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Thorp M, Balakasi K, Khan S, Stillson C, van Oosterhout JJ, Nichols BE, Cornell M, Dovel K. Men's Satisfaction with General Health Services is Associated with Future Use of HIV Testing in Malawi: A Community-Representative Survey. AIDS Behav 2024; 28:2639-2649. [PMID: 38869760 PMCID: PMC11286645 DOI: 10.1007/s10461-024-04352-9] [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] [Accepted: 04/16/2024] [Indexed: 06/14/2024]
Abstract
Across sub-Saharan Africa, men are less likely to know their HIV status than women, leading to later treatment initiation. Little is known about how experiences with general health services affect men's use of HIV testing. We used data from a 2019 community-representative survey of men in Malawi to understand frequency and cause of men's negative health service experiences (defined as men reporting they "would not recommend" a facility) and their association with future HIV testing. We conducted univariable and multivariable logistic regressions to determine which aspects of health facility visits were associated with would-not-recommend experiences and to determine if would-not-recommend experiences 12-24 months prior to the survey were associated with HIV testing in the 12 months prior to the survey. Among 1,098 men eligible for HIV testing in the 12 months prior to the survey, median age was 34 years; 9% of men reported at least one would-not-recommend experience, which did not differ by sociodemographics, gender norm beliefs, or HIV stigma beliefs. The factors most strongly associated with would-not-recommend experiences were cost (aOR 5.8, 95%CI 2.9-11.4), cleanliness (aOR 4.2, 95%CI 1.8-9.9), medicine availability (aOR 3.3, 95%CI 1.7-6.4), and wait times (aOR 2.7, 95%CI 1.5-5.0). Reporting a would-not-recommend experience 12-24 months ago was associated with a 59% decrease in likelihood of testing for HIV in the last 12 months (aOR 0.41; 95% CI:0.17-0.96). Dissatisfaction with general health services was strongly associated with reduced HIV testing. Coverage of high-priority screening services like HIV testing may benefit from improving overall health system quality.
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Affiliation(s)
- Marguerite Thorp
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
| | | | - Shaukat Khan
- FIND, The Global Alliance for Diagnostics, Geneva, Switzerland
| | | | | | | | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Kathryn Dovel
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Partners in Hope, Lilongwe, Malawi
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2
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Madut DB, Manavalan P, Mtalo A, Peter T, Ostermann J, Njau B, Thielman NM. Predictors of prior HIV testing and acceptance of a community-based HIV test offer among male bar patrons in northern Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002946. [PMID: 38408037 PMCID: PMC10896543 DOI: 10.1371/journal.pgph.0002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
Community-based HIV testing offers an alternative approach to encourage HIV testing among men in sub-Saharan Africa. In this study, we evaluated a community-based HIV testing strategy targeting male bar patrons in northern Tanzania to assess factors predictive of prior HIV testing and factors predictive of accepting a real-time HIV test offer. Participants completed a detailed survey and were offered HIV testing upon survey completion. Poisson regression was used to identify prevalence ratios for the association between potential predictors and prior HIV testing or real-time testing uptake. Of 359 participants analyzed, the median age was 41 (range 19-82) years, 257 (71.6%) reported a previous HIV test, and 321 (89.4%) accepted the real-time testing offer. Factors associated with previous testing for HIV (adjusted prevalence ratio [aPR], 95% CI) were wealth scores in the upper-middle quartile (1.25, 1.03-1.52) or upper quartile (1.35, 1.12-1.62) and HIV knowledge (1.04, 1.01-1.07). Factors that predicted real-time testing uptake were lower scores on the Gender-Equitable Men scale (0.99, 0.98-0.99), never testing for HIV (1.16, 1.03-1.31), and testing for HIV > 12 months prior (1.18, 1.06-1.31). We show that individual-level factors that influence the testing-seeking behaviors of men are not likely to impact their acceptance of an HIV offer.
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Affiliation(s)
- Deng B. Madut
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Preeti Manavalan
- Department of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Antipas Mtalo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Timothy Peter
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jan Ostermann
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, United States of America
| | - Bernard Njau
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nathan M. Thielman
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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3
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Ndlovu S, Ross A, Mulondo M. Interventions to improve young men's utilisation of HIV-testing services in KwaZulu-Natal, South Africa: perspectives of young men and health care providers. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:316-326. [PMID: 38117741 DOI: 10.2989/16085906.2023.2276897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
Introduction: HIV-testing services (HTS) are an important point of entry to prevention and treatment of HIV in South Africa. Despite the availability of HTS across the region and in SA, the uptake among men remains low, especially young men residing in rural and peri-urban communities. This study aimed to explore interventions that could improve the uptake of HTS among young men in KwaZulu-Natal.Methods: A descriptive exploratory qualitative study was conducted in which 17 young men and two health care providers in Ladysmith were purposively and conveniently sampled. Data were collected through semi-structured interviews using WhatsApp and landline audio calls between September and December 2021 and thematically analysed.Results: An improvement in the health care provider attitudes and service delivery, establishment of adherence clubs for young people living with HIV, ensuring a diverse and balanced health care provider staff composition at primary health care facilities, and increased demand creation in spaces frequented by men are vital for enhancing access and utilisation of HTS among young men. Additionally, health care providers believe that the presence of male health care providers, investment in health education, prioritising men in the morning at the primary health care facilities, and the establishment of male clinics within communities as key factors in improving the uptake of HTS among young men.Conclusion: To attract and retain young men in HTS and in HIV treatment and care, several improvements at primary health care facilities need to be implemented. These should focus on addressing the specific needs and preferences of young men, ensuring their comfort and engagement in health care.
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Affiliation(s)
- Sithembiso Ndlovu
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Andrew Ross
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mutshidzi Mulondo
- Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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4
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Chabikuli ON, Ditekemena JD, Sigwadhi LN, Mulenga A, Mboyo A, Bidashimwa D, Nachega JB. Advanced HIV Disease at Antiretroviral Therapy Initiation and Treatment Outcomes Among Children and Adolescents Compared to Adults Living With HIV in Kinshasa, Democratic Republic of the Congo. J Int Assoc Provid AIDS Care 2023; 22:23259582231221955. [PMID: 38146172 PMCID: PMC10752042 DOI: 10.1177/23259582231221955] [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: 06/16/2023] [Revised: 11/17/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
Background: Little is known about advanced HIV disease (AHD) at antiretroviral therapy (ART) initiation among children and adolescents living with HIV (CALHIV) and related age disparities in the Democratic Republic of the Congo (DRC). Methods: We conducted a retrospective cohort analysis of routine program data collected among adults, adolescents, and children living with HIV in 6 health zones in Kinshasa, DRC from 2005 to 2020. Results: Thirty-two percent of those who initiated ART had AHD. Compared to adults, adolescents had a 15% higher risk of AHD (RR: 1.15; 95% CI: 1.08-1.21; P < .001). Despite their higher risk of AHD, adolescents had a lower risk of mortality (aSHR: 0.72; 95% CI: 0.52-0.99; P = .047) and lower cumulative death events versus adults (aSHR: 0.44; 95% CI: 0.34-0.59; P < .001). Conclusions: ADH at ART initiation is highly prevalent in Kinshasa, DRC, and adolescents are disproportionally impacted. There is a need to scale up high-impact HIV interventions targeting CALHIV.
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Affiliation(s)
- Otto Nzapfurundi Chabikuli
- Family Health International (FHI 360), Durham, NC, USA
- Public Health Program, Graduate School, Howard University, Washington, DC, USA
| | - John D. Ditekemena
- Family Health International (FHI 360), Kinshasa, Democratic Republic of the Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Astrid Mulenga
- Family Health International (FHI 360), Kinshasa, Democratic Republic of the Congo
| | - Aimé Mboyo
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | | | - Jean B. Nachega
- Departments of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health; Center for Global Health, Johns Hopkins University Baltimore, MD, USA
- Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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5
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Belus JM, Joska JA, Bronsteyn Y, Rose AL, Andersen LS, Regenauer KS, Myers B, Hahn JA, Orrell C, Safren SA, Magidson JF. Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa. AIDS Behav 2022; 26:3630-3641. [PMID: 35895150 PMCID: PMC9550692 DOI: 10.1007/s10461-022-03765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/21/2022]
Abstract
Little is known about gender effects of alcohol and drug use (AOD) among people living with HIV (PLWH) in resource-limited settings. Using multilevel models, we tested whether gender moderated the effect of Khanya, a cognitive-behavioral therapy-based intervention addressing antiretroviral (ART) adherence and AOD reduction. We enrolled 61 participants from HIV care and examined outcomes at 3- and 6-months compared to enhanced treatment as usual (ETAU). Gender significantly moderated the effect of Khanya on ART adherence (measured using electronically-monitored and biomarker-confirmed adherence), such that women in Khanya had significantly lower ART adherence compared to men in Khanya; no gender differences were found for AOD outcomes. Exploratory trajectory analyses showed men in Khanya and both genders in ETAU had significant reductions in at least one AOD outcome; women in Khanya did not. More research is needed to understand whether a gender lens can support behavioral interventions for PLWH with AOD. Trial registry ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
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Affiliation(s)
- Jennifer M Belus
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Psychology, University of Maryland, College Park, MD, USA.
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Yosef Bronsteyn
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa.,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Steve A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
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6
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Makkan H, Maenetje P, Chetty-Makkan CM, Muchiri E, Latka MH, Edward VA, Price MA, Omosa-Manyonyi G, Lindan C. Attitudes Toward Gender-Based Violence Among Sexually Active Adult Men at High Risk for HIV in Rustenburg, South Africa. Am J Mens Health 2022; 16:15579883221106331. [PMID: 35748400 PMCID: PMC9234859 DOI: 10.1177/15579883221106331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gender-based violence (GBV) toward women is widespread and has been associated with increased HIV risk. We investigated attitudes toward GBV among men living in Rustenburg, South Africa, who were enrolled in a longitudinal HIV incidence study. Participants were 18 to 49 years old, reported high risk sexual activity in the last 3 months, and were HIV-uninfected. Attitudes toward GBV were evaluated using responses to a five-item standardized questionnaire about men perpetrating physical violence on a female spouse; responses to each item were scaled from 1 (no agreement) to 4 (strong agreement) and summed. Total scores >10 were considered permissive toward GBV. Among the 535 men analyzed, nearly half (N = 229, 42.8%) had a GBV score >10. Being young (18-24 years) (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI] [1.06, 2.22]), having less years of education (aOR = 1.61, 95% CI [1.11, 2.32]), and reporting no current sexual partner at baseline (aOR = 2.10, 95% CI [1.06, 4.14]) were independently associated with permissive attitudes toward GBV. The following behaviors reported in the last 3 months were also associated with high GBV scores: having a new female partner (aOR = 1.78, 95% CI [1.02, 3.10]), and having had an STI (aOR = 1.85, 95% CI [1.15, 2.99]). Consuming alcohol prior to sex in the last month (aOR = 1.59, 95% CI [1.09, 2.31]) was also associated with high GBV scores. A large proportion of South African HIV-uninfected men in this analysis reported permissive attitudes toward GBV. These attitudes were associated with HIV risk behavior. Integrating GBV and HIV prevention programs is essential.
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Affiliation(s)
- Heeran Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands
| | - Pholo Maenetje
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evans Muchiri
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Mary H Latka
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa
| | - Vinodh A Edward
- Rustenburg Research Centre, The Aurum Institute, Rustenburg, South Africa.,Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.,School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matt A Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,IAVI, New York, NY, USA
| | - Gloria Omosa-Manyonyi
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Christina Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Mbonye M, Siu G, Seeley J. Marginal men, respectable masculinity and access to HIV services through intimate relationships with female sex workers in Kampala, Uganda. Soc Sci Med 2022; 296:114742. [PMID: 35121368 DOI: 10.1016/j.socscimed.2022.114742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/15/2022]
Abstract
Masculinity influences men's sexual risk-taking behaviour and affects uptake of HIV services. We draw on data from a year-long (2019) ethnographic study focusing on men in relationships with female sex workers (FSW) in Kampala, Uganda to examine how and why two marginalised groups of people may interact to produce positive health behaviours. Data from in-depth interviews, focus group discussions and participant observation were collected and analysed. We discuss three main themes; the first of which focuses on marginalised masculinities and HIV risk. In this theme we show how accounts of men's life trajectories portrayed a remarkably similar pattern of early deprivation of opportunities and how this shaped construction of risky masculinities. The second theme describes men's relationships with FSW and how this facilitated access to HIV services. We discuss how very marginal women (FSWs) help very marginal men adopt more positive health behaviours. We show how threats to masculinities arising from sex work stigma, men's failure to have exclusive sexual rights over their FSW partner, and men's economic disadvantage are negotiated and dealt with to create an enabling environment for men's uptake of HIV services. The final theme focuses on the positive and negative practices of the men after engaging with HIV services. We conclude that the two marginalised groups can mobilise and combine new aspirations to produce positive health behaviours manifested through FSW assisting their male partners to access HIV services. We suggest that this perspective opens up new opportunities for engaging with marginalised groups and tackling the problem of high HIV infection among key populations.
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Affiliation(s)
- Martin Mbonye
- Makerere University, College of Health Sciences, School of Medicine, Child Health and Development Centre, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
| | - Godfrey Siu
- Makerere University, College of Health Sciences, School of Medicine, Child Health and Development Centre, Uganda; MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
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8
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Mukora-Mutseyekwa F, Mundagowa PT, Kangwende RA, Murapa T, Tirivavi M, Mukuwapasi W, Tozivepi SN, Uzande C, Mutibura Q, Chadambuka EM, Machinga M. Implementation of a campus-based and peer-delivered HIV self-testing intervention to improve the uptake of HIV testing services among university students in Zimbabwe: the SAYS initiative. BMC Health Serv Res 2022; 22:222. [PMID: 35177055 PMCID: PMC8855554 DOI: 10.1186/s12913-022-07622-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background The uptake of HIV testing services among adolescents and young adults in Zimbabwe is low due to stigma associated with the risk of mental and social harm. The WHO recommends HIV self-testing (HIVST) as an innovative approach to improve access to HIV testing for this hard-to-reach populations. This study describes the development and implementation of a coordinated multifaceted and multidisciplinary campus-based approach to improve the uptake of HIV testing among university students in Zimbabwe. Methods We utilized both quantitative and qualitative methods guided by the Exploration, Preparation, Implementation, and Sustainment Framework. A formative survey, in-depth interviews, and a scoping review were conducted as part of the situation analysis. Implementers (peer educators and health workers) were trained and community dialogue sessions were conducted to ascertain the determinants (enablers and barriers) influencing both the inner and outer contexts. Self-test kits were disbursed over 6 months before a summative evaluation survey was conducted. Qualitative data were analyzed thematically while the chi-squared test was used to analyze quantitative data. Results The formative evaluation showed that 66% of students intended to test and 44% of the enrolled students collected HIVST test kits. Giving comprehensive and tailored information about the intervention was imperative to dispel the initial skepticism among students. Youth-friendly and language-specific packaging of program materials accommodated the students. Despite the high acceptability of the HIVST intervention, post-test services were poorly utilized due to the small and isolated nature of the university community. Implementers recommended that the students seek post-test services off-site to ensure that those with reactive results are linked to treatment and care. Conclusions Peer-delivered HIVST using trained personnel was acceptable among adolescents and young adults offered the intervention at a campus setting. HIVST could increase the uptake of HIV testing for this population given the stigma associated with facility-based HTS and the need for routine HIV testing for this age group who may not otherwise test. An off-site post-test counseling option is likely to improve the implementation of a campus-based HIVST and close the linkage to treatment and care gap. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07622-1.
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Affiliation(s)
| | | | | | - Tsitsi Murapa
- Department of Students' Affairs, Africa University, P. O. Box, 1320, Mutare, Zimbabwe
| | - Mandla Tirivavi
- Clinical Research Centre, Africa University, 132 H. Chitepo Street, Mutare, Zimbabwe
| | - Waraidzo Mukuwapasi
- Clinical Research Centre, Africa University, 132 H. Chitepo Street, Mutare, Zimbabwe
| | | | - Charles Uzande
- HIV/STI/TB Unit, Ministry of Health and Child Care, Manicaland Province, Mutare, Zimbabwe
| | - Queen Mutibura
- HIV/STI/TB Unit, Ministry of Health and Child Care, Manicaland Province, Mutare, Zimbabwe
| | | | - Mazvita Machinga
- Chair of Pastoral Care & Counseling Services, Number 3, 13th Avenue, Mutare, Zimbabwe
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9
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Hakim AJ, Tippett Barr BA, Kinchen S, Musuka G, Manjengwa J, Munyati S, Gwanzura L, Mugurungi O, Ncube G, Saito S, Parekh BS, Patel H, Duong YT, Gonese E, Sleeman K, Ruangtragool L, Justman J, Herman-Roloff A, Radin E. Progress Toward the 90-90-90 HIV Targets in Zimbabwe and Identifying Those Left Behind. J Acquir Immune Defic Syndr 2021; 88:272-281. [PMID: 34321414 PMCID: PMC8526397 DOI: 10.1097/qai.0000000000002772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We present findings from the nationally representative Zimbabwe Population-based HIV Impact Assessment that characterize Zimbabwe's progress toward the Joint United Nations Programme on HIV/AIDS 90-90-90 targets. DESIGN We conducted a cross-sectional household survey. METHODS Consenting adults and children in the household were eligible to participate in Zimbabwe Population-based HIV Impact Assessment (October 2015-August 2016). Participants completed face-to-face interviews and provided blood for HIV, CD4, viral load, and syphilis testing. Viral load suppression (VLS) was defined as HIV RNA <1000 copies/mL. HIV-positive specimens were tested for the presence of selected antiretroviral drugs. Data were weighted. Analysis was restricted to HIV-positive adults aged 15-64 years. RESULTS We enrolled 11,098 men and 14,033 women aged 15-64 years. HIV prevalence was 14.1%. Of those living with HIV, 76.8% (95% confidence interval [CI]: 74.9 to 78.7) were aware of their HIV status or had detectable antiretroviral levels. Of these, 88.4% (95% CI: 87.1 to 89.7) were receiving antiretroviral therapy (ART), and of these people, 85.3% (95% CI: 83.4 to 87.1) had VLS. Male sex age 15-34 years and having 1 or more sexual partners were associated with being unaware of one's HIV-positive status. Age <50 years and not taking cotrimoxazole were associated with being less likely to be being both aware and taking ART. Male sex, age <50 years, and taking cotrimoxazole were associated with being on ART but not having VLS. CONCLUSIONS Zimbabwe has made great strides toward epidemic control. Focusing resources on case finding, particularly among men, people aged <35 years, and sexually active individuals can help Zimbabwe attain 90-90-90 targets.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Beth A Tippett Barr
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Steven Kinchen
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Godfrey Musuka
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Julius Manjengwa
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Shungu Munyati
- Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research & Training Institute, Harare, Zimbabwe
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Owen Mugurungi
- Ministry of Health and Child Care, Harare, Zimbabwe ; and
| | - Getrude Ncube
- Ministry of Health and Child Care, Harare, Zimbabwe ; and
| | - Suzue Saito
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Bharat S Parekh
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Hetal Patel
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Yen T Duong
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Elizabeth Gonese
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Katrina Sleeman
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Leala Ruangtragool
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
- ASPPH/CDC Allan Rosenfield Global Health Fellow, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Jessica Justman
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
| | - Amy Herman-Roloff
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Elizabeth Radin
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY
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10
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Hlatshwako T, Conserve D, Day S, Reynolds Z, Weir S, Tucker JD. Increasing Men's Engagement in HIV Testing and Treatment Programs Through Crowdsourcing: A Mixed-Methods Analysis in Eswatini. Sex Transm Dis 2021; 48:789-797. [PMID: 33675595 PMCID: PMC8418618 DOI: 10.1097/olq.0000000000001408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sub-Saharan African HIV programs have had limited success in engaging men. Crowdsourcing contests may be a useful method to spur men's engagement in HIV services. We evaluated contributions and social media response to a crowdsourcing contest focused on increasing men's engagement in Eswatini HIV services. METHODS We conducted a crowdsourcing contest to gain insight from the public on how HIV campaigns can more effectively engage young (20-40 years old) men in HIV services. Eligible submissions included images, songs, videos, and Internet memes. We used standard qualitative methods to examine textual themes from submissions. We examined social media response using Facebook analytics, comparing the number of people reached through crowdsourced HIV messages and the number of people reached through conventional HIV messages. RESULTS We received 144 submissions from 83 participants. They represented 55 towns and all 4 regions of Eswatini. The contest page gained 461 followers on Facebook. Emergent themes included appealing to men's roles as protectors by suggesting that they need to take care of their own health to continue safeguarding their families. Crowdsourced messages reached a mean of 88 individuals across 4 posts; conventional messages reached a mean of 75 individuals across 4 posts. CONCLUSIONS Crowdsourcing contest submissions provided insight on how to encourage men to engage in Eswatini HIV services. Crowdsourcing contests can be effective in collecting messages from men to create more locally relevant communication materials for HIV programs.
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Affiliation(s)
| | - Donaldson Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, SC
| | - Suzanne Day
- Institute for Global Health and Infectious Diseases
| | - Zahra Reynolds
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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What has comprehensive HIV/AIDS knowledge got to do with HIV testing among men in Kenya and Mozambique? Evidence from Demographic and Health Surveys. J Biosoc Sci 2021; 54:558-571. [PMID: 34099074 DOI: 10.1017/s0021932021000237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People living with undiagnosed HIV are big contributors to the transmission of the virus. Although measures have been made to scale up HIV prevention and voluntary counselling and testing in sub-Saharan Africa, testing coverage remains low in many sub-Saharan African countries, including Mozambique and Kenya, where most people live with HIV/AIDS. Studies have shown that, in most countries in sub-Saharan Africa, men are less likely to test for HIV compared with women. This study examined the relationship between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. Data were from the men's re-code file of the Demographic and Health Surveys of Mozambique and Kenya. Binary logistic regression models were generated and the results presented as crude odds ratios (cOR) and adjusted odds ratios (aOR). The prevalences of HIV testing in Kenya and Mozambique were 80.1% and 46.7%, respectively. Men in Mozambique who had comprehensive HIV/AIDS knowledge (aOR=1.26, CI: 1.07-1.47) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. In Kenya, men who had comprehensive HIV/AIDS knowledge (aOR=1.23, CI: 1.09-1.39) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. This study found a statistically strong significant association between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. To improve HIV testing rate among men, it is important that interventions are geared towards improving men's comprehensive HIV/AIDS knowledge, perhaps by expanding HIV/AIDS education programmes and campaigns. This could improve HIV testing rates and ensure the realization of the global HIV/AIDS target of 95-95-95 by the year 2030.
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Kiragga AN, Bwanika JM, Kyenkya J, Banturaki G, Kigozi J, Musinguzi D, Namimbi F, Chander G, Reynolds SJ, Manabe YC. Point-of-care testing for HIV and sexually transmitted infections reveals risky behavior among men at gambling centers in Uganda". Int J STD AIDS 2021; 32:903-910. [PMID: 33890852 DOI: 10.1177/09564624211000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In sub-Saharan Africa (SSA), men are generally difficult to engage in healthcare programs. However, sports gambling centers in SSA can be used as avenues for male engagement in health programs. We offered point-of-care HIV and syphilis testing for men located at five gambling centers in Uganda and assessed HIV risky sexual behavior. Among 507 men, 0.8% were HIV-positive and 3.8% had syphilis. Risky sexual behavior included condomless sex with partner(s) of unknown HIV status (64.9%), having multiple sexual partners (47.8%), engaging in transactional sex (15.5%), and using illicit drugs (9.3%). The majority at 64.5% were nonalcohol consumers, 22.9% were moderate users, and 12.6% had hazardous consumption patterns. In 12 months of follow-up, the incidence rate of syphilis was 0.95 (95% CI: 0.82-1.06) among 178 men. Thus, men in SSA have a high prevalence of syphilis and risky sexual behavior which should be more effectively addressed to reduce the risk of HIV acquisition.
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Affiliation(s)
- Agnes N Kiragga
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John M Bwanika
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,The Medical Concierge Group, Kampala, Uganda
| | - Joshua Kyenkya
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Banturaki
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Kigozi
- Outreach Department, College of Health Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Florence Namimbi
- Outreach Department, College of Health Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Geetanjali Chander
- Division of Infectious Diseases, Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven J Reynolds
- Division of Infectious Diseases, Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 2511National Institutes of Health, Bethesda, MD, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Quinn C, Kadengye DT, Johnson CC, Baggaley R, Dalal S. Who are the missing men? Characterising men who never tested for HIV from population-based surveys in six sub-Saharan African countries. J Int AIDS Soc 2019; 22:e25398. [PMID: 31631576 PMCID: PMC6801221 DOI: 10.1002/jia2.25398] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/06/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION We sought to characterize men who had never tested for HIV, understand factors associated with not testing, and measure survey HIV test uptake among never testers. We analysed nationally representative Demographic and Health Surveys of six African countries from 2013 to 2016: Ethiopia, Malawi, Zimbabwe, Rwanda, Lesotho and Zambia. METHODS Eligible men were household residents or overnight visitors aged 15 to 59 years. We analysed questionnaire responses on HIV testing, known behavioural risk factors, and corresponding HIV laboratory results. We used survey-weighted logistic regression to identify factors associated with never testing for HIV. RESULTS Approximately double the proportion of men had never tested for HIV compared to women (Malawi: 30% vs. 17%, p < 0.0001; Zimbabwe: 35% vs. 19%, p < 0.0001; Lesotho: 34% vs. 15%, p < 0.0001; Zambia: 36% vs. 20%, p < 0.0001); although, less of a differential existed in Ethiopia (54% vs. 56%, p = 0.12) and Rwanda (19% vs. 14%, p < 0.0001). When offered a test during the survey, 85% to 99% of sexually active men who reported never previously testing, accepted testing. HIV positivity ranged from <0.05% to 14% for never tested men. After adjusting for age, factors associated with never having tested for HIV were never being married (aOR range: 1.46 to 10.39), not having children (aOR: 1.36 to 3.59) and lower education (less than primary education aOR: 2.77 to 5.59). CONCLUSIONS Although higher proportions of men than women had never tested for HIV, 85% to 99% of men did accept a test when offered. Finding opportunities to offer HIV testing to single men without children, older men who have never tested, and those disadvantaged with less schooling and employment, alongside other facility and community-based services, will be important in identifying those living with undiagnosed HIV and improving men's health.
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Affiliation(s)
- Caitlin Quinn
- Department of HIV/AIDSWorld Health OrganizationGenevaSwitzerland
| | | | - Cheryl C Johnson
- Department of HIV/AIDSWorld Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Department of HIV/AIDSWorld Health OrganizationGenevaSwitzerland
| | - Shona Dalal
- Department of HIV/AIDSWorld Health OrganizationGenevaSwitzerland
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