in distrust between partners. Offering incentives for CHTC could change the focus of the pre-test discussion. We aimed to determine the impact of incentives for CHTC on uptake of couples testing and HIV case diagnosis in rural Zimbabwe. METHODS In this cluster-randomised trial, 68 rural communities (the clusters) in four districts receiving mobile HIV testing services were randomly assigned (1:1) to incentives for CHTC or not. Allocation was not masked to participants and researchers. Randomisation was stratified by district and proximity to a health facility. Within each stratum random permutation was done to allocate clusters to the study groups. In intervention communities, residents were informed that couples who tested together could select one of three grocery items worth US$1·50. Standard mobilisation for testing was done in comparison communities. The primary outcome was the proportion of individuals testing with a partner. Analysis was by intention to treat. 3 months after CHTC, couple-testers from four communities per group individually completed a telephone survey to evaluate any social harms resulting from incentives or CHTC. The effect of incentives on CHTC was estimated using logistic regression with random effects adjusting for clustering. The trial was registered with the Pan African Clinical Trial Registry, number PACTR201606001630356. FINDINGS From May 26, 2015, to Jan 29, 2016, of 24 679 participants counselled with data recorded, 14 099 (57·1%) were in the intervention group and 10 580 (42·9%) in the comparison group. 7852 (55·7%) testers in the intervention group versus 1062 (10·0%) in the comparison group tested with a partner (adjusted odds ratio 13·5 [95% CI 10·5-17·4]). Among 427 (83·7%) of 510 eligible participants who completed the telephone survey, 11 (2·6%) reported that they were pressured or themselves pressured their partner to test together; none regretted couples' testing. Relationship unrest was reported by eight individuals (1·9%), although none attributed this to incentives. INTERPRETATION Small non-monetary incentives, which are potentially scalable, were associated with significantly increased CHTC and HIV case diagnosis. Incentives did not increase social harms beyond the few typically encountered with CHTC without incentives. The intervention could help achieve UNAIDS 90-90-90 targets. FUNDING The study was funded by the UK Department for International Development, Irish AID, and Swedish SIDA, through Population Services International Zimbabwe under the Integrated Support Program.
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Affiliation(s)
- Euphemia L Sibanda
- CeSHHAR Zimbabwe, Avondale, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
| | | | | | | | | | | | - Karin Hatzold
- Population Services International, Washington, DC, USA
| | - Harsha Thirumurthy
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Frances M Cowan
- CeSHHAR Zimbabwe, Avondale, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Salazar-Austin N, Kulich M, Chingono A, Chariyalertsak S, Srithanaviboonchai K, Gray G, Richter L, van Rooyen H, Morin S, Sweat M, Mbwambo J, Szekeres G, Coates T, Celentano D. Age-Related Differences in Socio-demographic and Behavioral Determinants of HIV Testing and Counseling in HPTN 043/NIMH Project Accept. AIDS Behav 2018; 22:569-579. [PMID: 28589504 PMCID: PMC5718984 DOI: 10.1007/s10461-017-1807-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18-24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61-0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05-1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85-2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08-1.36), and marriage (aOR 1.55; 95% CI 1.37-1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18-24 vs. 25-32 years).
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Affiliation(s)
- N Salazar-Austin
- Department of Pediatrics, Johns Hopkins School of Medicine, 200 N. Wolfe St Room 3147, Baltimore, MD, 21287, USA.
| | - M Kulich
- Faculty of Mathematics and Physics, Department of Probability and Statistics, Charles University, Prague, Czech Republic
| | - A Chingono
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - S Chariyalertsak
- Department of Community Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - G Gray
- South African Medical Research Council, Cape Town, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | - L Richter
- University of the Witwatersrand, Johannesburg, South Africa
| | - H van Rooyen
- Human Sciences Research Council, Pretoria, South Africa
| | - S Morin
- Department of Medicine, University of California, San Francisco, USA
| | - M Sweat
- Division of Global and Community Health, Medical University of South Carolina, Charleston, SC, USA
| | - J Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - G Szekeres
- UCLA Center for World Health, University of California, Los Angeles, USA
| | - T Coates
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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McMahon JM, Chimenti R, Trabold N, Fedor T, Mittal M, Tortu S. Risk of Intimate Partner Violence and Relationship Conflict Following Couple-Based HIV Prevention Counseling: Results From the Harlem River Couples Project. JOURNAL OF INTERPERSONAL VIOLENCE 2017; 32:3709-3734. [PMID: 26319710 PMCID: PMC4769677 DOI: 10.1177/0886260515600878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Heterosexual transmission of HIV often occurs in the context of intimate sexual partnerships. There is mounting evidence that couple-based HIV prevention interventions may be more effective than individual-based interventions for promoting risk reduction within such relationships. Yet, concerns have been raised about the safety of couple-based prevention approaches, especially with regard to the risk of intimate partner violence against women. Although several international studies have examined the potential for adverse consequences associated with couple-based interventions, with inconsistent results, there is little data from U.S. studies to shed light on this issue. The current study analyzed data from a randomized trial conducted in New York City with 330 heterosexual couples to examine whether participation in couple-based or relationship-focused HIV counseling and testing (HIV-CT) interventions resulted in an increased likelihood of post-intervention breakups, relationship conflicts, or emotional, physical, or sexual abuse, compared with standard individual HIV-CT. Multinomial logistic regression was used to model the odds of experiencing change in partner violence from baseline to follow-up by treatment condition. A high prevalence of partner-perpetrated violence was reported by both male and female partners across treatment conditions, but there was no conclusive evidence of an increase in relationship dissolution or partner violence subsequent to participation in either the couple-based HIV-CT intervention or relationship-focused HIV-CT intervention compared with controls. Qualitative data collected from the same participants support this interpretation. HIV prevention interventions involving persons in primary sexual partnerships should be sensitive to relationship dynamics and the potential for conflict, and take precautions to protect the safety of both male and female participants.
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Affiliation(s)
| | | | | | | | - Mona Mittal
- 3 University of Maryland, College Park, MD, USA
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24
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Examining the Correlates of Sexually Transmitted Infection Testing Among Men Who Have Sex With Men in Ouagadougou and Bobo-Dioulasso, Burkina Faso. Sex Transm Dis 2017; 43:302-9. [PMID: 27100767 DOI: 10.1097/olq.0000000000000437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are a population at risk for HIV acquisition and transmission and other sexually transmitted infections (STIs). In Burkina Faso, the prevalence of HIV among MSM is higher than that of other reproductive-aged adults. Early and frequent STI testing and treatment can help prevent HIV acquisition and transmission and may improve linkage to care. METHODS A cross-sectional study used respondent-driven sampling of MSM in the urban centers of Ouagadougou and Bobo-Dioulasso, Burkina Faso, to complete a questionnaire and HIV and syphilis testing. The binary-dependent variable in these analyses was self-reported prior STI testing in the past 12 months. Independent variables included sociodemographic characteristics, sexual behaviors, and psychosocial factors, selected according to the modified social ecological model. Bivariate associations at the P<0.05 level were used to create a manual forward stepwise multivariable logistic regression. RESULTS Seventy-six percent of participants (511/672) did not test for STIs in the last 12 months. Testing for STIs was associated with STI symptoms (odds ratio [OR], 2.56; 95% confidence interval [95% CI], 1.39-4.76) and independently associated with depressive symptoms (adjusted OR, 1.49; 95% CI, 1.01-2.20) and discussing HIV and STIs with main male partners (adjusted OR, 1.73; 95% CI, 1.23-1.76). CONCLUSIONS These data suggest that periodic targeted STI screening for MSM in Burkina Faso may represent an important component of comprehensive HIV prevention programming. The relationship between depression and STI risks is well established, and these data further indicate that screening for depression may be warranted during these clinical encounters.
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Sileo KM, Wanyenze RK, Lule H, Kiene SM. "That would be good but most men are afraid of coming to the clinic": Men and women's perspectives on strategies to increase male involvement in women's reproductive health services in rural Uganda. J Health Psychol 2017; 22:1552-1562. [PMID: 26929173 PMCID: PMC5565706 DOI: 10.1177/1359105316630297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In Uganda, increasing male involvement in reproductive health services may improve women's access to care. The purpose of this study was to explore factors influencing male support for women's reproductive health services and to elicit suggestions for strategies to increase male involvement. In 2008-2009, focus groups ( N = 76) were conducted with men and women in a rural hospital in Uganda. A content analysis approach was used for data analysis. Our findings point to the need for multi-level approaches that educate and mobilize men, while improving quality of care at the facility level to increase male involvement in reproductive health services.
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Affiliation(s)
- Katelyn M. Sileo
- Division of Epidemiology and Biostatistics, San Diego State University Graduate School of Public Health, San Diego, CA, USA
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University Graduate School of Public Health, San Diego, CA, USA
- Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
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26
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Baggaley RF, Irvine MA, Leber W, Cambiano V, Figueroa J, McMullen H, Anderson J, Santos AC, Terris-Prestholt F, Miners A, Hollingsworth TD, Griffiths CJ. Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis. Lancet HIV 2017; 4:e465-e474. [PMID: 28768604 PMCID: PMC5614770 DOI: 10.1016/s2352-3018(17)30123-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/04/2017] [Accepted: 06/13/2017] [Indexed: 01/08/2023]
Abstract
Background Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. Methods We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Findings Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662–132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162–1 903 385) per death averted, and £628 874 (434 902–4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Interpretation Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high-prevalence regions are much higher (≥60%) than those of patients diagnosed earlier. Screening for HIV in primary care is cost-effective and should be promoted. Funding NHS City and Hackney, UK Department of Health, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care.
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Affiliation(s)
- Rebecca F Baggaley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Michael A Irvine
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada; British Columbia Center for Disease Control, Vancouver, Canada
| | - Werner Leber
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Valentina Cambiano
- Department of Infection and Population Health, University College London, London, UK
| | | | - Heather McMullen
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Jane Anderson
- Centre for Immunology and Infectious Disease, Blizard Institute, Queen Mary University of London, London, UK; Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Andreia C Santos
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
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Baxter C, Abdool Karim S. Combination HIV prevention options for young women in Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:109-21. [PMID: 27399041 DOI: 10.2989/16085906.2016.1196224] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although the number of new HIV infections has declined by over 30% in the past decade, the number of people who acquire HIV each year remains unacceptably high. In 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that there were about 2 million new HIV infections. The virus continues to spread, particularly in key populations, such as men who have sex with men (MSM), transgender individuals, sex workers and people who inject drugs. In Africa, young women have the highest HIV incidence rates. Scaling up known efficacious HIV prevention strategies for these groups at high risk is therefore a high priority. HIV prevention has generally been targeted at HIV-negative individuals or in some instances, entire communities. Prevention efforts are, however, shifting from a narrow focus on HIV-uninfected persons to a continuum of prevention that includes both HIV-negative and HIV-positive individuals. Given that a single HIV prevention intervention is unlikely to be able to alter the epidemic trajectory as HIV epidemics in communities are complex and comprise a mosaic of different risk factors and different routes of transmission, there is need to provide combination prevention. Hence, a mix of behavioural, biomedical and structural HIV prevention options is likely to be needed to alter the course of the HIV epidemic. The combination of HIV prevention interventions needed will vary depending on cultural context, the population targeted and the stage of the epidemic. This paper reviews the available HIV prevention strategies for young women and discusses new HIV prevention approaches in development.
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Affiliation(s)
- Cheryl Baxter
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , South Africa
| | - Salim Abdool Karim
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , South Africa.,b Department of Epidemiology , Columbia University , New York , USA
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Dupas P, Miguel E. Impacts and Determinants of Health Levels in Low-Income Countries. HANDBOOK OF ECONOMIC FIELD EXPERIMENTS 2017. [DOI: 10.1016/bs.hefe.2016.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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29
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Karita E, Nsanzimana S, Ndagije F, Wall KM, Mukamuyango J, Mugwaneza P, Remera E, Raghunathan PL, Bayingana R, Kayitenkore K, Bekan-Homawoo B, Tichacek A, Allen S. Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice. J Acquir Immune Defic Syndr 2016; 73:e51-e58. [PMID: 27741033 PMCID: PMC5367509 DOI: 10.1097/qai.0000000000001138] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/14/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Couples' voluntary HIV counseling and testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda. METHODS From 1988 to 1994 in Rwanda, pregnant and postpartum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and sexually transmitted infection rates, particularly among HIV-discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were reintroduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the prevention of mother-to-child transmission program expanded to >400 clinics. In 2009, the GoR adopted joint posttest counseling procedures, and in 2010 a quarterly follow-up program for discordant couples was established in government clinics with training and technical assistance. An estimated 80%-90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections. CONCLUSIONS Rwanda is the first African country to have established CVCT as standard of care in antenatal care. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda's success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators, and budgets. Governments, bilateral, and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections.
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Affiliation(s)
- Etienne Karita
- Project San Francisco (PSF), Kigali, Rwanda
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Felix Ndagije
- US Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - Kristin M. Wall
- Department of Epidemiology, School of Public Health, Emory University, Atlanta, GA
| | - Jeannine Mukamuyango
- Project San Francisco (PSF), Kigali, Rwanda
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Eric Remera
- Rwanda Biomedical Center (RBC), Kigali, Rwanda
| | - Pratima L. Raghunathan
- US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA; and
| | - Roger Bayingana
- Project San Francisco (PSF), Kigali, Rwanda
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kayitesi Kayitenkore
- Project San Francisco (PSF), Kigali, Rwanda
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Brigitte Bekan-Homawoo
- Project San Francisco (PSF), Kigali, Rwanda
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Amanda Tichacek
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Susan Allen
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
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Van Howe RS, Svoboda JS, Hodges FM. HIV infection and circumcision: cutting through the hyperbole. ACTA ACUST UNITED AC 2016; 125:259-65. [PMID: 16353456 DOI: 10.1177/146642400512500607] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to determine whether the justifications given for promoting mass circumcision as a preventive measure for HIV infection are reasonable and whether mass circumcision is a feasible preventive measure for HIV infection in developing countries. The medical literature concerning the practice of circumcision in the absence of medical indication was reviewed regarding its impact on HIV infection and related issues. The literature was analysed with careful attention to historical perspective. Our results show that the medical literature supporting mass circumcision for the prevention of HIV infection is inconsistent and based on observation studies. Even if the two ongoing randomised controlled trials in Africa show a protective benefit of circumcision, factors such as the unknown complication rate of the procedure, the permanent injury to the penis, human rights violations and the potential for veiled colonialism need to be taken into account. Based on the best estimates, mass circumcision would not be as cost-effective as other interventions that have been demonstrated to be effective. Even if effective, mass circumcision as a preventive measure for HIV in developed countries is difficult to justify.
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Landman KZ, Thielman NM, Mgonja A, Shao HJ, Itemba DK, Ndosi EM, Tribble AC, Shao JF, Bartlett JA, Crump JA. Antiretroviral Treatment Literacy Among HIV Voluntary Counseling and Testing Clients in Moshi, Tanzania, 2003 to 2005. ACTA ACUST UNITED AC 2016; 6:24-6. [PMID: 17329501 DOI: 10.1177/1545109706298479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antiretroviral treatment literacy leads to greater HIV testing and treatment and antiretroviral treatment adherence. Among northern Tanzanian subjects, antiretroviral treatment awareness was only 17%. Factors associated with low antiretroviral treatment literacy included having exchanged money or gifts for sex, living in rural areas, having more than 2 children, and having a primary education only. Previous HIV testing was protective against low antiretroviral treatment literacy. These results support refocusing HIV education efforts and increasing synergy between HIV prevention and treatment programs.
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Affiliation(s)
- Keren Z Landman
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina 27710, USA
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Do M, Figueroa ME, Lawrence Kincaid D. HIV Testing Among Young People Aged 16-24 in South Africa: Impact of Mass Media Communication Programs. AIDS Behav 2016; 20:2033-44. [PMID: 27102409 DOI: 10.1007/s10461-016-1402-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Knowing one's serostatus is critical in the HIV prevention, care and treatment continuum. This study examines the impact of communication programs on HIV testing in South Africa. Data came from 2204 young men and women aged 16-24 who reported to be sexually active in a population based survey. Structural equation modeling was used to test the directions and causal pathways between communication program exposure, HIV testing discussion, and having a test in the last 12 months. Bivariate and multivariate probit regressions provided evidence of exogeneity of communication exposure and the two HIV-related outcomes. One in three sampled individuals had been tested in the last 12 months. Communication program exposure only had an indirect effect on getting tested by encouraging young people to talk about testing. The study suggests that communication programs may create an environment that supports open HIV-related discussions and may have a long-term impact on behavior change.
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Affiliation(s)
- Mai Do
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA.
| | - Maria Elena Figueroa
- Johns Hopkins University Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - D Lawrence Kincaid
- Johns Hopkins University Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
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Johnston LG, Steinhaus MC, Sass J, Sirinirund P, Lee C, Benjarattanaporn P, Gass R. Recent HIV Testing Among Young Men Who Have Sex with Men in Bangkok and Chiang Mai: HIV Testing and Prevention Strategies Must Be Enhanced in Thailand. AIDS Behav 2016; 20:2023-32. [PMID: 26884309 DOI: 10.1007/s10461-016-1336-7] [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] [Indexed: 10/22/2022]
Abstract
HIV infection among men who have sex with men, particularly in Thai urban settings and among younger cohorts, is escalating. HIV testing and counseling (HTC) are important for prevention and obtaining treatment and care. We examine data from a 2013 survey of males, 15-24 years, reporting past-year sex with a male and living in Bangkok or Chiang Mai. Almost three quarters of young MSM (YMSM) in Bangkok and only 27 % in Chiang Mai had an HIV test in the previous year. Associations for HIV testing varied between cities, although having employment increased the odds of HIV testing for both cities. In Bangkok, family knowledge of same sex attraction and talking to parents/guardians about HIV/AIDS had higher odds of HIV testing. Expanded HTC coverage is needed for YMSM in Chiang Mai. All health centers providing HTC, including those targeting MSM, need to address the specific needs of younger cohorts.
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Kelley AL, Hagaman AK, Wall KM, Karita E, Kilembe W, Bayingana R, Tichacek A, Kautzman M, Allen SA. Promotion of couples' voluntary HIV counseling and testing: a comparison of influence networks in Rwanda and Zambia. BMC Public Health 2016; 16:744. [PMID: 27502690 PMCID: PMC4977827 DOI: 10.1186/s12889-016-3424-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/30/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Many African adults do not know that partners in steady or cohabiting relationships can have different HIV test results. Despite WHO recommendations for couples' voluntary counseling and testing (CVCT), fewer than 10 % of couples have been jointly tested and counseled. We examine the roles and interactions of influential network leaders (INLs) and influential network agents (INAs) in promoting CVCT in Kigali, Rwanda and Lusaka, Zambia. METHODS INLs were identified in the faith-based, non-governmental, private, and health sectors. Each INL recruited and mentored several INAs who promoted CVCT. INLs and INAs were interviewed about demographic characteristics, promotional efforts, and working relationships. We also surveyed CVCT clients about sources of CVCT information. RESULTS In Zambia, 53 INAs and 31 INLs were surveyed. In Rwanda, 33 INAs and 27 INLs were surveyed. Most (75 %-90 %) INAs believed that INL support was necessary for their promotional work. Zambian INLs reported being more engaged with their INAs than Rwandan INLs, with 58 % of Zambian INLs reporting that they gave a lot of support to their INAs versus 39 % in Rwanda. INAs in both Rwanda and Zambia reported promoting CVCT via group forums (77 %-97 %) and speaking to a community leader about CVCT (79 %-88 %) in the past month. More Rwandan INAs and INLs reported previous joint or individual HIV testing compared with their Zambian counterparts, of which more than half had not been tested. In Zambia and Rwanda, 1271 and 3895 CVCT clients were surveyed, respectively. Hearing about CVCT from INAs during one-on-one promotions was the most frequent source of information reported by clients in Zambia (71 %). In contrast, Rwandan couples who tested were more likely to have heard about CVCT from a previously tested couple (59 %). CONCLUSIONS CVCT has long been endorsed for HIV prevention but few couples have been reached. Influential social networks can successfully promote evidence-based HIV prevention in Africa. Support from more senior INLs and group presentations leveraged INAs' one-on-one promotions. The INL/INA model was effective in promoting couples to seek joint HIV testing and counseling and may have broader application to other sub-Saharan African countries to sustainably increase CVCT uptake.
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Affiliation(s)
- April L. Kelley
- Zambia Emory HIV Research Project (ZEHRP), Lusaka and Ndola, Zambia
| | - Ashley K. Hagaman
- Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Kristin M. Wall
- Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Department of Epidemiology, School of Public Health, Emory University, 1518 Clifton Road NE, GCR 458, Atlanta, GA 30322 USA
| | | | - William Kilembe
- Zambia Emory HIV Research Project (ZEHRP), Lusaka and Ndola, Zambia
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | - Susan A. Allen
- Rwanda Zambia HIV Research Group (RZHRG), Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Project San Francisco (PSF), Kigali, Rwanda
- Zambia Emory HIV Research Project (ZEHRP), Lusaka and Ndola, Zambia
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Carlos S, Nzakimuena F, Reina G, Lopez-Del Burgo C, Burgueño E, Ndarabu A, Osorio A, de Irala J. Factors that lead to changes in sexual behaviours after a negative HIV test: protocol for a prospective cohort study in Kinshasa. BMC Public Health 2016; 16:606. [PMID: 27439981 PMCID: PMC4955130 DOI: 10.1186/s12889-016-3285-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background Considering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo). Methods and design Prospective cohort study from December 2014 until March 2016. People 15–60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up. Discussion This is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.
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Affiliation(s)
- Silvia Carlos
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain. .,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. .,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain.
| | - Francis Nzakimuena
- CECFOR/Monkole Hospital, Kinshasa, Democratic Republic of Congo.,University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Gabriel Reina
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Clinic University of Navarra, Clinical Microbiology Department, Pamplona, Spain
| | - Cristina Lopez-Del Burgo
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain
| | - Eduardo Burgueño
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain.,CECFOR/Monkole Hospital, Kinshasa, Democratic Republic of Congo
| | - Adolphe Ndarabu
- CECFOR/Monkole Hospital, Kinshasa, Democratic Republic of Congo
| | - Alfonso Osorio
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain.,University of Navarra, School of Education and Psychology, Pamplona, Spain
| | - Jokin de Irala
- University of Navarra, Department of Preventive Medicine and Public Health, C/Irunlarrea, 1. 31080, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,University of Navarra, Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, Pamplona, Spain
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Grusky O, Duan N, Swanson AN, Woodbridge M, Leich J. Evaluating the Accessibility of HIV Testing Organizations. Eval Health Prof 2016; 27:189-205. [PMID: 15140294 DOI: 10.1177/0163278704264048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Consumer-based indicators were developed to evaluate the accessibility of private and public nonhospital HIV testing organizations. A comprehensive roster of 148 nonhospital HIV testing organizations in Los Angeles County was constructed from publicly available listings. A telephone survey protocol was used to contact sites and assess consumer relevant accessibility measures. Only 50% of the sites could be contacted and indicated that HIV testing was available. Hence, a consumer who tried to reach one site had only a 50-50 chance of success. HIV testing sites differed with regard to how frequently they offered testing; whether they offered anonymous and/or confidential testing; what types of counseling they provided; how quickly test results were available; and how friendly, helpful, attentive, and knowledgeable about testing procedures their attendants were. HIV testing sites must make their services accessible and be perceived by consumers as responsive if they are to be effective service providers.
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Affiliation(s)
- Oscar Grusky
- Department of Sociology, University of California, Los Angeles 90095-1551, USA.
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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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Onoya D, Mohlabane N, Maduna V, van Zyl J, Sewpaul R, Naidoo Y. Testing in the HIV Counselling and Testing (HCT) campaign, HIV risk behaviours and ART enrolment in South Africa. Public Health 2016; 136:152-60. [PMID: 27178129 DOI: 10.1016/j.puhe.2016.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 01/15/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine the association between testing in the 2010 HIV Testing and Counselling (HCT) campaign with HIV risk behaviours and enrolment on ART. STUDY DESIGN Data for this study were collected as part of a nationally representative cross-sectional household survey conducted in 2012 in South Africa. METHODS Consenting participants completed a structured questionnaire and provided a dry blood spot specimen which was tested for HIV antibodies and antiretroviral drugs. Multinomial logistic regression was used to examine the association between HIV testing history and explanatory variables of interest. RESULTS There was no association between testing in the 2010 HCT campaign and condom use at last sex, number of sexual partnerships or HIV knowledge. Individuals who tested in the HCT campaign were more likely to disclose their status (COR 2.6, 95% CI: 1.71-3.8) and those who tested HIV positive in the campaign were more likely to be receiving ART (COR 1.8, 95% CI: 1.1-2.9). Testing in the HCT campaign was associated with having received both pretest and post-test counselling while testing before the campaign was associated with having received HIV results with no counselling (COR 2.1, 95% CI: 1.2-3.8). CONCLUSION We highlight the success of the 2010 HCT campaign in improving HIV status disclosure and enrolment on ART as well as shortcomings on HIV risk behaviours and HIV knowledge. These may be related to issues of quality assurance in the counselling process. Our results further highlight possible HCT counselling inconsistencies across sectors requiring stronger public-private partnership in the delivery of HCT in South Africa.
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Affiliation(s)
- D Onoya
- Health Economics and Epidemiology Research Office, Wits Health Consortium, South Africa; School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - N Mohlabane
- HIV/AIDS, STI and TB Program, Human Sciences Research Council, South Africa
| | - V Maduna
- HIV/AIDS, STI and TB Program, Human Sciences Research Council, South Africa
| | - J van Zyl
- HIV/AIDS, STI and TB Program, Human Sciences Research Council, South Africa
| | - R Sewpaul
- Population Health, Health Systems and Innovation, Human Sciences Research Council, South Africa
| | - Y Naidoo
- HIV/AIDS, STI and TB Program, Human Sciences Research Council, South Africa
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Evangeli M, Pady K, Wroe AL. Which Psychological Factors are Related to HIV Testing? A Quantitative Systematic Review of Global Studies. AIDS Behav 2016; 20:880-918. [PMID: 26566783 PMCID: PMC4799267 DOI: 10.1007/s10461-015-1246-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Deciding to test for HIV is necessary for receiving HIV treatment and care among those who are HIV-positive. This article presents a systematic review of quantitative studies on relationships between psychological (cognitive and affective) variables and HIV testing. Sixty two studies were included (fifty six cross sectional). Most measured lifetime testing. HIV knowledge, risk perception and stigma were the most commonly measured psychological variables. Meta-analysis was carried out on the relationships between HIV knowledge and testing, and HIV risk perception and testing. Both relationships were positive and significant, representing small effects (HIV knowledge, d = 0.22, 95 % CI 0.14-0.31, p < 0.001; HIV risk perception, OR 1.47, 95 % CI 1.26-1.67, p < 0.001). Other variables with a majority of studies showing a relationship with HIV testing included: perceived testing benefits, testing fear, perceived behavioural control/self-efficacy, knowledge of testing sites, prejudiced attitudes towards people living with HIV, and knowing someone with HIV. Research and practice implications are outlined.
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Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
| | - Kirsten Pady
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Abigail L Wroe
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
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HIV-Alcohol Risk Reduction Interventions in Sub-Saharan Africa: A Systematic Review of the Literature and Recommendations for a Way Forward. AIDS Behav 2016; 20:484-503. [PMID: 26511865 DOI: 10.1007/s10461-015-1233-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sub-Saharan Africa bears 69 % of the global burden of HIV, and strong evidence indicates an association between alcohol consumption, HIV risk behavior, and HIV incidence. However, characteristics of efficacious HIV-alcohol risk reduction interventions are not well known. The purpose of this systematic review is to summarize the characteristics and synthesize the findings of HIV-alcohol risk reduction interventions implemented in the region and reported in peer-reviewed journals. Of 644 citations screened, 19 met the inclusion criteria for this review. A discussion of methodological challenges, research gaps, and recommendations for future interventions is included. Relatively few interventions were found, and evidence is mixed about the efficacy of HIV-alcohol risk reduction interventions. There is a need to further integrate HIV-alcohol risk reduction components into HIV prevention programming and to document results from such integration. Additionally, research on larger scale, multi-level interventions is needed to identify effective HIV-alcohol risk reduction strategies.
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Kamen C, Arganbright J, Kienitz E, Weller M, Khaylis A, Shenkman T, Smith S, Koopman C, Gore-Felton C. HIV-related stigma: implications for symptoms of anxiety and depression among Malawian women. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016; 14:67-73. [PMID: 25920985 DOI: 10.2989/16085906.2015.1016987] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An estimated 11% of the adult population in Malawi, Africa, is living with HIV/AIDS. The disease has taken a toll on communities, resulting in high morbidity and mortality. Malawian women carry the burden of being caretakers for individuals infected with HIV while also worrying about their own health. However, little is known about how HIV/ AIDS affects psychological functioning among Malawian women in areas hit hardest by the epidemic. To that end, this paper examined the influence of HIV-related stigma on symptoms of anxiety and depression among 59 women 17-46 years old who were recruited from the Namitete area of Malawi. Women who reported greater worry about being infected with HIV and greater HIV-related stigma were significantly more likely to report greater symptoms of anxiety and depression. These findings suggest that interventions that reduce HIV-related stigma are likely to enhance psychological functioning among Malawian women, which in turn will improve the women's quality of life and well-being.
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Affiliation(s)
- Charles Kamen
- a Behavioral Medicine Unit , University of Rochester , Rochester , New York , USA
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Alghabashi MT, Guthrie B. Systematic review of human immunodeficiency virus (HIV) knowledge measurement instruments used on the Arabian Peninsula. BMC Res Notes 2015; 8:646. [PMID: 26537121 PMCID: PMC4634190 DOI: 10.1186/s13104-015-1614-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background In 1984, the Kingdom of Saudi Arabia (KSA) began surveillance for human immunodeficiency virus (HIV) incidence and prevalence. However, no culturally-appropriate standardized questionnaire has been developed to measure HIV prevention knowledge in this population. Evidence exists that married Saudi women are especially at higher risk for infection, but lack knowledge of HIV modes of transmission and underestimate their personal risk of becoming infected. The objective of this paper is to present a critical review of existing HIV knowledge measurement tools developed for the KSA and other Arabian Peninsula populations, and to utilize this review to guide the development of a culturally- and gender-sensitive tool. Studies included were in English reporting results of a quantitative survey instrument as either an interview or self-reported questionnaire with questions about knowledge of HIV or AIDS. Surveys must have been given in English or Arabic, and must have been done in a population in the KSA or the Arabian Peninsula. The following data sources were searched for eligible studies: Google Scholar, Google Web, PubMed, PLoS, WHO publications, UN publications, news, and other peer-reviewed publication databases. Results Sixteen articles met criteria, and of these, 10 (63 %) were conducted in a KSA population, and a majority of the articles studied students of primary, secondary, or post-secondary schools (n = 9, 56 %). Five studies included only men, while the other 11 included both sexes. Conclusions The KSA’s public health goals should more specifically focus on measuring and improving knowledge in high-risk populations such as married women—an option currently limited by commonly available measurement instruments. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1614-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maram T Alghabashi
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA. .,Umm al-Qura University, Mecca, Saudi Arabia.
| | - Barbara Guthrie
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
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De Allegri M, Agier I, Tiendrebeogo J, Louis VR, Yé M, Mueller O, Sarker M. Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso. PLoS One 2015; 10:e0130216. [PMID: 26132114 PMCID: PMC4488464 DOI: 10.1371/journal.pone.0130216] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 05/17/2015] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to explore factors shaping the decision to undergo Human Immunodeficiency Virus (HIV) testing among men in rural Burkina Faso. Methods The study took place in 2009 in the Nouna Health District and adopted a triangulation mixed methods design. The quantitative component relied on data collected through a structured survey on a representative sample of 1130 households. The qualitative component relied on 38 in-depth interviews, with men purposely selected to represent variation in testing decision, age, and place of residence. A two-part model was conducted, with two distinct outcome variables, i.e. “being offered an HIV test” and “having done an HIV test”. The qualitative data analysis relied on inductive coding conducted by three independent analysts. Result Of the 937 men, 357 had been offered an HIV test and 97 had taken the test. Younger age, household wealth, living in a village under demographic surveillance, and knowing that HIV testing is available at primary health facilities were all positively associated with the probability of being offered an HIV test. Household wealth and literacy were found to be positively associated, and distance was found to be negatively associated with the probability of having taken an HIV test. Qualitative findings indicated that the limited uptake of HIV testing was linked to poor knowledge on service availability and to low risk perceptions. Conclusion With only 10% of the total sample ever having tested for HIV, our study confirmed that male HIV testing remains unacceptably low in Sub-Saharan Africa. This results from a combination of health system factors, indicating general barriers to access, and motivational factors, such as one’s own knowledge of service availability and risk perceptions. Our findings suggested that using antenatal care and curative services as the exclusive entry points into HIV testing may not be sufficient to reach large portions of the male population. Thus, additional strategies are urgently needed to increase service uptake.
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Affiliation(s)
- Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Isabelle Agier
- University of Montreal School of Public Health (ESPUM), Montreal, Canada, Research Centre of the University of Montreal Hospital Centre (CRCHUM), Montreal, Canada
| | | | - Valerie Renée Louis
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Olaf Mueller
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- * E-mail:
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Feyissa GT, Lockwood C, Munn Z. The effectiveness of home-based HIV counseling and testing in reducing stigma and risky sexual behavior among adults and adolescents: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513060-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Go VF, Frangakis C, Minh NL, Latkin C, Ha TV, Mo TT, Sripaipan T, Davis WW, Zelaya C, Vu PT, Celentano DD, Quan VM. Efficacy of a Multi-level Intervention to Reduce Injecting and Sexual Risk Behaviors among HIV-Infected People Who Inject Drugs in Vietnam: A Four-Arm Randomized Controlled Trial. PLoS One 2015; 10:e0125909. [PMID: 26011427 PMCID: PMC4444299 DOI: 10.1371/journal.pone.0125909] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/17/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Injecting drug use is a primary driver of HIV epidemics in many countries. People who inject drugs (PWID) and are HIV infected are often doubly stigmatized and many encounter difficulties reducing risk behaviors. Prevention interventions for HIV-infected PWID that provide enhanced support at the individual, family, and community level to facilitate risk-reduction are needed. Methods 455 HIV-infected PWID and 355 of their HIV negative injecting network members living in 32 sub-districts in Thai Nguyen Province were enrolled. We conducted a two-stage randomization: First, sub-districts were randomized to either a community video screening and house-to-house visits or standard of care educational pamphlets. Second, within each sub-district, participants were randomized to receive either enhanced individual level post-test counseling and group support sessions or standard of care HIV testing and counseling. This resulted in four arms: 1) standard of care; 2) community level intervention; 3) individual level intervention; and 4) community plus individual intervention. Follow-up was conducted at 6, 12, 18, and 24 months. Primary outcomes were self-reported HIV injecting and sexual risk behaviors. Secondary outcomes included HIV incidence among HIV negative network members. Results Fewer participants reported sharing injecting equipment and unprotected sex from baseline to 24 months in all arms (77% to 4% and 24% to 5% respectively). There were no significant differences at the 24-month visit among the 4 arms (Wald = 3.40 (3 df); p = 0.33; Wald = 6.73 (3 df); p = 0.08). There were a total of 4 HIV seroconversions over 24 months with no significant difference between intervention and control arms. Discussion Understanding the mechanisms through which all arms, particularly the control arm, demonstrated both low risk behaviors and low HIV incidence has important implications for policy and prevention programming. Trial Registration ClinicalTrials.gov NCT01689545
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Affiliation(s)
- Vivian F. Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nguyen Le Minh
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Tran Viet Ha
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Tran Thi Mo
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Teerada Sripaipan
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Wendy W. Davis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Carla Zelaya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Pham The Vu
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Vu Minh Quan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Lee SW, Deiss RG, Segura ER, Clark JL, Lake JE, Konda KA, Coates TJ, Caceres CF. A cross-sectional study of low HIV testing frequency and high-risk behaviour among men who have sex with men and transgender women in Lima, Peru. BMC Public Health 2015; 15:408. [PMID: 25896917 PMCID: PMC4407786 DOI: 10.1186/s12889-015-1730-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 04/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased HIV testing frequency among high-risk populations such as men who have sex with men (MSM) and male-to-female transgender women (TW) can lead to earlier treatment and potentially reduce HIV transmission. METHODS We analyzed baseline survey data from 718 high-risk, young (median age 29 [interquartile range 23-35]) MSM/TW enrolled in a community-based HIV prevention trial between 2008-2009. Participants were recruited from 24 neighborhoods in and around Lima, Peru. We assessed HIV testing frequency, testing behaviour, and motivations and barriers to testing. Multivariate analysis identified correlates to prior HIV testing. RESULTS Overall, 79.6% reported HIV testing within their lifetimes, however, only 6.2% reported an average of two tests per year, as per Peruvian Ministry of Health guidelines. The most commonly reported motivators for testing were to check one's health (23.3%), lack of condom use (19.7%), and availability of free testing (14.0%), while low self-perceived risk for HIV (46.9%), fear of a positive result (42.0%), and lack of access to testing services (35.7%) were the most frequently reported barriers. In multivariate analysis, factors independently associated with HIV testing included age [adjusted prevalence ratio (APR) 1.00, 95% CI (1.00-1.01)], transgender-identification vs. gay-identification [APR 1.11, 95% CI (1.03-1.20)], history of transactional sex [APR 1.16, 95% CI (1.07-1.27)], and prior sexually transmitted infection diagnosis [APR 1.15, 95% CI (1.07-1.24)]. CONCLUSIONS An overwhelming majority of participants did not meet the standard-of-care for testing frequency. The reported motivations and barriers to testing highlight issues of risk perception and accessibility. Our findings suggest utilizing non-traditional outreach methods and promoting HIV testing as a routine part of healthcare in Peru to encourage testing and knowledge of HIV serostatus.
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Affiliation(s)
- Sky W Lee
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Robert G Deiss
- Division of Global Public Health, University of California, La Jolla, San Diego, California, USA.
| | - Eddy R Segura
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Jesse L Clark
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Jordan E Lake
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Kelika A Konda
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Thomas J Coates
- Division of Infectious Diseases, University of California, Los Angeles, California, USA.
| | - Carlos F Caceres
- Unidad de Salud Sexualidad y Desarrollo Humano, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Amon JJ. Preventing HIV infections in children and adolescents in sub-Saharan Africa through integrated care and support activities: a review of the literature. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 1:143-9. [PMID: 25871817 DOI: 10.2989/16085906.2002.9626553] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sub-Saharan Africa has been hit harder by the HIV/AIDS pandemic than any other region of the world, and children under age eighteen represent one-third of all new HIV infections occurring there annually. While HIV prevention efforts targeting youth are well established, few prevention programmes provide comprehensive care and support services. One reason for this is that prevention messages are often targeted only at older adolescents, and care and support activities typically emphasise the needs of younger children. By expanding prevention activities to younger children, and expanding care and support activities to older adolescents, more holisitic, and truly integrated programmes can be developed which address the common factors which make children of any age particularly vulnerable to HIV infection, namely: inadequate access to health care and unstable familial and social environments. This paper reviews evidence of the potential impact of care and support activities on HIV prevention among youth, and presents a conceptual framework for the development of comprehensive, effective, integrated HIV/AIDS prevention and care programmes tailored to the specific needs of youth.
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Affiliation(s)
- Joseph J Amon
- a Department of Preventive Medicine and Biometrics , Uniformed Services University of the Health Sciences , 4301 Jones Bridge Road , Bethesda , MD , 20814 , United States of America
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Verani AR, Orago ASS, Kariuki CN, Muraguri N, Koros D, Marston B, De Cock KM. Law and pediatric HIV testing: realizing the right to health in Kenya. J Int Assoc Provid AIDS Care 2015; 13:379-83. [PMID: 23442496 DOI: 10.1177/2325957412473779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Realization of the right to health occurs along a continuum including national ratification of international treaties such as the Convention on the Rights of the Child, passage of domestic laws and policies that may specify modes of implementation and enforcement such as Kenya's Constitution and HIV and AIDS Prevention and Control Act, and actual implementation of domestic laws and policies such as through the regulation and delivery of health services. The stages heuristic theoretical framework describes the public policy continuum as consisting of marked stages: agenda setting, policy formulation, policy implementation, and evaluation. This case study illustrates the continuum in Kenya with regard to pediatric HIV testing. Kenya has made progress applying law, policy, and science to reduce vertical transmission of HIV and increase HIV testing of infants, although several challenges remain. Progress in policy implementation may reduce mother-to-child transmission and increase pediatric HIV testing.
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Tucker JD, Wei C, Pendse R, Lo YR. HIV self-testing among key populations: an implementation science approach to evaluating self-testing. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31145-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Conroy AA. The influence of relationship power dynamics on HIV testing in rural Malawi. JOURNAL OF SEX RESEARCH 2015; 52:347-59. [PMID: 24670263 PMCID: PMC4177026 DOI: 10.1080/00224499.2014.883590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Using the theory of gender and power (TGP) and data from the Tsogolo la Thanzi (TLT) study, we examined how relationship power shapes young people's decisions to test for HIV in rural Malawi (N=932), a high-HIV prevalence setting undergoing rapid expansions in testing services. We used generalized estimating equations (GEE) to examine associations among five constructs of relationship power (socioeconomic inequalities, relationship dominance, relationship violence, relationship unity, and mistrust), perceived risk, and receiving an HIV test over a 16-month period. The results indicate that young Malawians are testing for HIV at relatively high rates, repeatedly, and not just during pregnancy. Over the study period, 47.3% of respondents received at least one HIV test outside of TLT (range: 0-4). The GEE analysis revealed that men and women with higher levels of relationship unity were less likely to test for HIV. For men, being a victim of sexual coercion was an additional barrier to testing. Women's testing decisions were more strongly influenced by perceptions of a partner's risk for HIV than their own, whereas men relied more on self-assessments. The results highlight that testing decisions are deeply embedded within the relationship context, which should be considered in future HIV testing interventions.
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Affiliation(s)
- Amy A Conroy
- a Center for AIDS Prevention Studies , University of California , San Francisco
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