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Bile EC, Bachanas PJ, Jarvis JN, Maurice F, Makovore V, Chebani L, Jackson KG, Birhanu S, Maphorisa C, Mbulawa MB, Alwano MG, Sexton C, Modise SK, Bapati W, Segolodi T, Moore J, Fonjungo PN. Accuracy of point-of-care HIV and CD4 field testing by lay healthcare workers in the Botswana Combination Prevention Project. J Virol Methods 2023; 311:114647. [PMID: 36343742 DOI: 10.1016/j.jviromet.2022.114647] [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: 08/14/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
Accurate HIV and CD4 testing are critical in program implementation, with HIV misdiagnosis having serious consequences at both the client and/or community level. We implemented a comprehensive training and Quality Assurance (QA) program to ensure accuracy of point-of-care HIV and CD4 count testing by lay counsellors during the Botswana Combination Prevention Project (BCPP). We compared the performance of field testing by lay counsellors to results from an accredited laboratory to ascertain accuracy of testing. All trained lay counsellors passed competency assessments and performed satisfactorily in proficiency testing panel evaluations in 2013, 2014, and 2015. There was excellent agreement (99.6 %) between field and laboratory-based HIV test results; of the 3002 samples tested, 960 and 2030 were concordantly positive and negative respectively, with 12 misclassifications (kappa score 0.99, p < 0.0001). Of the 149 HIV-positive samples enumerated for CD4 count in the field using PIMA at a threshold of ≤ 350 cells/µl; there was 86 % agreement with laboratory testing, with only 21 misclassified. The mean difference between field and lab CD4 testing was - 16.16 cells/µl (95 % CI -5.4 to 26.9). Overall, there was excellent agreement between field and laboratory results for both HIV rapid test and PIMA CD4 results. A standard training package to train lay counsellors to accurately perform HIV and CD4 point-of-care testing in field settings was feasible, with point-of-care results obtained by lay counsellors comparable to laboratory-based testing.
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Affiliation(s)
- Ebi C Bile
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Pamela J Bachanas
- US Centers for Disease Control and Prevention Atlanta, United States
| | - Joseph N Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona Maurice
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Vongai Makovore
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Liziwe Chebani
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Keisha G Jackson
- US Centers for Disease Control and Prevention Atlanta, United States
| | - Sehin Birhanu
- US Centers for Disease Control and Prevention Atlanta, United States
| | | | - Mpaphi B Mbulawa
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Mary Grace Alwano
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Connie Sexton
- US Centers for Disease Control and Prevention Atlanta, United States
| | | | - William Bapati
- Tebelopele Counseling and Testing Center, Gaborone, Botswana
| | - Tebogo Segolodi
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Janet Moore
- US Centers for Disease Control and Prevention Atlanta, United States
| | - Peter N Fonjungo
- US Centers for Disease Control and Prevention Atlanta, United States.
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Mueses-Marín HF, Tello-Bolívar IC, Galindo-Orrego MI, Galindo-Quintero J. Perceptions about sexual risk, HIV and HIV-testing in Cali, Colombia. COLOMBIA MEDICA (CALI, COLOMBIA) 2018; 49:139-147. [PMID: 30104805 PMCID: PMC6084922 DOI: 10.25100/cm.v49i2.2945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction In Colombia, 20%-54% of the population with sexual practices at higher risk for HIV infection (men who have sex with men, transgender women, women sex workers) has sometime been tested. Objective To describe perceptions of sexual risk, HIV and HIV testing in people with risky sexual practices and people who identify themselves as heterosexual. Methods Between 2012 and 2014, it was carried a descriptive study using HIV screening out in Cali-Colombia with the voluntary participation of 940 people aged over 18 years. There were used: informed consent, structured questionnaire and HIV testing. Descriptive, bivariate and multivariate Poisson regression models were performed. Results Average age 28.5 ±10.9 years; 50% men. 357 (38%) were people from the traditional risk group for HIV infection; and 583 (62%) corresponded to the non-traditional risk group (heterosexual men and women). Likewise, 62% and 41% respectively had HIV test. 51% to 53% reported having sex when they consumed liquor; commercial sex was higher in the group with risky sexual practices (32% vs 3%), as well as anal relations (77% vs 23%), consistent use of condom (32% vs 9%), and HIV positive test (14.3% vs 1.6%). The multivariate analysis showed for both groups that having HIV test was associated with being older than 25 years and a history of sexually transmitted infection. Conclusions Differentiated education strategies are needed based on risky sexual behaviors and that consider the importance of regular HIV tests for early diagnosis and timely enrollment in care and treatment.
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Affiliation(s)
| | | | | | - Jaime Galindo-Quintero
- Grupo Educación y Salud en VIH/Sida. Corporación de Lucha Contra el Sida, Cali, Colombia
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Friedman EE, Dean HD, Duffus WA. Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Rep 2018; 133:392-412. [PMID: 29874147 DOI: 10.1177/0033354918774788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article). RESULTS Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.
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Affiliation(s)
- Eleanor E Friedman
- 1 Association of Schools and Programs of Public Health/CDC Public Health Fellowship Program, Atlanta, GA, USA.,2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,3 Chicago Center for HIV Elimination and University of Chicago Department of Medicine, Chicago, IL, USA
| | - Hazel D Dean
- 4 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne A Duffus
- 2 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Xu JF, Ming ZQ, Zhang YQ, Wang PC, Jing J, Cheng F. Family support, discrimination, and quality of life among ART-treated HIV-infected patients: a two-year study in China. Infect Dis Poverty 2017; 6:152. [PMID: 29157301 PMCID: PMC5697335 DOI: 10.1186/s40249-017-0364-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
Background By September 2016, approximately 653,865 people in China were living with HIV/AIDS (PLWHA) and 492,725 people were receiving antiretroviral therapy (ART). PLWHA frequently experience discrimination in all domains of their personal and social lives. The World Health Organization includes discrimination in its list of social determinants of health factors that have been linked to poor physical and psychological health. This paper identifies the family support enjoyed and discrimination faced by people infected with HIV and examines the effect they have on patients’ quality of life (QOL) as they undergo ART in China. Methods We conducted this observational cohort study of ART-treated patients with HIV in Guangxi Province using a questionnaire survey at baseline, 6, 12, and 24 months, starting in 2010. Descriptive analysis was used to describe the demographic characteristics (e.g., age, sex, educational level, marital status, and employment status) of participants. Generalized estimating equations (GEE) were employed to examine the relationships between family support, discrimination, and QOL. Results In the study, 90.4% (n = 281) of patients received family support at baseline, here defined as the initiation of ART, 91.8% (n = 244) received family support 6 months into ART, 95.5% (n = 220) at 12 months, and 94.3% (n = 230) at 24 months. The proportion of patients who did not feel discriminated against by their families was 87.2% (n = 274) at baseline, 90.4% (n = 229) 6 months into ART, 90.0% (n = 210) at 12 months, and 94.5% (n = 219) at 24 months. Patients’ overall QOL scores were positively associated with having received family support (OR = 2.74, P = 0.040, 95% CI: 1.68–4.47), not feeling discriminated against by their families (OR = 1.3, P = 0.041, 95% CI: 1.07–1.59) or discrimination from patients themselves, including never experiencing fear of abandonment by family (OR = 2.05, P = 0.025, 95% CI: 1.49–2.82). Conclusions Family support along with no or minimal discrimination was found to contribute to QOL among people infected with HIV. Their overall QOL tended to improve significantly as ART continued. This suggests that strategies meant to improve and strengthen family support, care for PLWHA, and promote HIV screening among high-risk populations should be explored by both policy makers and researchers. Electronic supplementary material The online version of this article (10.1186/s40249-017-0364-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun-Fang Xu
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Zhong-Qiang Ming
- Fukangda Health International Science & Technology, Beijing, China
| | - Yu-Qian Zhang
- The Paul H. Nitze School of Advanced International Studies, The Johns Hopkins University, Baltimore, USA
| | - Pei-Cheng Wang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.,Department of Sociology, Tsinghua University, Beijing, China
| | - Feng Cheng
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. .,Center for Global Health and Infectious Diseases of Tsinghua University, Beijing, China.
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Community intervention improves knowledge of HIV status of adolescents in Zambia: findings from HPTN 071-PopART for youth study. AIDS 2017; 31 Suppl 3:S221-S232. [PMID: 28665880 PMCID: PMC5497780 DOI: 10.1097/qad.0000000000001530] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the uptake of home-based HIV counselling and testing (HCT) in four communities of the HPTN 071 (PopART) trial in Zambia among adolescents aged 15-19 years and explore factors associated with HCT uptake. DESIGN The PopART for youth study is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa which aims to evaluate the acceptability and uptake of a HIV prevention package, including universal HIV testing and treatment, among young people. The study is nested within the HPTN 071 (PopART) trial. METHODS Using a door-to-door approach that includes systematically revisiting households, all adolescents enumerated were offered participation in the intervention and verbal consent was obtained. Data were analysed from October 2015 to September 2016. RESULTS Among 15 456 enumerated adolescents, 11 175 (72.3%) accepted the intervention. HCT uptake was 80.6% (8707/10 809) and was similar by sex. Adolescents that knew their HIV-positive status increased almost three-fold, from 75 to 210. Following visits from community HIV care providers, knowledge of HIV status increased from 27.6% (3007/10 884) to 88.5% (9636/10 884). HCT uptake was associated with community, age, duration since previous HIV test; other household members accepting HCT, having an HIV-positive household member, circumcision, and being symptomatic for STIs. CONCLUSION Through a home-based approach of offering a combination HIV prevention package, the proportion of adolescents who knew their HIV status increased from ∼28 to 89% among those that accepted the intervention. Delivering a community-level door-to-door combination, HIV prevention package is acceptable to many adolescents and can be effective if done in combination with targeted testing.
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Tucker JD, Tso LS, Hall B, Ma Q, Beanland R, Best J, Li H, Lackey M, Marley G, Rich ZC, Sou KL, Doherty M. Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention. EBioMedicine 2017; 17:163-171. [PMID: 28161401 PMCID: PMC5360566 DOI: 10.1016/j.ebiom.2017.01.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/21/2022] Open
Abstract
Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.
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Affiliation(s)
- Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China; Institute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, USA.
| | - Lai Sze Tso
- University of North Carolina Project-China, Guangzhou, China.
| | - Brian Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA.
| | - Qingyan Ma
- University of North Carolina Project-China, Guangzhou, China.
| | - Rachel Beanland
- HIV Department, World Health Organization, Geneva, Switzerland.
| | - John Best
- School of Medicine, University of California, San Francisco, San Francisco, USA.
| | - Haochu Li
- University of North Carolina Project-China, Guangzhou, China
| | - Mellanye Lackey
- Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA.
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China.
| | - Zachary C Rich
- University of North Carolina Project-China, Guangzhou, China.
| | - Ka-Lon Sou
- University of North Carolina Project-China, Guangzhou, China.
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland.
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Tso LS, Best J, Beanland R, Doherty M, Lackey M, Ma Q, Hall BJ, Yang B, Tucker JD. Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review. AIDS 2016; 30:1639-53. [PMID: 27058350 PMCID: PMC4889545 DOI: 10.1097/qad.0000000000001101] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To synthesize qualitative evidence on linkage to care interventions for people living with HIV. DESIGN Systematic literature review. METHODS We searched 19 databases for studies reporting qualitative evidence on linkage interventions. Data extraction and thematic analysis were used to synthesize findings. Quality was assessed using the Critical Appraisal Skills Programme tool and certainty of evidence was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach. RESULTS Twenty-five studies from 11 countries focused on adults (24 studies), adolescents (eight studies), and pregnant women (four studies). Facilitators included community-level factors (i.e., task shifting, mobile outreach, integrated HIV, and primary services, supportive cessation programs for substance users, active referrals, and dedicated case management teams), and individual-level factors (encouragement of peers/family and positive interactions with healthcare providers in transitioning into care). One key barrier for people living with HIV was perceived inability of providers to ensure confidentiality as part of linkage to care interventions. Providers reported difficulties navigating procedures across disparate facilities and having limited resources for linkage to care interventions. CONCLUSION Our findings extend the literature by highlighting the importance of task-shifting, mobile outreach, integrated HIV, and primary care services. Both community and individual-level factors may increase the feasibility and acceptability of HIV linkage to care interventions. These findings may inform policies to increase the reach of HIV services available in communities.
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Affiliation(s)
- Lai Sze Tso
- aUniversity of North Carolina Project-China, Guangzhou, ChinabInstitute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, North Carolina, USAcGuangdong Provincial Center for STD Control, Guangzhou, ChinadSchool of Medicine, University of California, San Francisco, California, USAeHIV/AIDS Department World Health Organization, Geneva SwitzerlandfUniversity of Utah, Salt Lake City, Utah, USAgGuangzhou Eighth People's Hospital, Guangzhou, ChinahDepartment of Psychology, Global and Community Mental Health Research Group, University of Macau, Macau, ChinaiDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Estimated age and gender profile of individuals missed by a home-based HIV testing and counselling campaign in a Botswana community. J Int AIDS Soc 2015; 18:19918. [PMID: 26028155 PMCID: PMC4450241 DOI: 10.7448/ias.18.1.19918] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/23/2015] [Accepted: 05/06/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION It would be useful to understand which populations are not reached by home-based HIV-1 testing and counselling (HTC) to improve strategies aimed at linking these individuals to care and reducing rates of onward HIV transmission. METHODS We present the results of a baseline home-based HTC (HBHTC) campaign aimed at counselling and testing residents aged 16 to 64 for HIV in the north-eastern sector of Mochudi, a community in Botswana with about 44,000 inhabitants. Collected data were compared with population references for Botswana, the United Nations (UN) estimates based on the National Census data and the Botswana AIDS Impact Survey IV (BAIS-IV). Analyzed data and references were stratified by age and gender. RESULTS A total of 6238 age-eligible residents were tested for HIV-1; 1247 (20.0%; 95% CI 19.0 to 21.0%) were found to be HIV positive (23.7% of women vs. 13.4% of men). HIV-1 prevalence peaked at 44% in 35- to 39-year-old women and 32% in 40- to 44-year-old men. A lower HIV prevalence rate, 10.9% (95% CI 9.5 to 12.5%), was found among individuals tested for the first time. A significant gender gap was evident in all analyzed subsets. The existing HIV transmission network was analyzed by combining phylogenetic mapping and household structure. Between 62.4 and 71.8% of all HIV-positive individuals had detectable virus. When compared with the UN and BAIS-IV estimates, the proportion of men missed by the testing campaign (48.5%; 95% CI 47.0 to 50.0%) was significantly higher than the proportion of missed women (14.2%; 95% CI 13.2 to 15.3%; p<0.0001). The estimated proportion of missed men peaked at about 60% in the age group 30 to 39 years old. The proportions of missed women were substantially smaller, at approximately 28% within the age groups 30 to 34 and 45 to 49 years old. CONCLUSIONS The HBHTC campaign seems to be an efficient tool for reaching individuals who have never been tested previously in southern African communities. However, about half of men from 16 to 64 years old were not reached by the HBHTC, including about 60% of men between 30 and 40 years old. Alternative HTC strategies should be developed to bring these men to care, which will contribute to reduction of HIV incidence in communities.
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