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Zhang Y, Johnson CC, Nguyen VTT, Ong JJ. Role of HIV self-testing in strengthening HIV prevention services. Lancet HIV 2024:S2352-3018(24)00187-5. [PMID: 39332440 DOI: 10.1016/s2352-3018(24)00187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 09/29/2024]
Abstract
HIV self-testing, which has been increasingly available since 2016, can substantially enhance the uptake of HIV testing, especially for key populations. Clinical trials have explored the application of self-testing in various HIV prevention strategies, including post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and voluntary medical male circumcision. Research indicates that self-testing can facilitate PrEP initiation and improve adherence and continuation. However, evidence on the effectiveness of linkage to PrEP post HIV self-testing is mixed, underscoring the need to further understand contextual factors and optimal implementation strategies. Studies on linking voluntary medical male circumcision post HIV self-testing show no statistically significant difference compared with standard voluntary medical male circumcision demand creation strategies. There is a shortage of trials examining the role of self-testing in PrEP reinitiation, PEP initiation, or PEP follow-up. Evidence for the use of HIV prevention models that support self-testing is accumulating, but there is a need for further research in different contexts and among different populations to assess its value when scaled up to contribute to reducing HIV infections globally.
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Affiliation(s)
- Ying Zhang
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Jason J Ong
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Paladhi UR, Katz DA, Otieno G, Hughes JP, Thirumurthy H, Lagat H, Masyuko S, Sharma M, Macharia P, Bosire R, Mugambi M, Kariithi E, Farquhar C. Effectiveness of Using Additional HIV Self-Test Kits as an Incentive to Increase HIV Testing Within Assisted Partner Services. J Acquir Immune Defic Syndr 2024; 96:457-464. [PMID: 38985443 PMCID: PMC11237351 DOI: 10.1097/qai.0000000000003455] [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: 12/19/2023] [Accepted: 04/11/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Incentives have shown mixed results in increasing HIV testing rates in low-resource settings. We investigated the effectiveness of offering additional self-tests (HIVSTs) as an incentive to increase testing among partners receiving assisted partner services (APS). SETTING Western Kenya. METHODS We conducted a single-crossover study nested within a cluster-randomized controlled trial. Twenty-four facilities were randomized 1:1 to (1) control: provider-delivered testing or (2) intervention: offered 1 HIVST or provider-delivered testing for 6 months (pre-implementation), then switched to offering 2 HIVSTs for 6 months (post-implementation). A difference-in-differences approach using generalized linear mixed models, accounting for facility clustering and adjusting for age, sex, and income, was used to estimate the effect of the incentive on HIV testing and first-time testing among partners in APS. RESULTS March 2021-June 2022, 1127 index clients received APS and named 8155 partners, among whom 2333 reported a prior HIV diagnosis and were excluded from analyses, resulting in 5822 remaining partners: 3646 (62.6%) and 2176 (37.4%) in the pre-implementation and post-implementation periods, respectively. Overall, 944/2176 partners (43%) were offered a second HIVST during post-preimplementation, of whom 34.3% picked up 2 kits, of whom 71.7% reported that the second kit encouraged HIV testing. Comparing partners offered 1 vs. two HIVSTs showed no difference in HIV testing (relative risk: 1.01, 95% confidence interval: 0.951 to 1.07) or HIV testing for the first time (relative risk: 1.23, 95% confidence interval: 0.671 to 2.24). CONCLUSIONS Offering a second HIVST as an incentive within APS did not significantly impact HIV testing or first-time testing, although those opting for 2 kits reported it incentivized them to test.
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Affiliation(s)
- Unmesha Roy Paladhi
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, USA
| | | | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
| | - Harison Lagat
- School of Nursing, University of Washington, Seattle, USA
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, USA
- Ministry of Health, Nairobi, Kenya
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Mary Mugambi
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Carey Farquhar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
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Drake AL, Jiang W, Kitao P, Farid S, Richardson BA, Katz DA, Wagner AD, Johnson CC, Matemo D, Stewart G, Kinuthia J. Preferences and uptake of home-based HIV self-testing for maternal retesting in Kenya. PLoS One 2024; 19:e0302077. [PMID: 39137189 PMCID: PMC11321582 DOI: 10.1371/journal.pone.0302077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To compare preferences, uptake, and cofactors for unassisted home-based oral self-testing (HB-HIVST) versus clinic-based rapid diagnostic blood tests (CB-RDT) for maternal HIV retesting. DESIGN Prospective cohort. METHODS Between November 2017 and June 2019, HIV-negative pregnant Kenyan women receiving antenatal care were enrolled and given a choice to retest with HB-HIVST or CB-RDT. Women were asked to retest between 36 weeks gestation and 1-week post-delivery if the last HIV test was <24 weeks gestation or at 6 weeks postpartum if ≥24 weeks gestation, and self-report on retesting at a 14-week postpartum. RESULTS Overall, 994 women enrolled and 33% (n = 330) selected HB-HIVST. HB-HIVST was selected because it was private (n = 224, 68%), convenient (n = 211, 63%), and offered flexibility in the timing of retesting (n = 207, 63%), whereas CB-RDT was selected due to the trust of providers to administer the test (n = 510, 77%) and convenience of clinic testing (n = 423, 64%). Among 905 women who reported retesting at follow-up, 135 (15%) used HB-HIVST. Most (n = 595, 94%) who selected CB-RDT retested with this strategy, compared to 39% (n = 120) who selected HB-HIVST retesting with HB-HIVST. HB-HIVST retesting was more common among women with higher household income and those who may have been unable to test during pregnancy (both retested postpartum and delivered <37 weeks gestation) and less common among women who were depressed. Most women said they would retest in the future using the test selected at enrollment (99% [n = 133] HB-HIVST; 93% [n = 715] CB-RDT-RDT). CONCLUSIONS While most women preferred CB-RDT for maternal retesting, HB-HIVST was acceptable and feasible and could be used to expand HIV retesting options.
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Affiliation(s)
- Alison L. Drake
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Wenwen Jiang
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Peninah Kitao
- Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya
| | - Shiza Farid
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Barbra A. Richardson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Cheryl C. Johnson
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Daniel Matemo
- Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya
| | - GraceJohn Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - John Kinuthia
- Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya
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Chu IYH, Weatherburn P, Wright T, Samba P, Nicholls EJ, McCabe L, Gafos M, Dunn DT, Trevelion R, Burns FM, Rodger AJ, Witzel TC. Needs & networks: understanding the role and impact of social networks on HIV (self-)testing among GBMSM and trans people in England and Wales. BMC Public Health 2024; 24:1984. [PMID: 39054509 PMCID: PMC11271186 DOI: 10.1186/s12889-024-18487-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/29/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Understanding how HIV self-testing (HIVST) can meet the testing needs of gay, bisexual and other men who have sex with men (GBMSM) and trans people whose social networks vary is key to upscaling HIVST implementation. We aim to develop a contextual understanding of social networks and HIV testing needs among GBMSM (cis and transgender) and trans women in SELPHI (An HIV Self-testing Public Health Intervention), the UK's largest randomised trial on HIVST. METHODS This study re-analysed qualitative interviews conducted from 2015 to 2020. Forty-three in-person interviews were thematically analysed using the Framework Method. Our analytic matrix inductively categorised participants based on the unmet needs for HIV testing and the extent of social network support. The role of social networks on HIVST behaviour was explored based on individuals' testing trajectories. RESULTS Four distinct groups were identified based on their unmet testing needs and perceived support from social networks. Optimisation advocates (people with high unmet needs and with high network support, n = 17) strived to tackle their remaining barriers to HIV testing through timely support and empowerment from social networks. Privacy seekers (people with high unmet needs and with low network support, n = 6) prioritised privacy because of perceived stigma. Opportunistic adopters (people with low unmet needs and with high network support, n = 16) appreciated social network support and acknowledged socially privileged lives. Resilient testers (people with low unmet needs and with low network support, n = 4) might hold potentially disproportionate confidence in managing HIV risks without sustainable coping strategies for potential seroconversion. Supportive social networks can facilitate users' uptake of HIVST by: (1) increasing awareness and positive attitudes towards HIVST, (2) facilitating users' initiation into HIVST with timely support and (3) affording participants an inclusive space to share and discuss testing strategies. CONCLUSIONS Our proposed categorisation may facilitate the development of differentiated person-centred HIVST programmes. HIVST implementers should carefully consider individuals' unmet testing needs and perceived levels of social support, and design context-specific HIVST strategies that link people lacking supportive social networks to comprehensive HIV care.
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Affiliation(s)
- Isaac Yen-Hao Chu
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK.
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Peter Weatherburn
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, 149 Tottenham Court Rd, W1T 7BN, London, UK
| | - Phil Samba
- The Love Tank CIC, The Green House, 244-254 Cambridge Heath Road, E2 9DA, London, UK
| | - Emily Jay Nicholls
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ, London, UK
| | - Mitzy Gafos
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - David T Dunn
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ, London, UK
| | - Roy Trevelion
- HIV i-Base, 107 The Maltings, 169 Tower Bridge Road, SE1 3LJ, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - T Charles Witzel
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
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Hu S, Jing F, Fan C, Dai Y, Xie Y, Zhou Y, Lv H, He X, Wu D, Tucker JD, Tang W. Social network strategies to distribute HIV self-testing kits: a global systematic review and network meta-analysis. J Int AIDS Soc 2024; 27:e26342. [PMID: 39048927 PMCID: PMC11269052 DOI: 10.1002/jia2.26342] [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: 11/06/2023] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST). METHODS Using search terms related to social network interventions and HIVST, we searched five databases for trials published between 1st January 2010 and 30th June 2023. Outcomes included uptake of HIV testing, HIV prevalence and linkage to antiretroviral therapy (ART) or HIV care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI). RESULTS Among the 4496 manuscripts identified, 39 studies fulfilled the inclusion criteria, including one quasi-experimental study, 22 randomized controlled trials and 16 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 16 studies) and peer educators (distributed to unknown peers, 8 studies). Among social networks, simulating the possibilities of ranking position, peer distribution had the highest uptake of HIV testing (84% probability), followed by partner distribution (80% probability) and peer educator distribution (74% probability). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.76, 95% CI 1.50-2.07, 10 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. DISCUSSION All of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Linkage to ART or HIV care remained comparable to facility-based testing across the three HIVST distribution strategies. CONCLUSIONS Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally. PROSPERO NUMBER CRD42022361782.
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Affiliation(s)
- Siyue Hu
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- School of Public HealthSouthern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
| | - Fengshi Jing
- Faculty of Data ScienceCity University of MacauTaipaChina
| | - Chengxin Fan
- University of North Carolina Project – ChinaGuangzhouChina
- School of Public HealthNanjing Medical UniversityNanjingChina
| | - Yifan Dai
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- School of Public HealthSouthern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke‐NUS Medical SchoolSingapore
| | - Yi Zhou
- Zhuhai Center for Diseases Control and PreventionZhuhaiChina
| | - Hang Lv
- Zhuhai Center for Diseases Control and PreventionZhuhaiChina
| | - Xi He
- Zhuhai Xutong Voluntary Services CenterZhuhaiChina
| | - Dan Wu
- University of North Carolina Project – ChinaGuangzhouChina
- School of Public HealthNanjing Medical UniversityNanjingChina
- London School of Hygiene and Tropical MedicineLondonUK
| | - Joseph D. Tucker
- University of North Carolina Project – ChinaGuangzhouChina
- London School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
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Eger WH, Mutchler A, Santamour T, Meaders S, Pines HA, Bazzi AR, Tookes HE, Bartholomew TS. Decentralized HIV testing: comparing peer and mail-based distribution strategies to improve the reach of HIV self-testing among people who use drugs in Florida. Harm Reduct J 2024; 21:116. [PMID: 38880929 PMCID: PMC11181602 DOI: 10.1186/s12954-024-01031-9] [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] [Received: 01/16/2024] [Accepted: 06/01/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION People who use drugs (PWUD) are at increased risk for HIV infection. HIV self-testing (HIVST) is a promising method for identifying new infections, but optimal distribution strategies remain understudied. METHODS To characterize PWUD by HIVST distribution strategy (peers vs. mail), we examined data from July 2022 to June 2023 collected from a real-world HIVST program led by the non-profit, Florida Harm Reduction Collective. We used descriptive statistics and Poisson regressions with robust error variance to compare those who received HIVST through peers or via mail by socio-demographics, Ending the HIV Epidemic (EHE) county designation, and HIV testing experience. RESULTS Among 728 participants, 78% received HIVST from peers, 47% identified as cisgender female, 48% as heterosexual, and 45% as non-White; 66% resided in an EHE county, and 55% had no HIV testing experience. Compared to those who received an HIV self-test from peers, those who received tests via mail were less likely to be cisgender male (vs. cisgender female; prevalence ratio [PR] = 0.59, 95% confidence interval [CI]: 0.43, 0.81), non-Hispanic Black (vs. non-Hispanic White; PR = 0.57, 95% CI: 0.36, 0.89) or from EHE counties (vs. non-EHE counties; PR = 0.33, 95% CI: 0.25, 0.44). Those who received tests via mail were also more likely to identify their sexual orientation as "Other/Undisclosed" (vs. straight/heterosexual; PR = 2.00, 95% CI: 1.51, 2.66). CONCLUSION Our findings support the role of community-based HIVST distribution strategies in increasing HIV testing coverage among PWUD. Additional research could help inform the equitable reach of HIVST.
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Affiliation(s)
- William H Eger
- School of Social Work, San Diego State University, San Diego, CA, USA
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alexa Mutchler
- Florida Harm Reduction Collective, St. Petersburg, FL, USA
| | - Tim Santamour
- Florida Harm Reduction Collective, St. Petersburg, FL, USA
| | - Shelby Meaders
- Florida Harm Reduction Collective, St. Petersburg, FL, USA
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather A Pines
- School of Public Health, San Diego State University, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Hansel E Tookes
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Nsereko GM, Kobusingye LK, Musanje K, Nangendo J, Nantamu S, Baluku MM. Self-testing knowledge and beliefs on HIV self-testing use in central Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002869. [PMID: 38865354 PMCID: PMC11168646 DOI: 10.1371/journal.pgph.0002869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/02/2024] [Indexed: 06/14/2024]
Abstract
The government of Uganda and its implementing partners have made significant investments in HIV self-testing (HST) services to reduce clinic-related barriers to HIV testing. However, although HSTs have been around for a reasonable time, their uptake, especially among unskilled working individuals, has remained suboptimal, which threatens the efforts to achieve the 95-95-95 UNAIDS goals to end HIV by 2030. This study set out to examine whether knowledge and individual beliefs about self-testing influence the use of HIV self-tests among causal workers in Kampala. This cross-sectional study was conducted among 453 participants selected via systematic random sampling from Darling Uganda Ltd. in Wakiso district between July and September 2023. Standardized questionnaires were used, and the analysis was performed using Pearson Correlations and Linear Regression in SPSS. The findings indicate that HIV self-testing (HST) knowledge was positively related to HST use (r = .387, p≤.01), perceived susceptibility (r = .212, p≤.01), perceived benefits (r = .152, p≤.01), and perceived barriers (r = .101, p≤.05). Individual beliefs, that is, perceived susceptibility (r = .355, p≤.01), perceived benefits (r = .487, p≤.01), and perceived barriers (r = .148, p≤.01), were significantly related to HST use. Perceived benefits were the best predictor of HST use among this population (β = .442, p = .000). Therefore, (44.2%) of HST use was attributed to the benefits attached to the service. Therefore, increasing awareness regarding the benefits of HST among such populations increases the chances of HIV testing, particularly among men. This can pave the way for the 95-95-95 goal by 2030 of UNAIDS.
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Affiliation(s)
- Gerald Mukisa Nsereko
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Loyce Kiiza Kobusingye
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Khamisi Musanje
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Simon Nantamu
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Martin Mabunda Baluku
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
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Kaptchuk RP, Thakker J, Bell J, Okram S, Gopinath U, Mehta SH, Reddy AK, Loeb TA, Arumugam V, Tandon S, Parthasarathy MR, Ghosh SC, Singh A, Joshi DS, Kaur S, Solomon SS, McFall AM. HIV self-testing in India: implementation and qualitative evaluation of a web-based programme with virtual counsellor support. J Int AIDS Soc 2024; 27:e26302. [PMID: 38861458 PMCID: PMC11166186 DOI: 10.1002/jia2.26302] [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: 10/26/2023] [Accepted: 05/16/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION To achieve epidemic control of infectious diseases, engaging higher-burden populations with accessible diagnostic services is critical. HIV self-testing (HIVST) is a promising option. METHODS We implemented an online HIVST programme for key populations across India. Eligible clients were 18 years or older, self-reported a negative or unknown HIV status and reported not taking antiretroviral therapy. Clients who reported a prior HIV diagnosis were not eligible to receive an HIVST kit. HIVST clients received kits via courier or in person at pre-determined pick-up points supported by trained counselling staff. Virtual counsellors engaged clients online and by phone and offered support to register, access, and complete HIVST free of cost. Virtual counsellors supported clients to report results and engage with follow-up services. Follow-up included linking clients with a positive result to confirmatory testing and HIV care services. We assessed programmatic data across HIV continuum outcomes and conducted a qualitative evaluation through interviews with purposively sampled clients. RESULTS Between 30 June 2021 and 30 September 2022, 5324 clients ordered an HIVST kit (76% men, 13% women, 7% transgender people, 4% unknown gender). Of the 4282 clients reporting results (94% of those who received a kit), 6% screened positive, among whom 72% (n = 184) completed confirmatory testing. Themes from 41 client interviews included satisfaction about the convenience and privacy of services and the discreet nature of kit delivery. Respondents were drawn to the convenience of HIVST and appreciated gaining courage and comfort throughout the process from virtual counsellor support. For respondents who screened positive, challenges to care linkage included fearing judgemental questions from public providers and wanting more time before starting treatment. Clients shared concerns about kit accuracy and suggested that instructional materials be provided with more diverse language options. CONCLUSIONS Web-based HIVST services with tailored support appeared to facilitate HIV service access and engagement of harder-to-reach populations across India. Assistance from a community-oriented counsellor proved important to overcome literacy barriers and mistrust in order to support the HIVST process and service linkage. Learnings can inform global efforts to improve the critical step of diagnosis in achieving epidemic control for HIV and other infectious diseases.
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Affiliation(s)
- Rose Pollard Kaptchuk
- Department of International HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jalpa Thakker
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jade Bell
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Saya Okram
- Y.R. Gaitonde Centre for AIDS Research and EducationChennaiIndia
| | - Usha Gopinath
- Y.R. Gaitonde Centre for AIDS Research and EducationChennaiIndia
| | - Shruti H. Mehta
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ajay Kumar Reddy
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Talia A. Loeb
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | | | | | | | - Aditya Singh
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Sukhvinder Kaur
- United States Agency for International DevelopmentWashingtonDCUSA
| | - Sunil Suhas Solomon
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Allison M. McFall
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Harkness A, Giusto A, Hamilton AB, Hernandez‐Ramirez RU, Spiegelman D, Weiner BJ, Beidas RS, Larson ME, Lippman SA, Wainberg ML, Smith JD. Navigating grey areas in HIV and mental health implementation science. J Int AIDS Soc 2024; 27:e26271. [PMID: 38923301 PMCID: PMC11197965 DOI: 10.1002/jia2.26271] [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: 08/16/2023] [Accepted: 04/29/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high-impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, "grey areas," or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. DISCUSSION A group of IS experts affiliated with NIMH-funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH-related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence-based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. CONCLUSIONS HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high-impact HIV/MH implementation research.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health StudiesUniversity of MiamiCoral GablesFloridaUSA
| | - Ali Giusto
- Department of PsychiatryColumbia University Irving Medical CenterNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Alison B. Hamilton
- Center for the Study of Healthcare InnovationImplementation & Policy, VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Department of Psychiatry & Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Raul U. Hernandez‐Ramirez
- Department of BiostatisticsCenter for Interdisciplinary Research on AIDSand Center for Methods in Implementation and Prevention ScienceYale School of Public HealthNew HavenConnecticutUSA
| | - Donna Spiegelman
- Department of BiostatisticsCenter for Interdisciplinary Research on AIDSand Center for Methods in Implementation and Prevention ScienceYale School of Public HealthNew HavenConnecticutUSA
| | - Bryan J. Weiner
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Rinad S. Beidas
- Department of Medical Social SciencesFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Michaela E. Larson
- School of Nursing and Health StudiesUniversity of MiamiCoral GablesFloridaUSA
- Division of Prevention ScienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sheri A. Lippman
- Division of Prevention ScienceUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Milton L. Wainberg
- Department of PsychiatryColumbia University Irving Medical CenterNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Justin D. Smith
- Department of Population Health SciencesSpencer Fox Eccles School of Medicine at the University of UtahSalt Lake CityUtahUSA
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O'Reilly A, Mavhu W, Neuman M, Kumwenda MK, Johnson CC, Sinjani G, Indravudh P, Choko A, Hatzold K, Corbett EL. Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study. BMC Infect Dis 2024; 22:979. [PMID: 38566003 PMCID: PMC10985843 DOI: 10.1186/s12879-024-09231-1] [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: 08/23/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has largely been oral-fluid-based. We investigated whether users preferred blood-based (i.e. using blood sample derived from a finger prick) or oral fluid-based HIVST in rural and urban Malawi. METHODS At clinics providing HIV testing services (n = 2 urban; n = 2 rural), participants completed a semi-structured questionnaire capturing sociodemographic data before choosing to test using oral-fluid-based HVST, blood-based HIVST or provider-delivered testing. They also completed a self-administered questionnaire afterwards, followed by a confirmatory test using the national algorithm then appropriate referral. We used simple and multivariable logistic regression to identify factors associated with preference for oral-fluid or blood-based HIVST. RESULTS July to October 2018, N = 691 participants enrolled in this study. Given the choice, 98.4% (680/691) selected HIVST over provider-delivered testing. Of 680 opting for HIVST, 416 (61.2%) chose oral-fluid-based HIVST, 264 (38.8%) chose blood-based HIVST and 99.1% (674/680) reported their results appropriately. Self-testers who opted for blood-based HIVST were more likely to be male (50.3% men vs. 29.6% women, p < 0.001), attending an urban facility (43% urban vs. 34.6% rural, p = 0.025) and regular salary-earners (49.5% regular vs. 36.8% non-regular, p = 0.012). After adjustment, only sex was found to be associated with choice of self-test (adjusted OR 0.43 (95%CI: 0.3-0.61); p-value < 0.001). Among 264 reporting blood-based HIVST results, 11 (4.2%) were HIV-positive. Blood-based HIVST had sensitivity of 100% (95% CI: 71.5-100%) and specificity of 99.6% (95% CI: 97.6-100%), with 20 (7.6%) invalid results. Among 416 reporting oral-fluid-based HIVST results 18 (4.3%) were HIV-positive. Oral-fluid-based HIVST had sensitivity of 88.9% (95% CI: 65.3-98.6%) and specificity of 98.7% (95% CI: 97.1-99.6%), with no invalid results. CONCLUSIONS Offering both blood-based and oral-fluid-based HIVST resulted in high uptake when compared directly with provider-delivered testing. Both types of self-testing achieved high accuracy among users provided with a pre-test demonstration beforehand. Policymakers and donors need to adequately plan and budget for the sensitisation and support needed to optimise the introduction of new quality-assured blood-based HIVST products.
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Affiliation(s)
| | - Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Moses K Kumwenda
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Augustin Choko
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Elizabeth L Corbett
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Drake AL, Jiang W, Kitao P, Farid S, Richardson BA, Katz DA, Wagner AD, Johnson CC, Matemo D, Stewart GJ, Kinuthia J. Preferences and uptake of home-based HIV self-testing for maternal retesting in Kenya. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.28.24305050. [PMID: 38585992 PMCID: PMC10996825 DOI: 10.1101/2024.03.28.24305050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Objective To compare preferences, uptake, and cofactors for unassisted home-based oral self-testing (HB-HIVST) versus clinic-based rapid diagnostic blood tests (CB-RDT) for maternal HIV retesting. Design Prospective cohort. Methods Between November 2017 and June 2019, HIV-negative pregnant Kenyan women receiving antenatal care were enrolled and given a choice to retest with HB-HIVST or CB-RDT. Women were asked to retest between 36 weeks gestation and 1 week post-delivery if the last HIV test was <24 weeks gestation or at 6 weeks postpartum if ≥24 weeks gestation, and self-report on retesting at a 14 week postpartum. Results Overall, 994 women enrolled and 33% (n=330) selected HB-HIVST. HB-HIVST was selected because it was private (68%), convenient (63%), and offered flexibility in timing of retesting (63%), whereas CB-RDT was selected due to trust of providers to administer the test (77%) and convenience of clinic testing (64%). Among 905 women who reported retesting at follow-up, 135 (15%) used HB-HIVST. Most (94%) who selected CB-RDT retested with this strategy, compared to 39% who selected HB-HIVST retesting with HB-HIVST. HB-HIVST retesting was more common among women with higher household income and those who may have been unable to test during pregnancy (both retested postpartum and delivered <37 weeks gestation) and less common among women who were depressed. Most women said they would retest in the future using the test selected at enrollment (99% HB-HIVST; 93% CB-RDT-RDT). Conclusions While most women preferred CB-RDT for maternal retesting, HB-HIVST was acceptable and feasible and may increase retesting coverage and partner testing.
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Affiliation(s)
- Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Wenwen Jiang
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Peninah Kitao
- Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya
| | - Shiza Farid
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Cheryl C Johnson
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Daniel Matemo
- Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace-John Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya
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Bazzi AR, Valasek CJ, Stamos-Buesig T, Eger WH, Harvey-Vera A, Vera CF, Syvertsen JL, Storholm ED, Bartholomew TS, Tookes HE, Strathdee SA, Pines HA. Health, harm reduction, and social service providers' perspectives on the appropriateness and feasibility of peer distribution of HIV self-test kits among people who use drugs. Harm Reduct J 2024; 21:29. [PMID: 38311717 PMCID: PMC10838430 DOI: 10.1186/s12954-024-00950-x] [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: 10/10/2023] [Accepted: 01/26/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND People who use drugs (PWUD) experience elevated HIV risk and numerous barriers to facility-based HIV testing. HIV self-testing (HIVST) could circumvent many of those barriers and is acceptable among PWUD, yet HIVST implementation for PWUD is limited. Service providers' perspectives on specific HIVST delivery strategies could help increase availability for PWUD. METHODS From April-November 2021, we interviewed 16 health, harm reduction, and social service providers working with PWUD in San Diego, CA. Interviews and rapid thematic analysis explored perspectives on HIVST's utility and appropriateness, as well as the feasibility of and anticipated challenges with specific HIVST delivery strategies, including peer or secondary distribution. RESULTS Participants viewed HIV as a significant threat to PWUD health and confirmed the presence of numerous barriers to local facility-based HIV testing. Participants viewed HIVST as a promising and potentially empowering solution. Based on community familiarity with secondary distribution of harm reduction supplies (i.e., naloxone) and information, participants viewed secondary distribution of HIVST kits as an appropriate and feasible strategy for increasing the reach of HIVST, but also described potential barriers (e.g., engaging socially disconnected individuals, ensuring linkages to services following HIVST) and provided suggestions for alternative HIVST kit delivery models (e.g., harm reduction vending machines). CONCLUSIONS Service providers viewed secondary distribution of HIVST kits among PWUD as promising, appropriate, and feasible, yet specialized efforts may be needed to reach the most marginalized individuals and ensure consistent provision of educational information and referral supports that maximize the impact of this approach.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- School of Public Health, Boston University, Boston, MA, USA.
| | - Chad J Valasek
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - William H Eger
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer L Syvertsen
- Department of Anthropology, University of California, Riverside, Riverside, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, USA
| | | | - Hansel E Tookes
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Heather A Pines
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, USA
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Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Nangendo J, Wanyenze RK, Obeng-Amoako GO, Muwema M, Mukisa J, Okiring J, Kabami J, Karamagi CA, Semitala FC, Kalyango JN, Kamya MR, Katahoire AR. Health provider perspectives of Village Health Team-delivered oral HIV self-testing among men in Central Uganda: a qualitative evaluation using RE-AIM framework. RESEARCH SQUARE 2024:rs.3.rs-3816613. [PMID: 38343851 PMCID: PMC10854283 DOI: 10.21203/rs.3.rs-3816613/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background HIV self-testing (HIVST) is a practical and effective way to provide HIV testing services to at-risk and underserved populations, particularly men. Utilizing Village Health Teams (VHTs) could enhance community-based delivery of oral HIVST to reach the last un-tested individuals who may be at-risk of infection. However, little is known about what VHTs and facility-based healthcare workers think about facilitating oral HIVST and delivery of subsequent HIV services. We investigated the views of health providers on oral HIVST delivered by VHTs among men in rural communities in Central Uganda. Methods We conducted a qualitative study in Mpigi district, interviewing 27 health providers who facilitated oral HIV self-testing among men. The providers consisting of 15 VHTs and 12 facility-based health workers were purposively selected. All interviews were audio-recorded, transcribed verbatim, and translated to English for a hybrid inductive-deductive thematic analysis. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Implementation Science framework to generate and categorize open codes. Results In terms of reaching men with HIV testing services, the providers considered HIVST to be a fast and convenient method, which could boost HIV testing. However, they also had concerns about its accuracy. In terms of effectiveness, HIVST was perceived as a reliable, user-friendly, and efficient approach to HIV testing. However, it depended on the user's preference for testing algorithms. Regarding adoption, HIVST was considered to enhance autonomy, well-suited for use in the community, and offered opportunities for linkage and re-linkage into care. However, at times HIVST faced hesitance. As for Implementation, VHTs had various support roles in HIVST but had concerns about social insecurities and delays in seeking subsequent facility-based services after HIVST. Regarding Maintenance, providers recommended several ways to improve oral HIVST including; optimizing tracking of HIVST distribution and use, improving linkage and retention in care after HIVST, diversifying HIVST for combined HIV prevention packages and including more languages, broadening sensitization among potential HIVST users and health providers, differentiating distribution models, and prioritizing targeted HIVST efforts. Conclusion HIVST has the potential to increase testing rates and engagement of men in HIV services. However, for it to be implemented on a population-wide scale, continuous sensitization of potential users and health providers is necessary, along with streamlined structures for tracking kit distribution, use, and reporting of results. Further implementation research may be necessary to optimize the role of health providers in facilitating HIVST.
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Affiliation(s)
| | | | | | | | - John Mukisa
- Makerere University College of Health Sciences
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Chan HK, Sem X, Ivanova Reipold E, Pannir Selvam SBA, Salleh NA, Mohamad Gani AHB, Fajardo E, Shilton S, Abu Hassan MR. Usability and acceptability of oral fluid- and blood-based hepatitis C virus self-testing among the general population and men who have sex with men in Malaysia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001770. [PMID: 38170720 PMCID: PMC10763960 DOI: 10.1371/journal.pgph.0001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
Hepatitis C self-testing (HCVST) is emerging as an additional strategy that could help to expand access to HCV testing. We conducted a study to assess the usability and acceptability of two types of HCVST, oral fluid- and blood-based, among the general population and men who have sex with men (MSM) in Malaysia. An observational study was conducted in three primary care centres in Malaysia. Participants who were layman users performed the oral fluid- and blood-based HCVST sequentially. Usability was assessed by calculating the rate of errors observed, the rate of difficulties faced by participants as well as inter-reader (self-test interpreted by self-tester vs interpreted by trained user) and inter-operator concordances (self-test vs test performed by trained user). The acceptability of HCV self-testing was assessed using an interviewer-administered semi-structured questionnaire. Participants were also required to read contrived test results which included "positive", "negative", and "invalid". There was a total of 200 participants (100 general population, 100 MSM; mean age 33.6 ± 14.0 years). We found a high acceptability of oral fluid- and blood-based HCVST across both general population and MSM. User errors, related to timekeeping and reading within stipulated time, were common. However, the majority of the participants were still able to obtain and interpret results correctly, including that of contrived results, although there was substantial difficulty interpreting weak positive results. The high acceptability of HCVST among the participants did not appreciably change after they had experienced both tests, with 97.0% of all participants indicating they would be willing to use HCVST again and 98.5% of them indicating they would recommend it to people they knew. There was no significant difference between the general population and MSM in these aspects. Our study demonstrates that both oral fluid- and blood-based HCVST are highly acceptable among both the general population and MSM. Both populations also showed comparable ability to conduct the tests and interpret the results. Overall, this study suggests that HCVST could be introduced as an addition to existing HCV testing services in Malaysia. Further studies are needed to establish the optimal positioning of self-testing alongside facility-based testing to expand access to HCV diagnosis in the country.
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Affiliation(s)
- Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
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Pines HA, Eger WH, Skaathun B, Vera CF, Harvey-Vera A, Rangel G, Strathdee SA, Bazzi AR. Willingness to use and distribute HIV self-testing kits among people who inject drugs in the San Diego-Tijuana border region. Harm Reduct J 2024; 21:4. [PMID: 38172795 PMCID: PMC10765917 DOI: 10.1186/s12954-023-00922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND HIV self-testing (HIVST) could increase HIV testing access among people who inject drugs (PWID), and secondary distribution (i.e., peer-delivery) of HIVST kits in PWID social networks could further expand coverage. We assessed willingness to use and distribute HIVST kits among PWID in the San Diego-Tijuana border region. METHODS From 2020 to 2021, HIV-negative PWID in San Diego, USA, and Tijuana, Mexico, completed surveys and provided data on individual (N = 539) and social network (N = 366) characteristics. We used modified Poisson regression to examine the effects of individual and social network characteristics on willingness to use and distribute HIVST kits. RESULTS Most participants were willing to use (81%) and distribute (81%) HIVST kits. At the individual level, prior HIV testing was positively associated with willingness to use (adjusted prevalence ratio [aPR] = 1.24, 95% confidence interval [CI] 1.10-1.40) and distribute (aPR = 1.27, 95% CI 1.12-1.43) HIVST kits, while perceiving oneself to be at higher HIV risk than others was negatively associated with willingness to use HIVST kits (aPR = 0.83, 95% CI 0.74-0.93). At the network level, willingness to distribute HIVST kits was positively associated with network size (aPR = 1.04 per member, 95% CI 1.01-1.08) and greater proportions of one's network encouraging them to use drugs (aPR = 1.29, 95% CI 1.16-1.44) and having a history of homelessness (aPR = 1.51, 95% CI 1.31-1.74) or detention/arrest (aPR = 1.57, 95% CI 1.36-1.82), and negatively associated with a greater proportion of one's network including "very close" persons (aPR = 0.80, 95% CI 0.69-0.94). CONCLUSIONS We found high potential for HIVST kits and their secondary distribution to increase HIV testing among PWID who face the greatest barriers to facility-based testing.
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Affiliation(s)
- Heather A Pines
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - William H Eger
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Britt Skaathun
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gudelia Rangel
- Mexico Section of the US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | | | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, Boston University, Boston, MA, USA
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Katzenschlager S, Brümmer LE, Schmitz S, Tolle H, Manten K, Gaeddert M, Erdmann C, Lindner A, Tobian F, Grilli M, Pollock NR, Macé A, Erkosar B, Carmona S, Ongarello S, Johnson CC, Sacks JA, Denkinger CM, Yerlikaya S. Comparing SARS-CoV-2 antigen-detection rapid diagnostic tests for COVID-19 self-testing/self-sampling with molecular and professional-use tests: a systematic review and meta-analysis. Sci Rep 2023; 13:21913. [PMID: 38081881 PMCID: PMC10713601 DOI: 10.1038/s41598-023-48892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Self-testing is an effective tool to bridge the testing gap for several infectious diseases; however, its performance in detecting SARS-CoV-2 using antigen-detection rapid diagnostic tests (Ag-RDTs) has not been systematically reviewed. This study aimed to inform WHO guidelines by evaluating the accuracy of COVID-19 self-testing and self-sampling coupled with professional Ag-RDT conduct and interpretation. Articles on this topic were searched until November 7th, 2022. Concordance between self-testing/self-sampling and fully professional-use Ag-RDTs was assessed using Cohen's kappa. Bivariate meta-analysis yielded pooled performance estimates. Quality and certainty of evidence were evaluated using QUADAS-2 and GRADE tools. Among 43 studies included, twelve reported on self-testing, and 31 assessed self-sampling only. Around 49.6% showed low risk of bias. Overall concordance with professional-use Ag-RDTs was high (kappa 0.91 [95% confidence interval (CI) 0.88-0.94]). Comparing self-testing/self-sampling to molecular testing, the pooled sensitivity and specificity were 70.5% (95% CI 64.3-76.0) and 99.4% (95% CI 99.1-99.6), respectively. Higher sensitivity (i.e., 93.6% [95% CI 90.4-96.8] for Ct < 25) was estimated in subgroups with higher viral loads using Ct values as a proxy. Despite high heterogeneity among studies, COVID-19 self-testing/self-sampling exhibits high concordance with professional-use Ag-RDTs. This suggests that self-testing/self-sampling can be offered as part of COVID-19 testing strategies.Trial registration: PROSPERO: CRD42021250706.
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Affiliation(s)
- Stephan Katzenschlager
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Lukas E Brümmer
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- German Center for Infection Research (DZIF), Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - Stephani Schmitz
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Department of Developmental Biology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hannah Tolle
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Katharina Manten
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Mary Gaeddert
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | | | - Andreas Lindner
- Charité Center for Global Health, Institute of International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Tobian
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | | | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | | | | | | | - Cheryl C Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Jilian A Sacks
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Claudia M Denkinger
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- German Center for Infection Research (DZIF), Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - Seda Yerlikaya
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
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Witzel TC, Nicholls EJ, McCabe L, Weatherburn P, McCormack S, Bonell C, Gafos M, Lampe FC, Speakman A, Dunn D, Ward D, Phillips AN, Pebody R, Gabriel MM, Collaco-Moraes Y, Rodger AJ, Burns FM. Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study. Sex Transm Infect 2023; 99:534-540. [PMID: 37607814 PMCID: PMC10715485 DOI: 10.1136/sextrans-2023-055840] [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: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIV Self-testing Public Health Intervention), the largest randomised trial of HIVST in a high-income country to date. METHODS 10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively. RESULTS Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did. DISCUSSION HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up. TRIAL REGISTRATION NUMBER ISRCTN20312003.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Weatherburn
- Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Christopher Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mitzy Gafos
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Michelle M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
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Kerkhoff AD, West NS, Del Mar Castro M, Branigan D, Christopher DJ, Denkinger CM, Nhung NV, Theron G, Worodria W, Yu C, Muyoyeta M, Cattamanchi A. Placing the values and preferences of people most affected by TB at the center of screening and testing: an approach for reaching the unreached. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:27. [PMID: 39239641 PMCID: PMC11376596 DOI: 10.1186/s44263-023-00027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/04/2023] [Indexed: 09/07/2024]
Abstract
To reach the millions of people with tuberculosis (TB) undiagnosed each year, there is an important need to provide people-centered screening and testing services. Despite people-centered care being a key pillar of the WHO END-TB Strategy, there have been few attempts to formally characterize and integrate the preferences of people most affected by TB - including those who have increased exposure to TB, limited access to services, and/or are at increased risk for TB - into new tools and strategies to improve screening and diagnosis. This perspective emphasizes the importance of preference research among people most affected by TB, provides an overview of qualitative preference exploration and quantitative preference elicitation research methods, and outlines how preferences can be applied to improve the acceptability, accessibility, and appropriateness of TB screening and testing services via four key opportunities. These include the following: (1) Defining the most preferred features of novel screening, triage, and diagnostic tools, (2) exploring and prioritizing setting-specific barriers and facilitators to screening and testing, (3) understanding what features of community- and facility-based strategies for improving TB detection and treatment are most valued, and (4) identifying the most relevant and resonant communication strategies to increase individual- and community-level awareness and demand. Preference research studies and translation of their findings into policy/guidance and operationalization have enormous potential to close the existing gaps in detection in high burden settings by enhancing the people-centeredness and reach of screening and diagnostic services to people most affected by TB who are currently being missed and left behind.
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Affiliation(s)
- Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Nora S West
- Pulmonary, Critical Care Allergy and Sleep Medicine, University of California San Francisco, San Francisco, USA
| | - Maria Del Mar Castro
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Claudia M Denkinger
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Center of Infection Research, Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - Nguyen Viet Nhung
- University of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi, Vietnam
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - William Worodria
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
- World Alliance for Lung and Intensive Care in Uganda, Kampala, Uganda
| | - Charles Yu
- Center for Tuberculosis Research, De La Salle Medical and Health Sciences Institute, City of Dasmarinas, The Philippines
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Adithya Cattamanchi
- Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
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20
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Hu S, Jing F, Fan C, Dai Y, Xie Y, Zhou Y, Lv H, He X, Wu D, Tucker JD, Tang W. Social Network Strategies to Distribute HIV Self-testing Kits: A Global Systematic Review and Network Meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.05.23298135. [PMID: 37986939 PMCID: PMC10659482 DOI: 10.1101/2023.11.05.23298135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Introduction Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST). Methods Using search terms related to social network interventions and HIVST, we searched five databases for trials published between January 1st, 2010, and June 30th, 2023. Outcomes included uptake of HIV testing, HIV seroconversion, and linkage to antiretroviral therapy (ART) or HIV Care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI). Results and discussion Among the 3,745 manuscripts identified, 33 studies fulfilled the inclusion criteria, including one quasi-experimental study, 17 RCTs and 15 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 10 studies), and peer educators (distributed to unknown peers, 8 studies). The results showed that all of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Among social networks, peer distribution had the highest uptake of HIV testing (79% probability, SUCRA 0.92), followed by partner distribution (72% probability, SUCRA 0.71), and peer educator distribution (66% probability, SUCRA 0.29). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.45, 95% CI 1.05-2.02, 7 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. Linkage to ART or HIV Care remained comparable to facility-based testing across the three HIVST distribution strategies. Conclusions Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally.PROSPERO Number: CRD42022361782.
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Affiliation(s)
- Siyue Hu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Fengshi Jing
- Faculty of Data Science, City University of Macau, Taipa, Macao SAR, China
| | - Chengxin Fan
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Dai
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Hang Lv
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D. Tucker
- University of North Carolina Project – China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
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21
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Mavhu W, Makamba M, Hatzold K, Maringwa G, Takaruza A, Mutseta M, Ncube G, Cowan FM, Sibanda EL. Preferences for oral-fluid-based or blood-based HIV self-testing and provider-delivered testing: an observational study among different populations in Zimbabwe. BMC Infect Dis 2023; 22:973. [PMID: 37848810 PMCID: PMC10583299 DOI: 10.1186/s12879-023-08624-y] [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: 03/22/2022] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND There is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations. METHODS At clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings. RESULTS May to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34-0.93) and those previously married aOR0.56 (0.34-0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28-3.13), 2.55 (1.28-5.07), 2.76 (1.48-5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96-0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47-17.41), 3.38 (2.03-5.62) and 2.23 (1.38-3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09-0.92). CONCLUSIONS Most testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations.
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Affiliation(s)
- Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Memory Makamba
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Galven Maringwa
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Albert Takaruza
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | | | | | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Euphemia L Sibanda
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe.
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
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22
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Ortblad KF, Kwach B, Zhang S, Asewe M, Ongwen PA, Malen RC, Harkey K, Odoyo J, Gathii P, Rota G, Sharma M, Were DK, Ngure K, Omollo V, Bukusi EA. Measuring the performance of HIV self-testing at private pharmacies in Kenya: a cross-sectional study. J Int AIDS Soc 2023; 26:e26177. [PMID: 37848405 PMCID: PMC10581952 DOI: 10.1002/jia2.26177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) has the potential to support daily oral pre-exposure prophylaxis (PrEP) delivery in private pharmacies, but many national guidelines have not approved HIVST for PrEP dispensing. In Kenya, pharmacy providers are permitted to deliver HIVST, but often do not have the required certification to deliver rapid diagnostic testing (RDT). We estimated the performance of provider-delivered HIVST compared to RDT, the standard of care for PrEP delivery, at private pharmacies in Kenya to inform decisions on the use of HIVST for PrEP scale-up. METHODS At 20 pharmacies in Kisumu County, we trained pharmacy providers (pharmacists and pharmaceutical technologists) on blood-based HIVST use and client assistance (if requested). We recruited pharmacy clients purchasing sexual and reproductive health-related products (e.g. condoms) and enrolled those ≥18 years with self-reported behaviours associated with HIV risk. Enrolled clients received HIVST with associated provider counselling, followed by RDT by a certified HIV testing services (HTS) counsellor. Pharmacy providers and clients independently interpreted HIVST results prior to RDT (results interpreted only by the HTS counsellor). We calculated the sensitivity and specificity of pharmacy provider-delivered HIVST compared to HTS counsellor-administered RDT. RESULTS Between March and June 2022, we screened 1691 clients and enrolled 1500; 64% (954/1500) were female and the median age was 26 years (IQR 22-31). We additionally enrolled 40 providers; 42% (17/40) were pharmacy owners and their median years of experience was 6 (IQR 4-10). The majority (79%, 1190/1500) of clients requested provider assistance with HIVST and providers spent a median of 20 minutes (IQR 15-43) with each HIVST client. The sensitivity of provider-delivered HIVST at the pharmacy was high when interpreted by providers (98.5%, 95% CI 97.8%, 99.1%) and clients (98.8%, 95% CI 98.0%, 99.3%), as was the specificity of HIVST in this setting (provider-interpretation: 96.9%, 95% CI 89.2%, 99.6%; client-interpretation: 93.8%, 95% CI 84.8%, 98.3%). CONCLUSIONS When compared to the national HIV testing algorithm, provider-delivered blood-based HIVST at private pharmacies in Kenya performed well. These findings suggest that blood-based HIVST may be a useful tool to support PrEP initiation and continuation at private pharmacies and potentially other community-based delivery settings.
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Affiliation(s)
- Katrina F. Ortblad
- Public Health Sciences DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Benn Kwach
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Shengruo Zhang
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Magdalene Asewe
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | | | - Rachel C. Malen
- Public Health Sciences DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Kendall Harkey
- Public Health Sciences DivisionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Josephine Odoyo
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | | | - Greshon Rota
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Monisha Sharma
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | - Kenneth Ngure
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Victor Omollo
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Elizabeth Anne Bukusi
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWashingtonUSA
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23
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Towns JM, Tieosapjaroen W, Mello MB, Baggaley RC, Johnson CC, Jamil MS, Rowley J, Barr-DiChiara M, Terris-Prestholt F, Chen MY, Chow EPF, Fairley CK, Zhang L, Ong JJ. The role of syphilis self-testing as an additional syphilis testing approach in key populations: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e726-e734. [PMID: 37482070 DOI: 10.1016/s2468-2667(23)00128-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Syphilis is causing epidemics in many countries. Syphilis self-testing (SST) has potential to increase testing and treatment coverage in the same manner as documented for self-testing of, for example, HIV, hepatitis C virus, and COVID-19. We aimed to synthesise current evidence on the utility of SST. METHODS We conducted a systematic review and, where possible, meta-analysis. We searched MEDLINE, Embase, CINAHL, Scopus, and Web of Science for publications published from Jan 1, 2000, to Oct 13, 2022. We included publications with original data on any syphilis rapid tests, including dual HIV-syphilis tests. Study populations were not restricted. We used random-effects meta-analysis to calculate the pooled proportion of people offered SST who undertook the test. The systematic review was registered in PROSPERO (CRD42022302129). FINDINGS In total, 40 499 citations were identified. 11 publications from seven studies from the USA, Zimbabwe, and China met eligibility criteria. Of those, four studies reported data from men who have sex with men and five studies used dual HIV-SST. Using data from one randomised controlled trial and three observational studies, the pooled proportion of people who received SST kits who undertook the test was 88% (95% CI 85-91). No studies provided data on the sensitivity or specificity of SST. Overall, user and provider preference for SST was high, with participants reporting convenience, privacy, rapid results, autonomy, trust in blood-based tests, decreased facility contact, and time savings, with individuals being able to correctly self-test. Publications from China reported that SST had lower costs per person tested than existing facility-based testing options. INTERPRETATION Our review builds on the literature for self-testing across different disease areas and demonstrates that SST has the potential to reach underserved populations. As this review found that SST use was acceptable and feasible to implement, SST can be used as an additional syphilis testing approach. Since no data on the sensitivity and specificity of SST were found, further implementation research will be required to guide the best strategies for SST service delivery and future scale-up. FUNDING WHO, Australian National Health and Medical Research Council, and Unitaid.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Jane Rowley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | | | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Nangendo J, Katahoire AR, Karamagi CA, Obeng-Amoako GO, Muwema M, Okiring J, Kabami J, Semitala FC, Kalyango JN, Wanyenze RK, Kamya MR. Uptake and perceptions of oral HIV self-testing delivered by village health teams among men in Central Uganda: A concurrent parallel mixed methods analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002019. [PMID: 37315008 PMCID: PMC10266653 DOI: 10.1371/journal.pgph.0002019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
The World Health Organization (WHO) recommends HIV self-testing (HIVST) to increase access to and utilization of HIV services among underserved populations. We assessed the uptake and perceptions of oral HIVST delivered by Village Health Teams (VHTs) among men in a peri-urban district in Central Uganda. We used a concurrent parallel mixed methods study design and analyzed data from 1628 men enrolled in a prospective cohort in Mpigi district, Central Uganda between October 2018 and June 2019. VHTs distributed HIVST kits and linkage-to-care information leaflets to participants in 30 study villages allowing up-to 10 days each to self-test. At baseline, we collected data on participant socio-demographics, testing history and risk behavior for HIV. During follow-up, we measured HIVST uptake (using self-reports and proof of a used kit) and conducted in-depth interviews to explore participants' perceptions of using HIVST. We used descriptive statistics to analyze the quantitative data and a hybrid inductive, and deductive thematic analysis for the qualitative data and integrated the results at interpretation. The median age of men was 28 years, HIVST uptake was 96% (1564/1628), HIV positivity yield was 4% (63/1564) and reported disclosure of HIVST results to sexual partners and significant others was 75.6% (1183/1564). Men perceived HIVST as a quick, flexible, convenient, and more private form of testing; allowing disclosure of HIV test results to sexual partners, friends and family, and receiving social support. Others perceived it as an opportunity for knowing or re-confirming their sero-status and subsequent linkage or re-linkage to care and prevention. Utilizing VHT networks for community-based delivery of HIVST is effective in reaching men with HIV testing services. Men perceived HIVST as highly beneficial but needed more training on performing the test and the integrating post-test counseling support to optimize use of the test for diagnosing HIV.
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Affiliation(s)
- Joanita Nangendo
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Anne R. Katahoire
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles A. Karamagi
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gloria O. Obeng-Amoako
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- International Centre for Evaluation and Development, Tema, Ghana
| | - Mercy Muwema
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaffer Okiring
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jane Kabami
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Fred C. Semitala
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Joan N. Kalyango
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rhoda K. Wanyenze
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
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25
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Soe P, Johnston LG, Makuza JD, Karim ME. The association between HIV self-test awareness and recent HIV testing uptake in the male population in Gambia: data analysis from 2019-2020 demographic and health survey. BMC Infect Dis 2023; 23:360. [PMID: 37237265 DOI: 10.1186/s12879-023-08254-4] [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: 01/28/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The Gambian Ministry of Health is supportive of HIV self-testing (HIVST) and HIVST initiatives are being piloted as an additional strategy to increase HIV testing for individuals not currently reached by existing services, particularly men. This study aimed to determine awareness of HIVST among Gambian men, and whether prior awareness of HIVST is associated with recent HIV testing uptake. METHODS We used men's cross-sectional data from the 2019-2020 Gambian Demographic and Health Survey. We employed design-adjusted multivariable logistic regression to examine the association between HIVST awareness and recent HIV testing. Propensity-score weighting was conducted as sensitivity analyses. RESULTS Of 3,308 Gambian men included in the study, 11% (372) were aware of HIVST and 16% (450) received HIV testing in the last 12 months. In the design-adjusted multivariable analysis, men who were aware of HIVST had 1.76 times (95% confidence interval: 1.26-2.45) the odds of having an HIV test in the last 12 months, compared to those who were not aware of HIVST. Sensitivity analyses revealed similar findings. CONCLUSION Awareness of HIVST may help increase the uptake of HIV testing among men in Gambia. This finding highlights HIVST awareness-raising activities to be an important intervention for nationwide HIVST program planning and implementation in Gambia.
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Affiliation(s)
- Phyumar Soe
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Lisa G Johnston
- LGJ Consultants, Inc., Valencia, Spain
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Loiusiana, Spain
| | - Jean Damascene Makuza
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
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26
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O'Byrne P, Musten A, McCready L, Robinson R, Durrant G, Tigert J, Orser L. HIV self-testing enabled access to testing for Black persons: The GetaKit study. Res Nurs Health 2023; 46:236-241. [PMID: 36573589 DOI: 10.1002/nur.22293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
In Ontario, new HIV diagnoses continue to affect gay, bisexual, and other men who have sex with men (gbMSM) and persons of African, Caribbean, or Black (ACB) ethnicities. Because treatment and suppressed viral loads flow from diagnosis, testing is key. We sought to determine the outcomes of online ordering and mail-out of free at-home HIV self-testing in Ontario, Canada. We implemented the GetaKit study to offer such free HIV self-testing using the INSTI® test and offered it via a website (GetaKit.ca) to eligible persons in Ontario. From April 1, 2021 to January 31, 2022, we distributed kits to 1551 persons; 40% were white and 26% were ACB. We found that ACB participants were less likely to fulfill established criteria for HIV PrEP, such as previous sexually transmitted infections diagnoses and drug use, despite having a similar test positivity rate. We also found that ACB women, who may represent a larger number of new infections than previously thought, did not have a higher rate of first-time testing. Our results suggest that HIV self-testing can enable testing, but that work is required to increase uptake among ACB persons and women. Overall, HIV self-testing thus corresponded with increased testing among persons who were Black, yet lower rates of results reporting. Patient or Public Contributions: Community members from the AIDS Committee of Ottawa, Max Ottawa, and Black Cap, and nurses from Ottawa Public Health were involved in the design, promotion, and implementation of this study.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | - Alexandra Musten
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | | | - Robin Robinson
- Black Coalition for AIDS Prevention, Ontario, Toronto, Canada
| | | | | | - Lauren Orser
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
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Hu S, Lu Y, He X, Zhou Y, Wu D, Tucker JD, Yang B, Tang W. Effectiveness of the secondary distribution of HIV self-testing with and without monetary incentives among men who have sex with men living with HIV in China: study protocol for a randomized controlled trial. BMC Infect Dis 2023; 23:160. [PMID: 36918824 PMCID: PMC10013267 DOI: 10.1186/s12879-023-08062-w] [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: 11/24/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The HIV epidemic is still expanding among men who have sex with men (MSM) in China, but HIV testing rates remain suboptimal. Network-based interventions, such as secondary distribution, have shown promise to expand HIV self-testing (HIVST) among partners of MSM living with HIV (MLWH) but have not been widely implemented. Monetary incentives could enhance the secondary distribution of HIVST in some settings. We will conduct a randomized controlled trial to examine the effectiveness of monetary incentives in expanding the secondary distribution of HIVST among MLWH in China. METHODS We will recruit 200 eligible participants at three antiretroviral therapy (ART) clinics in China. Participants are eligible if they are 18 years of age or over, assigned as male at birth, have had anal sex with men, are living with HIV, are willing to apply for the HIVST kit at ART clinics, and are willing to provide personal contact information for follow-up. Eligible participants will be randomly assigned in a 1:1 ratio to one of two groups: standard secondary distribution group and secondary distribution group with monetary incentives. Participants (defined as "index") will distribute the HIVST kits to members of their social network (defined as "alter") and will be required to complete a baseline survey and a 3-month follow-up survey. All alters will be encouraged to report their testing results by taking photos of used kits and completing an online survey. The primary study outcomes will compare the mean number of alters and newly-tested alters motivated by each index participant in each group. Secondary study outcomes will include the mean number of alters who tested positive, the cost per person tested, and the cost per HIV diagnosed for each group. DISCUSSION Few studies have evaluated interventions to enhance the implementation of secondary distribution. Our study will provide information on the effectiveness of monetary incentives in expanding HIVST secondary distribution among MLWH. The findings of this trial will contribute to implementing HIVST secondary distribution services among MLWH in China and facilitating HIV case identifications. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200064517; http://www.chictr.org.cn/showproj.aspx?proj=177896 . Registered on 10th October 2022.
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Affiliation(s)
- Siyue Hu
- School of Public Health, Southern Medical University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,University of North Carolina Project - China, Guangzhou, China
| | - Ying Lu
- University of North Carolina Project - China, Guangzhou, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project - China, Guangzhou, China.,London School of Hygiene and Tropical Medicine, London, UK.,West China School of Public Health, Sichuan University, Chengdu, China
| | - Joseph D Tucker
- University of North Carolina Project - China, Guangzhou, China.,London School of Hygiene and Tropical Medicine, London, UK
| | - Bin Yang
- School of Public Health, Southern Medical University, Guangzhou, China. .,Dermatology Hospital of Southern Medical University, Guangzhou, China.
| | - Weiming Tang
- School of Public Health, Southern Medical University, Guangzhou, China. .,Dermatology Hospital of Southern Medical University, Guangzhou, China. .,University of North Carolina Project - China, Guangzhou, China.
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Cordingley O, McCrimmon T, West BS, Darisheva M, Primbetova S, Terlikbaeva A, Gilbert L, El-Bassel N, Frye V. Preferences for an HIV Self-Testing Program Among Women who Engage in sex Work and use Drugs in Kazakhstan, Central Asia. RESEARCH ON SOCIAL WORK PRACTICE 2023; 33:296-304. [PMID: 37426726 PMCID: PMC10328443 DOI: 10.1177/10497315221128594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Purpose Women engaged in sex work (WESW) who use drugs face barriers to HIV testing. HIV self-testing (HST) may empower sex workers to learn their HIV status; however, it is not scaled up among WESW in Kazakhstan. This study aimed to explore barriers and facilitators to traditional HIV testing and HST among this population. Method We conducted 30 in-depth interviews (IDIs) and four focus groups (FGs) with Kazakhstani WESW who use drugs. Pragmatic analysis was used to explore key themes from qualitative data. Results Participants welcomed HST due to its potential to overcome logistical challenges by accessing HIV testing, as well as the stigma that WESW faces in traditional HIV testing. Participants desired emotional and social support for HST, and for linkage to HIV care and other services. Discussion HST among women who exchange sex and use drugs can be successfully implemented to mitigate stigma and barriers to HIV testing.
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Affiliation(s)
- Olivia Cordingley
- School of Social Work, Columbia University School of Social Work, New York, NY, USA
| | - Tara McCrimmon
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Brooke S. West
- School of Social Work, Columbia University School of Social Work, New York, NY, USA
| | | | | | | | - Louisa Gilbert
- School of Social Work, Columbia University School of Social Work, New York, NY, USA
| | - Nabila El-Bassel
- School of Social Work, Columbia University School of Social Work, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
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Eshun-Wilson I, Ford N, Mody A, Beres L, Schwartz S, Baral S, Geng EH. Strengthening implementation guidelines for HIV service delivery: Considerations for future evidence generation and synthesis. PLoS Med 2023; 20:e1004168. [PMID: 36877738 PMCID: PMC10027212 DOI: 10.1371/journal.pmed.1004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/20/2023] [Indexed: 03/07/2023] Open
Abstract
Ingrid Eshun-Wilson and colleagues summarize gaps in primary HIV implementation research methods and reporting, and propose areas for future methodological development.
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Affiliation(s)
- Ingrid Eshun-Wilson
- Division of Infectious Diseases, School of Medicine, Washington University in Saint Louis, Saint Louis, Missouri, United States of America
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Nathan Ford
- Department of HIV, Viral Hepatitis and Sexually Transmitted Infectionss, World Health Organization, Geneva, Switzerland
| | - Aaloke Mody
- Division of Infectious Diseases, School of Medicine, Washington University in Saint Louis, Saint Louis, Missouri, United States of America
| | - Laura Beres
- Department of International Health, John Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Sheree Schwartz
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, School of Medicine, Washington University in Saint Louis, Saint Louis, Missouri, United States of America
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30
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Gosset D, Plathey M, Lert F, Lasry S, Jedrzejewski T, Gazalet P, L'Yavanc T, Pierre N, Kachal A, Frémondière M, Ohayon M, Palich R. Distribution of HIV self-tests by men who have sex with men attending a French sexual health centre: results of the OTO study. Sex Transm Infect 2023; 99:116-119. [PMID: 35459755 DOI: 10.1136/sextrans-2022-055417] [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: 01/14/2022] [Accepted: 04/02/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV self-tests (HSTs) have been deployed to reduce the burden of undiagnosed HIV infections in subpopulations undertested. We assumed that patients attending sexual health centres could themselves distribute HSTs in their close network. This study aimed to assess the proportion and the characteristics of the participants who distributed HSTs, as well as the characteristics of people who received HSTs. METHODS Three HSTs were given to patients attending "Le 190" Sexual Health Center, Paris, France, having consented for the study, between July 2018 and August 2020. Participants had to distribute HSTs within 6 months, preferably to individuals in their close circle who have not been tested for a long time. Then they had to complete a self-questionnaire, exploring HIV status, sexual practices, number of distributed HSTs, profile of persons who received HSTs, and if known, result of used HSTs. Univariable logistic regression was used to determine factors associated with HST distribution. RESULTS Overall, 682/1062 (64%) patients accepted to be included in the study, and 283/682 (42%) completed the questionnaire. 97% were men who have sex with men (MSMs), including 86 (30%) HIV-positive individuals and 119 (42%) HIV Pre-Exposure Prophylaxis (PrEP) users. The proportion of participants having distributed 0, 1, 2 or 3 HSTs was 31%, 15%, 27% and 27%, respectively. Participants having distributed at least one HST (n=195, 69%) were more likely to have previously used HSTs themselves (OR=3.90, 95% CI=1.84 to 8.29, p<0.001). On the 901 HSTs in possession of participants who answered the questionnaire, 455 (50%) were distributed. 79% of recipients were MSMs, and 42% of whom had not been tested for more than 1 year. The result was known for 220 HSTs, including 5 positive (2.3%). CONCLUSION MSMs attending sexual health centres could be good disseminators of HSTs, targeting a population with high level of undiagnosed HIV infections, especially if they have already experimented it.
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Affiliation(s)
- Daniel Gosset
- Department of Infectious Disease, Hospital Tenon, Paris, France .,"Le 190" Sexual Health Center, Paris, France
| | | | | | - Stéphane Lasry
- Department of Infectious Disease, Hospital Tenon, Paris, France.,"Le 190" Sexual Health Center, Paris, France
| | | | | | - Thomas L'Yavanc
- "Le 190" Sexual Health Center, Paris, France.,Hôpital Jean Jaurès, Paris, France
| | | | | | | | - Michel Ohayon
- Department of Infectious Disease, Hospital Tenon, Paris, France.,"Le 190" Sexual Health Center, Paris, France
| | - Romain Palich
- "Le 190" Sexual Health Center, Paris, France.,Sorbonne University, Paris, France
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31
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Fonner VA, Luhmann N, Siegfried N, Johnson C, Baggaley R, Ford N, Jamil MS. Use of indirect evidence from HIV self-testing to inform the WHO hepatitis C self-testing recommendation. BMJ Glob Health 2023; 8:bmjgh-2022-011633. [PMID: 36787960 PMCID: PMC9930562 DOI: 10.1136/bmjgh-2022-011633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/07/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Virginia A Fonner
- Global Health and Population Research, FHI 360, Durham, North Carolina, USA
| | - Niklas Luhmann
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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32
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Nichols BE, de Nooy A, Benade M, Balakasi K, Mphande M, Rao G, Claassen CW, Khan S, Stillson C, Russell CA, Doi N, Dovel K. Facility-based HIV self-testing strategies may substantially and cost-effectively increase the number of men and youth tested for HIV in Malawi: results from an individual-based mathematical model. J Int AIDS Soc 2022; 25:e26020. [PMID: 36251161 PMCID: PMC9575938 DOI: 10.1002/jia2.26020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Malawi is rapidly closing the gap in achieving the UNAIDS 95-95-95 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is, therefore, an urgent need to identify innovative and low-cost strategies to maintain and increase testing coverage without diverting resources from other HIV services. The objective of this study is to model different combinations of facility-based HIV testing modalities and determine the most cost-effective strategy to increase the proportion of men and youth testing for HIV. METHODS A data-driven individual-based model was parameterized with data from a community-representative survey (socio-demographic, health service utilization and HIV testing history) of men and youth in Malawi (data collected August 2019). In total, 79 different strategies for the implementation of HIV self-testing (HIVST) and provider-initiated-testing-and-counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men/youth tested for HIV in a 12-month period, cost-effectiveness and human resource requirements. The testing yield was assumed to be constant across the scenarios. RESULTS Facility-based HIVST offered year-round resulted in the greatest increase in the proportion of men and youth tested in the OPD (from 45% to 72%-83%), was considered cost-saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year-round HIVST in the OPD remained on the cost-effectiveness frontier. CONCLUSIONS Facility-based HIVST is a cost-effective strategy to increase the proportion of men/youth tested for HIV in Malawi and decreases the human resource requirements for HIV testing in the OPD-providing additional healthcare worker time for other priority healthcare activities.
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Affiliation(s)
- Brooke E. Nichols
- Department of Global Health, School of Public HealthBoston UniversityBostonMassachusettsUSA,Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the WitwatersrandJohannesburgSouth Africa,Department of Medical MicrobiologyAmsterdam University Medical CentreAmsterdamthe Netherlands,Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | - Alexandra de Nooy
- Department of Medical MicrobiologyAmsterdam University Medical CentreAmsterdamthe Netherlands,Right to CareJohannesburgSouth Africa
| | - Mariet Benade
- Department of Global Health, School of Public HealthBoston UniversityBostonMassachusettsUSA
| | | | | | | | - Cassidy W. Claassen
- Center for International Health, Education, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA,Division of Infectious Diseases, Department of MedicineUniversity of Zambia School of MedicineLusakaZambia
| | - Shaukat Khan
- Clinton Health Access InitiativeBostonMarylandUSA
| | | | - Colin A. Russell
- Department of Global Health, School of Public HealthBoston UniversityBostonMassachusettsUSA,Department of Medical MicrobiologyAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Naoko Doi
- Clinton Health Access InitiativeBostonMarylandUSA
| | - Kathryn Dovel
- Right to CareJohannesburgSouth Africa,Division of Infectious Diseases, Department of MedicineUniversity of California Los Angeles David Geffen School of MedicineLos AngelesCaliforniaUSA
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Dibble KE, Murray SM, Wiginton JM, Maksut JL, Lyons CE, Aggarwal R, Augustinavicius JL, Al-Tayyib A, Sey EK, Ma Y, Flynn C, German D, Higgins E, Anderson BJ, Menza TW, Orellana ER, Flynn AB, Wermuth PP, Kienzle J, Shields G, Baral SD. Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States. BMC Health Serv Res 2022; 22:1179. [PMID: 36127682 PMCID: PMC9490978 DOI: 10.1186/s12913-022-08572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Complex manifestation of stigma across personal, community, and structural levels and their effect on HIV outcomes are less understood than effects in isolation. Yet, multilevel approaches that jointly assesses HIV criminalization and personal sexual behavior stigma in relation to HIV testing have not been widely employed or have only focused on specific subpopulations. The current study assesses the association of three types of MSM-related sexual behavior-related stigma (family, healthcare, general social stigma) measured at both individual and site levels and the presence/absence of laws criminalizing HIV transmission with HIV testing behaviors to inform HIV surveillance and prevention efforts among HIV-negative MSM in a holistic and integrated way. Methods We included nine National HIV Behavioral Surveillance (NHBS) 2017 sites: Baltimore, MD; Denver, CO; Detroit, MI; Houston, TX; Long Island/Nassau-Suffolk, NY; Los Angeles, CA; Portland, OR; San Diego, CA; and Virginia Beach and Norfolk, VA. Multivariable generalized hierarchical linear modeling was used to examine how sexual behavior stigmas (stigma from family, anticipated healthcare stigma, general social stigma) measured at the individual and site levels and state HIV criminalization legislation (no, HIV-specific, or sentence-enhancement laws) were associated with past-year HIV testing behaviors across sites (n = 3,278). Results The majority of MSM across sites were tested for HIV in the past two years (n = 2,909, 95.4%) with the average number of times tested ranging from 1.79 (SD = 3.11) in Portland, OR to 4.95 (SD = 4.35) in Los Angeles, CA. In unadjusted models, there was a significant positive relationship between stigma from family and being tested for HIV in the past two years. Site-level HIV-specific criminalization laws were associated with an approximate 5% reduction in the prevalence of receiving any HIV test in the past two years after individual level stigma and sociodemographic covariate adjustments (PR = 0.94, 95% CI, 0.90–0.99). Conclusions Structural barriers faced by MSM persist and ending the HIV epidemic in the US requires a supportive legal environment to ensure effective engagement in HIV services among MSM. Home-based solutions, such as self-testing, used to deliver HIV testing may be particularly important in punitive settings while legal change is advocated for on the community and state levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08572-4.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carrie E Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Rohin Aggarwal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jura L Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alia Al-Tayyib
- Denver Public Health & Hospital Authority, Denver, CO, 80204, USA
| | - Ekow Kwa Sey
- Los Angeles County Department of Public Health, Los Angeles, CA, 90012, USA
| | - Yingbo Ma
- Los Angeles County Department of Public Health, Los Angeles, CA, 90012, USA
| | - Colin Flynn
- Center for HIV Surveillance, Epidemiology, & Evaluation, Maryland Department of Health, Baltimore, MD, 21202, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Emily Higgins
- Division of HIV and STI Programs, Michigan Department of Health and Human Services (MDHHS), Lansing, MI, 48909, USA
| | - Bridget J Anderson
- Bureau of Communicable Disease Control, New York State Department of Health, Albany, NY, 12237, USA
| | - Timothy W Menza
- HIV Data and Analysis Program, Oregon Health Authority, Portland, OR, 97232, USA
| | - E Roberto Orellana
- Regional Research Institute, Portland State University, Portland, OR, 97201, USA.,School of Social Work, University of Washington, Seattle, WA, 98105, USA
| | - Anna B Flynn
- Surveillance & Federal Reporting Section, Maternal, Child, & Adolescent Health Division, California Department of Health,, San Francisco, CA, 94102, USA
| | - Paige Padgett Wermuth
- Division of Management Policy & Community Health (MPACH), The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, 77030, USA
| | - Jennifer Kienzle
- Division of Disease Prevention, Virginia Department of Health, HIV Surveillance, Richmond, VA, 23219, USA
| | - Garrett Shields
- Division of Disease Prevention, Virginia Department of Health, HIV Surveillance, Richmond, VA, 23219, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Ivanova Reipold E, Fajardo E, Juma E, Bukusi D, Bermudez Aza E, Jamil MS, Johnson CC, Farquhar C, Easterbrook P, Monroe-Wise A. Usability and acceptability of oral fluid hepatitis C self-testing among people who inject drugs in Coastal Kenya: a cross-sectional pilot study. BMC Infect Dis 2022; 22:738. [PMID: 36109704 PMCID: PMC9479404 DOI: 10.1186/s12879-022-07712-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are disproportionally affected by hepatitis C virus (HCV) infection and many remain undiagnosed. HCV self-testing (HCVST) may be an effective approach to increase testing uptake, but has rarely been used among PWID. We assessed the usability and acceptability of HCVST among PWID in Kenya. METHODS We conducted a cross-sectional study nested within a cohort study between August and December 2020 on Kenya's North Coast region. Participants were handed a prototype oral fluid HCVST kit and asked to conduct the test relying on the instructions for use. Usability was assessed by documenting errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. RESULTS Among 150 participants, 19% were female and 65.3% had primary level education or lower. 71.3% made at least one error, 56.7% experienced some difficulty during at least one step, and the majority of participants (78%) required assistance during at least one step of the procedure. Most common errors occurred when placing the tube into the stand (18%), collecting the oral fluid sample (24%) and timing of reading results (53%). There was a strong association between presence of symptoms of opiate withdrawals and observed errors (94% vs 62%; p = 0.016) in a sub-group of 74 participants assessed. Inter-reader and inter-operator concordance were 97.7% (kappa: 0.92) and 99.2% (kappa: 0.95), respectively. Acceptability assessed by asking whether participants would choose to use HCVST prior to and after conducting HCVST was 98% and 95%, respectively. CONCLUSIONS We found a high acceptability of oral fluid HCVST among PWID. User errors were common and were associated with the presence of withdrawal symptoms among users. Despite errors, most participants were able to obtain and interpret results correctly. These findings suggest that this group of users may benefit from greater messaging and education including options to receive direct assistance when self-testing for HCV.
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Affiliation(s)
| | - Emmanuel Fajardo
- FIND, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Emily Juma
- VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - David Bukusi
- VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Muhammad S Jamil
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Case Johnson
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Carey Farquhar
- Departments of Global Health, Epidemiology and Medicine, University of Washington, Seattle, WA, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, WA, USA
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Temporal changes in paediatric and adolescent HIV outcomes across the care continuum in Zambia: an interrupted time-series analysis. THE LANCET HIV 2022; 9:e563-e573. [PMID: 35905754 PMCID: PMC9394542 DOI: 10.1016/s2352-3018(22)00127-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Paediatric and adolescent HIV treatment programmes in sub-Saharan Africa have rapidly expanded and evolved over the past decade. Real-world evidence of how the implementation of new policies over time has affected treatment outcomes is inadequate, but is crucial for guiding the implementation of the next phases of the HIV treatment response for children. We examined how treatment outcomes in Zambia's national paediatric and adolescent HIV treatment programmes have changed over time as new policies were implemented. METHODS We used data from Zambia's routine electronic health record to analyse children and adolescents living with HIV who were antiretroviral therapy (ART) naive between the ages of 0 and 19 years who were newly enrolled in care between Jan 1, 2011, and March 31, 2019, at 102 health facilities in Lusaka and Western provinces supported by the Centre for Infectious Disease Research in Zambia. Sociodemographic factors, clinical data, facility-level data, and visit history were obtained from the national electronic health record and laboratory systems used in routine HIV care in Zambia. We aimed to characterise the changes in the distribution of the age and sex of new enrolees over time. We used an interrupted time-series design to examine the rates of ART initiation, retention in care, time to ART initiation, and first-line ART regimens among new enrolees across different age strata as they changed over time with the adoption of new ART guidelines in 2014 and 2017. FINDINGS Between Jan 1, 2011, and March 31, 2019, 26 214 children and adolescents living with HIV who were ART naïve were newly enrolled at one of 102 ART facilities in two provinces in Zambia. Rates of new enrolees increased by 25-35% among children younger than 15 years over time, but by 92·3% between 2011 and 2017 among adolescents, with the largest absolute increase among adolescent girls. Rates of ART initiation increased steadily and in parallel across all age groups from before the implementation of the 2014 guidelines to after the implementation of the 2017 guidelines (<2 years, 42·4% for 2014 and 81·6% for 2017; 2 to <5 years, 39·3% for 2014 and 82·8% for 2017; 5 to <15 years, 49·2% for 2014 and 86·6% for 2017; 15 to 19 years, 52·4% for 2014 and 86·2% for 2017); median time to ART initiation went from 2-3 months to same-day initiation during this same time period. Rates of retention on ART 6 months after linkage saw much smaller improvements over time (<2 years, 35·4% for 2014 and 52·0% for 2017; 2 to <5 years, 40·2% for 2014 and 54·4% for 2017; 5 to <15 years, 46·7% for 2014 and 63·4% for 2017; 15 to 19 years, 40·1% for 2014 and 52·7% for 2017). INTERPRETATION Improvements in ART initiation occurred largely in parallel across age groups over time, despite universal treatment being implemented at different timepoints for different ages. Although the rates of ART initiation reach high levels, retention on ART was low. This analysis provides a comprehensive examination of how paediatric and adolescent outcomes have evolved over the past decade in Zambia and identifies where more targeted efforts will be needed over the next decade. FUNDING National Institutes of Health.
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Chimbindi N, Shahmanesh M. PrEP dispensing with HIV self-testing. Lancet HIV 2022; 9:e450-e451. [PMID: 35777404 DOI: 10.1016/s2352-3018(22)00171-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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37
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Moradi G, Amini EE, Valipour A, Tayeri K, Kazerooni PA, Molaeipour L, Moradi Y. The study of feasibility and acceptability of using HIV self-tests in high-risk Iranian populations (FSWs, MSM, and TGs): a cross-sectional study. Harm Reduct J 2022; 19:61. [PMID: 35659310 PMCID: PMC9164176 DOI: 10.1186/s12954-022-00641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to evaluate the feasibility of using the HIV self-test in high-risk Iranian groups (MSM, FSWs, and TGs). Methods This study was a mixed study designed as a quantitative–qualitative study conducted between October 1, 2020, and June 22, 2021, in Tehran and Karaj, Iran. The sample size needed for this study generally was 1000 people, including FSWs, MSM, and transgender individuals. Convenience and snowball sampling methods were used to collect the samples. Results A total of 930 eligible respondents were enrolled in the study, of whom 456 (49%) were female and 49 (5.3%) were transgender (98% of TGs were male to female), and their mean age was 33.63 years (10.54 SD). The feasibility of using HIV self-tests in Iranian high-risk groups was significantly high. The majority of participants (97%) did not have any confidentiality problems while preparing or performing the test. In general, feasibility was assessed based on five questions. The overall feasibility score was 6.33 (0.824 SD). Taking tests, reading HIV test results, finding a safe place to do the test, and accessing HIV self-tests showed a high average. Conclusion HIV self-testing was highly acceptable and feasible among high-risk populations, so routine HIV testing was efficiently possible.
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Affiliation(s)
- Ghobad Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Elnaz Ezzati Amini
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Azam Valipour
- HIV/AIDS Control Office, Center for Communicable Diseases, Ministry of Health, Tehran, Iran
| | - Katayoon Tayeri
- HIV/AIDS Control Office, Center for Communicable Diseases, Ministry of Health, Tehran, Iran
| | - Parvin Afsar Kazerooni
- HIV/AIDS Control Office, Center for Communicable Diseases, Ministry of Health, Tehran, Iran
| | - Leila Molaeipour
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. .,Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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38
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Joseph Davey DL, Wall KM, Naidoo N, Naidoo D, Xaba G, Serao C, Malone T, Dovel K. HIV testing and linkage to ART following secondary distribution of HIV self-test kits to male partners of women living with HIV: a pilot randomized control trial in Mpumalanga, South Africa. J Int AIDS Soc 2022; 25:e25937. [PMID: 35690880 PMCID: PMC9188623 DOI: 10.1002/jia2.25937] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/12/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION South African men are underrepresented in HIV testing and treatment services. Secondary distribution of oral HIV self-test (HIVST) kits by women living with HIV (WLHIV) to their male partners (i.e. index partner HIVST) may increase men's testing and treatment but has been understudied. METHODS Between March and July 2021, we evaluated the effectiveness of index partner HIVST versus the standard of care (SOC) (invitations for men's facility-based testing) on men's testing in a 1:1 randomized control trial. Eligibility criteria included: WLHIV; ≥18 years of age; attending one of four high-density rural clinics; have a working cell phone; and self-reported having a primary male partner of unknown serostatus. The primary outcome was the proportion of WLHIV reporting that her partner tested for HIV within 3 months after enrolment. RESULTS We enrolled 180 WLHIV and 176 completed an endline survey (mean age = 35 years, 15% pregnant, 47% unmarried or non-cohabiting). In the HIVST arm, 78% of male partners were reported to have tested for HIV versus 55% in SOC (RR = 1.41; 95% CI = 1.14-1.76). In the HIVST arm, nine men were reactive with HIVST (14% positivity), six were confirmed HIV positive with standard testing (67%) and all of those started antiretroviral therapy (ART), and four HIV-negative men started pre-exposure prophylaxis (PrEP) (5%). In SOC, six men were diagnosed with HIV (12% positivity), 100% started ART and seven HIV-negative men started PrEP (16%). One case of verbal intimate partner violence was reported in the HIVST arm. CONCLUSIONS Secondary distribution of HIVST to partners of WLHIV was acceptable and effective for improving HIV testing among men in rural South Africa in our pilot study. Interventions are needed to link reactive HIVST users to confirmatory testing and ART.
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Affiliation(s)
- Dvora L Joseph Davey
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Gugu Xaba
- BroadReach Healthcare, Johannesburg, South Africa
| | - Claire Serao
- BroadReach Healthcare, Johannesburg, South Africa
| | - Todd Malone
- BroadReach Healthcare, Johannesburg, South Africa
| | - Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Rivera A, Martinez P, Braunstein S. Video-based HIV testing services among cisgender men who have sex with men as a component of an HIV behavioural surveillance study during the COVID-19 pandemic in New York City: implementation, feasibility and lessons learned. Sex Transm Infect 2022; 98:310-311. [PMID: 34193531 PMCID: PMC8249171 DOI: 10.1136/sextrans-2021-055110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/09/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Alexis Rivera
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Pablo Martinez
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Sarah Braunstein
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
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40
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Fajardo E, Watson V, Kumwenda M, Usharidze D, Gogochashvili S, Kakhaberi D, Giguashvili A, Johnson CC, Jamil MS, Dacombe R, Stvilia K, Easterbrook P, Ivanova Reipold E. Usability and acceptability of oral-based HCV self-testing among key populations: a mixed-methods evaluation in Tbilisi, Georgia. BMC Infect Dis 2022; 22:510. [PMID: 35641908 PMCID: PMC9154030 DOI: 10.1186/s12879-022-07484-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 05/18/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hepatitis C virus self-testing (HCVST) is an additional approach that may expand access to HCV testing. We conducted a mixed-methods cross-sectional observational study to assess the usability and acceptability of HCVST among people who inject drugs (PWID), men who have sex with men (MSM) and transgender (TG) people in Tbilisi, Georgia. METHODS The study was conducted from December 2019 to June 2020 among PWID at one harm reduction site and among MSM/TG at one community-based organization. We used a convergent parallel mixed-methods design. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. A subset of participants participated in cognitive and in-depth interviews. RESULTS A total of 90 PWID, 84 MSM and 6 TG were observed performing HCVST. PWID were older (median age 35 vs 24) and had a lower level of education compared to MSM/TG (27% vs 59%). The proportion of participants who completed all steps successfully without assistance was 60% among PWID and 80% among MSM/TG. The most common error was in sample collection and this was observed more often among PWID than MSM/TG (21% vs 6%; p = 0.002). More PWID requested assistance during HCVST compared to MSM/TG (22% vs 8%; p = 0.011). Acceptability was high in both groups (98% vs 96%; p = 0.407). Inter-reader agreement was 97% among PWID and 99% among MSM/TG. Qualitative data from cognitive (n = 20) and in-depth interviews (n = 20) was consistent with the quantitative data confirming a high usability and acceptability. CONCLUSIONS HCVST was highly acceptable among key populations in Georgia of relatively high educational level, and most participants performed HCVST correctly. A significant difference in usability was observed among PWID compared to MSM/TG, indicating that PWID may benefit from improved messaging and education as well as options to receive direct assistance when self-testing for HCV.
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Affiliation(s)
- Emmanuel Fajardo
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Victoria Watson
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Moses Kumwenda
- grid.419393.50000 0004 8340 2442Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi ,grid.10595.380000 0001 2113 2211College of Medicine, University of Malawi (CoM), Blantyre, Malawi
| | | | | | - David Kakhaberi
- Community-Based Organization Equality Movement, Tbilisi, Georgia
| | - Ana Giguashvili
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Cheryl C. Johnson
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Russell Dacombe
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Ketevan Stvilia
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Philippa Easterbrook
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Elena Ivanova Reipold
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
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Jordão T, Magno L, Pereira M, Rossi TRA, de Almeida Silva P, Figueiredo MAA, de Brito Lima Prado NM, Dos Santos AM, Cangussu MC, Dourado I. Willingness of health care providers to offer HIV self-testing from specialized HIV care services in the northeast of Brazil. BMC Health Serv Res 2022; 22:713. [PMID: 35637470 PMCID: PMC9149328 DOI: 10.1186/s12913-022-08091-2] [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] [Received: 07/13/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background The insufficient knowledge regarding the serological status of people affected with human immunodeficiency virus (HIV) is a concern in Brazil. HIV self-testing (HIVST) has been proved to have great potential for increasing testing, especially among vulnerable populations. The large-scale distribution of HIVST by the Brazilian public health system has increased in recent years. We aimed to investigate the awareness of HIVST among health care providers (HCP) from specialized HIV/AIDS care services in the state of Bahia, Northeast Brazil. Further we investigated HCP acceptability and willingness to offer its use. Methods A cross-sectional study on HCP from 29 specialized care services (SCS) located in 21 cities in the state of Bahia. HCP working in the service for at least 6 months were included. Sociodemographic, occupational, and behavioral data were collected using a questionnaire. Descriptive statistics were carried out. Bivariate, and multivariate analyses estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using logistic regression were conducted. Results The awareness and acceptability of HIVST and the willingness to provide it were 79.8, 55.2, and 47.1%, respectively. Few HCP reported that the SCS where they worked dispensed HIVST (3.6%), and 13.5% received some information or training on HIVST. Factors associated with willingness to offer HIVST were: HIVST acceptability (aOR = 9.45; 95% CI: 4.53–19.71), willingness to use HIVST on themselves (aOR = 4.45; 95% CI: 1.62–12.24), confidence in offering HIVST to clients (aOR = 5.73; 95% CI: 2.26–12.72), and considering everyone eligible for HIVST (aOR = 2.88; 95% CI: 1.25–6.59). Conclusions Although most HCP were aware of HIVST, acceptability and willingness to provide it to the clients was moderate. The scale up of HIVST as a mean for the HIV prevention and control policy in Brazil, requires further training of HCP and better implementation of this program. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08091-2.
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Affiliation(s)
- Tiago Jordão
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Diretoria de Vigilância Epidemiológica da Bahia, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil. .,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
| | - Marcos Pereira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Thais Regis Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | - Pedro de Almeida Silva
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | | | | | - Adriano Maia Dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brazil
| | | | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Zhang Y, Wiseman V, Applegate TL, Lourenco RDA, Street DJ, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton BR, Grulich A, Stoove M, Holt M, Kaldor J, Guy R, Ong JJ. Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. Front Med (Lausanne) 2022; 9:839479. [PMID: 35514755 PMCID: PMC9063480 DOI: 10.3389/fmed.2022.839479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background In Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM. Methods Preferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences. Findings We recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution. Interpretation Our findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,*Correspondence: Ye Zhang
| | - Virginia Wiseman
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya L. Applegate
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah J. Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsty Smith
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Muhammad S. Jamil
- Global Human immunodeficiency virus (HIV), Hepatitis and Sexually transmitted infections (STIs) Programmes, World Health Organization, Geneva, Switzerland
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia,School of Population Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Adam Hynes
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin R. Bavinton
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - John Kaldor
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Haas AD, Radin E, Birhanu S, Low AJ, Saito S, Sachathep K, Balachandra S, Manjengwa J, Duong YT, Jonnalagadda S, Payne D, Bello G, Hakim AJ, Smart T, Ahmed N, Cuervo-Rojas J, Auld A, Patel H, Parekh B, Williams DB, Barradas DT, Mugurungi O, Mulenga LB, Voetsch AC, Justman JE. Prevalence of and factors associated with late diagnosis of HIV in Malawi, Zambia, and Zimbabwe: Results from population-based nationally representative surveys. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000080. [PMID: 36962254 PMCID: PMC10021857 DOI: 10.1371/journal.pgph.0000080] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Late diagnosis of HIV (LD) increases the risk of morbidity, mortality, and HIV transmission. We used nationally representative data from population-based HIV impact assessment (PHIA) surveys in Malawi, Zambia, and Zimbabwe (2015-2016) to characterize adults at risk of LD and to examine associations between LD and presumed HIV transmission to cohabiting sexual partners. METHODS We estimated the prevalence of LD, defined as CD4 count <350 cells/μL, among adults newly diagnosed with HIV during the surveys and odds ratios for associated factors. We linked newly diagnosed adults (index cases) to their household sexual partners and calculated adjusted odds ratios for associations between LD of the index case, viral load of the index case, and duration of HIV exposure in the relationship, and the HIV status of the household sexual partner. RESULTS Of 1,804 adults who were newly diagnosed with HIV in the surveys, 49% (882) were diagnosed late. LD was associated with male sex, older age, and almost five times the odds of having an HIV-positive household sexual partner (adjusted odds ratio [aOR], 4.65 [95% confidence interval: 2.56-8.45]). Longer duration of HIV exposure in a relationship and higher viral load of the index case were both independently associated with higher odds of having HIV-positive household sexual partners. Individuals with HIV exposure of more than 5 years had more than three times (aOR 3.42 [95% CI: 1.63-7.18]) higher odds of being HIV positive than those with less than 2 years HIV exposure. The odds of being HIV positive were increased in individuals who were in a relationship with an index case with a viral load of 400-3499 copies/mL (aOR 4.06 [95% CI 0.45-36.46]), 3,500-9,999 copies/mL (aOR 11.32 [95% CI: 4.08-31.39]), 10,000-49,999 copies/mL (aOR 17.07 [95% CI: 9.18-31.72]), and ≥50,000 copies/mL (aOR 28.41 [95% CI: 12.18-66.28]) compared to individuals who were in a relationship with an index case with a viral load of <400 copies/mL. CONCLUSIONS LD remains a challenge in Southern Africa and is strongly associated with presumed HIV transmission to household sexual partners. Our study underscores the need for earlier HIV diagnosis, particularly among men and older adults, and the importance of index testing.
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Affiliation(s)
- Andreas D. Haas
- ICAP, Columbia University, New York, New York, United States of America
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elizabeth Radin
- ICAP, Columbia University, New York, New York, United States of America
| | - Sehin Birhanu
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrea J. Low
- ICAP, Columbia University, New York, New York, United States of America
| | - Suzue Saito
- ICAP, Columbia University, New York, New York, United States of America
| | | | | | - Julius Manjengwa
- ICAP, Columbia University, New York, New York, United States of America
| | - Yen T. Duong
- ICAP, Columbia University, New York, New York, United States of America
| | - Sasi Jonnalagadda
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Danielle Payne
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - George Bello
- Government of Malawi, Ministry of Health, Lilongwe, Malawi
| | - Avi J. Hakim
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Theo Smart
- ICAP, Columbia University, New York, New York, United States of America
| | - Nahima Ahmed
- ICAP, Columbia University, New York, New York, United States of America
| | - Juliana Cuervo-Rojas
- ICAP, Columbia University, New York, New York, United States of America
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andrew Auld
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Hetal Patel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel B. Williams
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Owen Mugurungi
- Government of Zimbabwe, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Andrew C. Voetsch
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Eustaquio PC, Figuracion R, Izumi K, Morin MJ, Samaco K, Flores SM, Brink A, Diones ML. Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study. BMC Public Health 2022; 22:366. [PMID: 35189850 PMCID: PMC8860324 DOI: 10.1186/s12889-022-12705-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. METHODS We did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits. RESULTS HIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01-4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46-7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15-2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32-0.62]). CONCLUSIONS HIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.
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Affiliation(s)
- Patrick C Eustaquio
- LoveYourself, Inc, 715 Anglo Bldg., Shaw Blvd, 1550, Mandaluyong City, Philippines.
| | - Roberto Figuracion
- Family Planning Organization of the Philippines, Inc, Iloilo Chapter - Rajah Community Center, 2F Dulalia Building, Rizal St, 5000, Iloilo City, Iloilo City Proper, Philippines
| | - Kiyohiko Izumi
- World Health Organization, Philippines, Ground Floor Building 3 San Lazaro Compound, C. S. Gatmaitan Ave, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | - Mary Joy Morin
- Department of Health, Philippines, Compound San Lazaro St, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | - Kenneth Samaco
- World Health Organization, Philippines, Ground Floor Building 3 San Lazaro Compound, C. S. Gatmaitan Ave, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | - Sarah May Flores
- Department of Health, Philippines, Compound San Lazaro St, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | | | - Mona Liza Diones
- Family Planning Organization of the Philippines, Inc, Iloilo Chapter - Rajah Community Center, 2F Dulalia Building, Rizal St, 5000, Iloilo City, Iloilo City Proper, Philippines
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Guerras JM, Belza MJ, Fuster MJ, de la Fuente L, García de Olalla P, Palma D, García-Pérez JN, Hoyos J. Knowledge and Prior Use of HIV Self-Testing in Madrid and Barcelona among Men Who Have Sex with Men More than One Year after Its Legal Authorization in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031096. [PMID: 35162118 PMCID: PMC8834423 DOI: 10.3390/ijerph19031096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/25/2023]
Abstract
This study assessed the knowledge and prior use of HIV self-testing in a sample of men who have sex with men (MSM) recruited in a sexual health clinic and two community-based testing sites in Madrid and Barcelona, >12 months after its legal authorization. Between March 2019 and December 2020, we recruited 2044 MSM. Participants completed a self-administered questionnaire while waiting to be tested for HIV and other STIs. We built two Poisson regression models to assess factors associated with prior knowledge and with use. Among those who had used self-testing in the past we assessed frequency of use and several aspects related to the last testing episode. The proportion of participants that knew about the existence of self-testing and had already used it was of 26.3% and 5.1% respectively. Both, knowledge and use were independently associated with being born in Spain or other western European countries, university education and more recent HIV testing. Additionally, knowledge was associated with older age, having a more favorable economic situation, and not living sexuality in total secrecy. Use was also associated with having received money in exchange for sex. Most (69.5%) reported having self-tested once, 64.8% had self-tested <12 months ago, 63.8% self-tested alone and 71.4% acquired the kit at a pharmacy over the counter. In spite of its authorization and becoming legally available, knowledge and use of HIV self-testing remain low among MSM attending sites specialized in the diagnosis of HIV and other STIs. When designing scale-up strategies, lower levels of knowledge and use in less favored subgroups of MSM need to be factored in.
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Affiliation(s)
- Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - María-José Fuster
- Sociedad Española Interdisciplinaria del SIDA, SEISIDA, 28036 Madrid, Spain;
- Departamento de Psicología Social y de las Organizaciones, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
| | - Luis de la Fuente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - Patricia García de Olalla
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - David Palma
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | | | - Juan Hoyos
- Independent Researcher, 28013 Madrid, Spain;
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Serumondo J, Shilton S, Nshimiyimana L, Karame P, Dushimiyimana D, Fajardo E, Remera E, Rwibasira GN, Martínez-Pérez GZ. Values and preferences for hepatitis C self-testing among the general population and healthcare workers in Rwanda. BMC Infect Dis 2021; 21:1064. [PMID: 34649503 PMCID: PMC8514804 DOI: 10.1186/s12879-021-06773-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022] Open
Abstract
Background In 2018, Rwanda launched a 5-year hepatitis C virus (HCV) elimination plan as per the World Health Organization global targets to eliminate HCV by 2030. To improve awareness of HCV status, strategies are needed to ensure easy access to HCV testing by as-yet unreached populations. HCV-self-testing, an innovative strategy, could further increase HCV testing uptake. This assessment explores perceptions around HCV self-testing among members of the public and healthcare workers in Rwanda. Methods A qualitative study was undertaken in Masaka District Hospital, comprising individual interviews, group interviews and participatory action research (PAR) activities. Purposive and snowball sampling methods guided the selection of informants. Informed consent was obtained from all participants. A thematic analysis approach was used to analyse the findings. Results The participants comprised 36 members of the public and 36 healthcare workers. Informants appreciated HCV self-testing as an innovative means of increasing access to HCV testing, as well as an opportunity to test privately and subsequently autonomously decide whether to seek further HCV care. Informants further highlighted the need to make HCV self-testing services free of charge at the nearest health facility. Disadvantages identified included the lack of pre/post-test counselling, as well as the potential psychosocial harm which may result from the use of HCV self-testing. Conclusion HCV self-testing is perceived to be an acceptable method to increase HCV testing in Rwanda. Further research is needed to assess the impact of HCV self-testing on HCV cascade of care outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06773-6.
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Affiliation(s)
| | - Sonjelle Shilton
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland.
| | | | | | | | - Emmanuel Fajardo
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Eric Remera
- Rwanda Biomedical Centre (RBC), Kigali, Rwanda
| | | | - Guillermo Z Martínez-Pérez
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland.,Department of Physiatrics and Nursing, University of Saragossa, Zaragoza, Spain
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Neuman M, Fielding KL, Ayles H, Cowan FM, Hensen B, Indravudh PP, Johnson C, Sibanda EL, Hatzold K, Corbett EL. ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data. BMJ Glob Health 2021; 6:e004986. [PMID: 34275871 PMCID: PMC8287607 DOI: 10.1136/bmjgh-2021-004986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Measuring linkage after community-based testing, particularly HIV self-testing (HIVST), is challenging. Here, we use data from studies of community-based HIVST distribution, conducted within the STAR Initiative, to assess initiation of antiretroviral therapy (ART) and factors driving differences in linkage rates. METHODS Five STAR studies evaluated HIVST implementation in Malawi, Zambia and Zimbabwe. New ART initiations during the months of intervention at clinics in HIVST and comparison areas were presented graphically, and study effects combined using meta-analysis. Meta-regression was used to estimate associations between the impact of community-based HIVST distribution and indicators of implementation context, intensity and reach. Effect size estimates used (1) prespecified trial definitions of ART timing and comparator facilities and (2) exploratory definitions accounting for unexpected diffusion of HIVST into comparison areas and periods with less distribution of HIVST than was expected. RESULTS Compared with arms with standard testing only, ART initiations were higher in clinics in HIVST distribution areas in 4/5 studies. The prespecified meta-analysis found positive but variable effects of HIVST on facility ART initiations (RR: 1.14, 95% CI 0.93 to 1.40; p=0.21). The exploratory meta-analysis found a stronger impact of HIVST distribution on ART initiations (RR: 1.29, 95% CI 1.08 to 1.55, p=0.02).ART initiations were higher in studies with greater self-reported population-level intensity of HIVST use (RR: 1.12; 95% CI 1.04 to 1.21; p=0.02.), but did not differ by national-level indicators of ART use among people living with HIV, number of HIVST kits distributed per 1000 population, or self-reported knowledge of how to link to care after a reactive HIVST. CONCLUSION Community-based HIVST distribution has variable effect on ART initiations compared with standard testing service alone. Optimising both support for and approach to measurement of effective and timely linkage or relinkage to HIV care and prevention following HIVST is needed to maximise impact and guide implementation strategies.
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Affiliation(s)
- Melissa Neuman
- Department of Infectious Disease Epidemiology and MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Katherine L Fielding
- Department of Infectious Disease Epidemiology and MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances M Cowan
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Pitchaya P Indravudh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
- TB-HIV Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
| | - Cheryl Johnson
- HIV, Hepatitis and STI Department, World Health Organization, Geneva, Switzerland
| | - Euphemia Lindelwe Sibanda
- Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karin Hatzold
- Population Services International, Washington, District of Columbia, USA
| | - Elizabeth Lucy Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- TB-HIV Group, Malawi Liverpool Wellcome Trust, Blantyre, Malawi
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Martínez-Pérez GZ, Nikitin DS, Bessonova A, Fajardo E, Bessonov S, Shilton S. Values and preferences for hepatitis C self-testing among people who inject drugs in Kyrgyzstan. BMC Infect Dis 2021; 21:609. [PMID: 34171990 PMCID: PMC8233180 DOI: 10.1186/s12879-021-06332-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) continues to be a major public-health burden in this highly stigmatised population. To halt transmission of HCV, rapid HCV self-testing kits represent an innovative approach that could enable PWID to know their HCV status and seek treatment. As no HCV test has yet been licenced for self-administration, it is crucial to obtain knowledge around the factors that may deter or foster delivery of HCV self-testing among PWID in resource-constrained countries. METHODS A qualitative study to assess values and preferences relating to HCV self-testing was conducted in mid-2020 among PWID in the Bishkek and Chui regions of Kyrgyzstan. Forty-seven PWID participated in 15 individual interviews, two group interviews (n = 12) and one participatory action-research session (n = 20). Responses were analysed using a thematic analysis approach with 4 predefined themes: awareness of HCV and current HCV testing experiences, and acceptability and service delivery preferences for HCV self-testing. Informants' insights were analysed using a thematic analysis approach. This research received local ethics approval. RESULTS Awareness of HCV is low and currently PWID prefer community-based HCV testing due to stigma encountered in other healthcare settings. HCV self-testing would be accepted and appreciated by PWID. Acceptability may increase if HCV self-testing: was delivered in pharmacies or by harm reduction associations; was free of charge; was oral rather than blood-based; included instructions with images and clear information on the test's accuracy; and was distributed alongside pre- and post-testing counselling with linkage to confirmatory testing support. CONCLUSIONS HCV self-testing could increase awareness of and more frequent testing for HCV infection among PWID in Kyrgyzstan. It is recommended that peer-driven associations are involved in the delivery of any HCV self-testing. Furthermore, efforts should be maximised to end discrimination against PWID at the healthcare institutions responsible for confirmatory HCV testing and treatment provision.
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Affiliation(s)
- Guillermo Z Martínez-Pérez
- Department of Physiatrics and Nursing, University of Zaragoza, Calle Domingo Miral s/n, 50009, Zaragoza, Spain
| | - Danil S Nikitin
- Global Research Institute Foundation (GLORI), 125 Suyumbaev Street apt 21, 720011, Bishkek, Kyrgyzstan
| | - Alla Bessonova
- Kyrgyz Network of Harm Reduction (KNHR), 21 Yug-2 Microdistrict apt 55, 720052, Bishkek, Kyrgyzstan
| | - Emmanuel Fajardo
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Sergei Bessonov
- Kyrgyz Network of Harm Reduction (KNHR), 21 Yug-2 Microdistrict apt 55, 720052, Bishkek, Kyrgyzstan
| | - Sonjelle Shilton
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, 1202, Geneva, Switzerland.
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