A comprehensive theoretical framework for the implementation and evaluation of opt-out HIV testing

Evaluation of an emergency department opt-out provider-driven HIV and syphilis screening and linkage-to-care program

OBJECTIVE

While the effectiveness of emergency departments (ED) in screening for HIV and syphilis is understood, less is known about dual screening programs. We aim to evaluate the impact of an opt-out provider-initiated HIV and syphilis program on screening, diagnosis, and linkage to care outcomes.

METHODS

We performed a retrospective review of patients screened pre (2014-2017) and post (2017-2021) program implementation. Primary outcomes include HIV and syphilis screening, incidence of positive tests, and proportion of patients linked to care. Secondary outcomes included pre-exposure prophylaxis (PrEP) referral and successful linkage rates for HIV-negative syphilis-positive patients.

RESULTS

Pre-implementation, 882 HIV tests were performed, of which 22 (2.49%) were new cases and 18 (81.82%) were linked to care; 754 syphilis tests were performed, of which 33 (4.38%) were active infections and 30 (90.91%) were treated. No eligible patients received PrEP referral. Post-implementation, 12,999 HIV tests were performed, of which 73 (0.56%) were new cases and 55 (75.34%) were linked to care; 10,885 syphilis tests were performed, of which 216 (1.98%) were active infections and 188 (87.04%) were treated. 25 (9.09%) eligible patients were referred for PrEP, and four (16.0%) attended their appointment.

CONCLUSIONS

Post-implementation, there was a 1373.81% and 1343.63% increase in screening, and a 231.82% and 554.55% increase in positive cases of HIV and syphilis, respectively. Dual screening programs can be successfully implemented within the existing ED framework to increase screening and early detection for HIV and syphilis.

Facilitators, Barriers, and Outcomes of Self-Initiated HIV Testing: An Integrative Literature Review

BACKGROUND AND PURPOSE

HIV testing is an essential tool for identifying people at risk for HIV infection and linking those who are infected to care. Despite the recommendation for routine HIV testing for people who are vulnerable to HIV infection, healthcare professionals experience difficulties initiating discussions related to sexual health and recommending HIV testing. Healthcare professionals not offering HIV testing is a frequently reported reason for delays in testing. Self-initiated HIV testing is understudied and vital to improving HIV testing rates, treatment, and the process of HIV prevention. The main aim of this integrative literature review is to identify facilitators, barriers, and outcomes of self-initiated HIV testing.

METHOD

A search of PubMed, CINAHL, PsycINFO, EBSCO host, and Google Scholar, revealed 31 studies that met the inclusion criteria.

RESULTS

Self-initiated HIV testing is voluntarily requested and completed by individuals either using self-testing kits or in a setting that provides HIV testing. Perception of susceptibility to HIV infection, privacy, access to HIV testing sites or self-testing kits, and knowledge related to HIV infection and testing, were some of the salient facilitators and barriers to self-initiated HIV testing. Findings from our review indicate several benefits to self-initiated HIV testing, including early identification of acute HIV infection, increased likelihood for the uptake of HIV prevention interventions, and a reduction in sexual risk behaviors.

IMPLICATION FOR PRACTICE

Nursing initiatives geared toward promoting self-initiated HIV testing will lead to prompt diagnoses and linkages to treatment which will further improve nursing care and a variety of health outcomes.

STIGMA TOWARDS PEOPLE LIVING WITH HIV/AIDS AMONG COUNSELING OFFICERS IN SOUTH SULAWESI, INDONESIA

Background: Human Immunodeficiency Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS) has become a global problem nowadays. To reduce its spread, Voluntary Counseling and Testing (VCT) and Provider-Initiated Testing and Counseling (PITC) have been provided. However, these interventions remain ineffective to discover new cases, as the stigma among health officers may exist. Objective: To compare the stigma towards people living with HIV/AIDS between VCT and PITC officers. Methods: This was a descriptive comparative study conducted in Makassar City, Parepare City and Sidenreng Rappang Regency, South Sulawesi Province, Indonesia. There were 139 samples were selected using a convenience sampling technique, which consisted of 66 VCT counseling officers and 73 PITC officers. The questionnaire from Health Policy Project in Thailand was used to measure the HIV/AIDS related-stigma. Data were analyzed using descriptive statistics and Mann Whitney test.  Results: Findings showed that there was a statistically significant difference in stigma between the group of VCT and PITC on people living with HIV/AIDS (PLWHA), which the mean of stigma in the PITC group (73.07) was higher than the mean value in the VCT group (66.61).  Conclusion: There was a significant difference in stigma between VCT and PITC officers towards PLWHA. It is suggested that PITC curriculum should be evaluated, and supervision and monitoring in both VCT and PITC groups should be implemented regularly to reduce the stigma towards PLWHA.

A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project)

RATIONALE AND OBJECTIVES

Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies.

METHODS

We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients.

RESULTS

Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies.

CONCLUSION

Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.