HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis

This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I². This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.

Using the Lifeworld Approach to Improve HIV Testing

Major guidelines for HIV recommend that testing should be provided in a way that is adapted to the lifeworld of groups at risk. However, precise definitions as to what adaption to the lifeworld means are missing. Therefore, this research project evaluated how the lifeworld approach can be operationalized in regard to HIV testing and how voluntary counseling and testing services can use this approach to improve efficacy. A survey for VCT providers in Germany showed a limited number of factors influencing the adaption to the lifeworld of groups at risk. The opening hours, the number of languages used in public relations, and the comfort of the waiting zone are important for all clients. For men who have sex with men, information material for use in social networks and peer volunteers are relevant. Intravenous drug users are concerned with participation, (low) costs, and counseling. For migrants, continuing staff training and anonymity are important.

Comparisons of New HIV Rapid Test Kit Performance

The development of rapid point-of-care tests for HIV infection has greatly reduced the problem of failure to return for test results. Test manufacturers are now developing test kits that can test for two or even three diseases at the same time, multiple-disease test kits. This study reports on the sensitivity and specificity of HIV tests when included on multi-disease test kits. 1029 participants were recruited from 2011 to 2014. HIV test kit sensitivities ranged from 91.1 to 100%, and the HIV test kit specificities from 99.5 to 100%. The two HIV kits which used oral fluid instead of blood performed well.

The Development and Evaluation of a Life Skills Programme for Young Adult Offenders

The purpose of this research project was to develop, implement, and evaluate a Life Skills programme for young adult male long-term offenders with the aim of improving their life skills that, in turn, could enable them to adjust more effectively in the correctional environment. Experimental research was used to investigate the effectiveness of the programme. In this study, 96 literate young adult male offenders between the ages of 21 and 25 years, with long sentences, were selected randomly. The participants were assigned randomly into an experimental and a control group. The Solomon four-group design was utilized to control for the effect of pretest sensitization. The measurements of the effectiveness of the programme were conducted before the programme commenced, directly (short term) after, 3 months (medium term) after, and 6 months (long term) after. The findings indicated that the programme had limited success in equipping the offenders with the necessary skills crucial to their survival in a correctional centre. The programme did, however, have significant effects, especially on problem solving and anger management in the short and medium term. These improvements were not long lived.

Measures and Metrics for Feasibility of Proof-of-Concept Studies With Human Immunodeficiency Virus Rapid Point-of-Care Technologies: The Evidence and the Framework

Supplemental digital content is available in the text.

Objective

Pilot (feasibility) studies form a vast majority of diagnostic studies with point-of-care technologies but often lack use of clear measures/metrics and a consistent framework for reporting and evaluation. To fill this gap, we systematically reviewed data to (a) catalog feasibility measures/metrics and (b) propose a framework.

Methods

For the period January 2000 to March 2014, 2 reviewers searched 4 databases (MEDLINE, EMBASE, CINAHL, Scopus), retrieved 1441 citations, and abstracted data from 81 studies. We observed 2 major categories of measures, that is, implementation centered and patient centered, and 4 subcategories of measures, that is, feasibility, acceptability, preference, and patient experience. We defined and delineated metrics and measures for a feasibility framework. We documented impact measures for a comparison.

Findings

We observed heterogeneity in reporting of metrics as well as misclassification and misuse of metrics within measures. Although we observed poorly defined measures and metrics for feasibility, preference, and patient experience, in contrast, acceptability measure was the best defined. For example, within feasibility, metrics such as consent, completion, new infection, linkage rates, and turnaround times were misclassified and reported. Similarly, patient experience was variously reported as test convenience, comfort, pain, and/or satisfaction. In contrast, within impact measures, all the metrics were well documented, thus serving as a good baseline comparator. With our framework, we classified, delineated, and defined quantitative measures and metrics for feasibility.

Conclusions

Our framework, with its defined measures/metrics, could reduce misclassification and improve the overall quality of reporting for monitoring and evaluation of rapid point-of-care technology strategies and their context-driven optimization.

Stressful point-of-care rapid testing for human immunodeficiency virus, hepatitis C virus, and syphilis

Even with technological advances in point-of-care rapid testing for HIV, hepatitis, and syphilis, individuals may still find the experience of submitting to testing, and receiving results, to be stressful. Participants completed the rapid test experience questionnaires to assess stress both prior to and after the specimen collection. Participants completed the risk behavior assessment, the coping strategies indicator, and the Barratt impulsivity scale. Participants chose which rapid tests they wanted using a list administered via computer. Logistic regression analysis was used to model self-reported stress prior to testing and after testing. A total of 1097 individuals completed testing. Individuals who scored high on avoidance reported a stressful experience at pretest (OR = 1.15, CI = 1.04, 1.26) while higher educational attainment was associated with no stress at both time points. Injection drug users, avoidant, and impulsive individuals experience stress either before or after rapid testing. Education appears to be protective against stressful testing.

Application of the Extended Health Control Belief Model to Predict Hepatitis A and B Vaccinations

BACKGROUND

Adult vaccination compliance rates vary according to sample and type of vaccine administered (influenza, pneumococcal). This study looked at vaccination of a community sample of low-income, minority adults.

METHODS

Nurses offered free vaccination for hepatitis A and B in the form of the combined Twinrix vaccine to adults on a walk-in basis. In addition to dosing information, participants completed the Risk Behavior Assessment, the Coping Strategies Indicator and the Cardiovascular Risk Assessment. Skaff's extended Health Belief Model was used as the theoretical framework. Count regression was used to model receipt of one, two, or three doses.

RESULTS

The majority of participants were male with a mean age of 40 years. The distribution of doses was: 173 individuals (27.6%) received one dose only, 261 (41.7%) received two doses, and 191 (30.5%) received three doses of vaccine. The multivariate count regression model including being male, having previously been told by a health care provider that one has syphilis, having severe negative emotions, and perceived social support were associated with participants' receiving fewer doses of hepatitis vaccine. A greater problem-solving score was associated with a higher number of vaccine doses received.

CONCLUSION

Despite free vaccinations offered in an easily accessible community setting, the majority of participants failed to complete the hepatitis vaccine series. More effort is needed to get adult men to participate in hepatitis vaccination clinics. Additional research is necessary to understand barriers other than cost to adults receiving vaccination.

Rapid HIV antibody testing among men who have sex with men who visited a gay bathhouse in Hangzhou, China: a cross-sectional study

OBJECTIVE

To understand the prevalence and correlates of rapid HIV antibody testing (RHT) among men who have sex with men (MSM) clients of gay bathhouses.

DESIGN

Cross-sectional questionnaire survey.

SETTING

This study was conducted in a gay bathhouse in Hangzhou, China.

PARTICIPANTS

354 MSM were validly recruited from October to December 2012. Inclusion criteria were (1) men who visited the gay bathhouse, (2) men who had engaged in sex with men during the previous 6 months, (3) first-time participants in this survey and (4) men who were HIV-negative if already tested.

MEASURES

Sociodemographic measures included factors related to sexual behaviour and HIV risk perception, and the scales of HIV-related knowledge and behavioural intervention that each participant received.

RESULTS

Of the 354 participants, 222 (62.7%) were rapid tested during the previous 6 months; of them, 66.2% were tested at the Centers for Disease Prevention and Control (CDC), and 46.8% at gay venues. The following factors were independently associated with rapid testing within the previous 6 months: sexual initiation at 20-29 years of age, ever having undergone standard testing, ever having seen a sexually transmitted disease doctor, consistent use of condom during the past 6 months, familiarity with RHT and perception of possible HIV infection.

CONCLUSIONS

Publicity of RHT and risk education for HIV infection are necessary to promote RHT among MSM who visit gay bathhouses. The characteristics of sexual behaviours among those who do and do not undergo RHT should be taken into consideration while promoting the service in this group.

Sensitivity and specificity of point-of-care rapid combination syphilis-HIV-HCV tests

Background

New rapid point-of-care (POC) tests are being developed that would offer the opportunity to increase screening and treatment of several infections, including syphilis. This study evaluated three of these new rapid POC tests at a site in Southern California.

Methods

Participants were recruited from a testing center in Long Beach, California. A whole blood specimen was used to evaluate the performance of the Dual Path Platform (DPP) Syphilis Screen & Confirm, DPP HIV-Syphilis, and DPP HIV-HCV-Syphilis rapid tests. The gold-standard comparisons were Treponema pallidum passive particle agglutination (TPPA), rapid plasma reagin (RPR), HCV enzyme immunoassay (EIA), and HIV-1/2 EIA.

Results

A total of 948 whole blood specimens were analyzed in this study. The sensitivity of the HIV tests ranged from 95.7–100% and the specificity was 99.7–100%. The sensitivity and specificity of the HCV test were 91.8% and 99.3%, respectively. The treponemal-test sensitivity when compared to TPPA ranged from 44.0–52.7% and specificity was 98.7–99.6%. The non-treponemal test sensitivity and specificity when compared to RPR was 47.8% and 98.9%, respectively. The sensitivity of the Screen & Confirm test improved to 90.0% when cases who were both treponemal and nontreponemal positive were compared to TPPA+/RPR ≥1∶8.

Conclusions

The HIV and HCV on the multi-infection tests showed good performance, but the treponemal and nontreponemal tests had low sensitivity. These results could be due to a low prevalence of active syphilis in the sample population because the sensitivity improved when the gold standard was limited to those more likely to be active cases. Further evaluation of the new syphilis POC tests is required before implementation into testing programs.

Preferences for rapid point-of-care HIV testing in Nova Scotia, Canada

Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates of clients receiving test results, numbers of individuals aware of their status and timely access to care for those who test positive. In addition, several studies have shown that rapid POC testing for HIV is highly acceptable to clients in a variety of clinical and community-based health care settings. Most acceptability studies conducted in North America, however, have been conducted in large, urban environments where concentrations of HIV testing sites and testing innovations are greatest. Using a survey of client preferences at a sexual health clinic in Halifax, Nova Scotia, we suggest that HIV test seekers living in a region outside of Canada's major urban HIV epicentres find rapid POC testing highly acceptable. We compare the results of the Halifax survey with existing acceptability studies of rapid POC HIV testing in North America and suggest ways in which it might be of particular benefit to testing clients and potential clients in Nova Scotia and other regions of Canada that currently have few opportunities for anonymous or rapid testing. Overall, we found that rapid POC HIV testing was highly desirable at this study site and may serve to overcome many of the challenges associated with HIV prevention and testing outside of well-resourced metropolitan environments.

Missed opportunities for hepatitis C testing in opioid treatment programs

HCV has surpassed HIV as a cause of death in the United States and is particularly prevalent among injection drug users. I examined the availability of on-site HCV testing in a nationally representative sample of opioid treatment programs. Nearly 68% of these programs had the staff required for HCV testing, but only 34% offered on-site testing. Availability of on-site testing increased only slightly with the proportion of injection drug users among clients. The limited HCV testing services in opioid treatment programs is a key challenge to reducing HCV in the US population.

Factors associated with HIV-testing history among Black men who have sex with men (BMSM) in Los Angeles County

Black men who have sex with men (BMSM) are disproportionately affected with HIV, and nearly half are unaware of their status. Those unaware of their status are more likely to engage in risky behavior; thus, HIV-testing uptake is crucial. This study explored correlates of past-two-year HIV-testing history. BMSM (n = 102) completed self-administered questionnaires. Fisher exact test indicated that BMSM at clubs/bars and Gay Pride events had higher rates of being tested within the past two years (86%-65%) than did participants who responded to online advertisements (44%, p < .001). Among those untested for HIV, slightly half reported receptive anal sex without a condom (48%, p = .033), used the Internet seeking sex (54%, p < .001), low HIV knowledge (52%, p = .005), and less education. Literacy and tailored online interventions might be worth considering to increase HIV-testing uptake.

Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward

Early commencement of antiretroviral treatment can be beneficial and economical in the long run. Despite global advances in access to care, a significant proportion of adults presenting at HIV/AIDS care facilities present with advanced HIV disease. Understanding factors associated with late presentation for HIV/AIDS services is critical to the development of effective programs and treatment strategies. Literature on factors associated with late presentation for an HIV diagnosis is reviewed. Highlighted is the current emphasis on socio-demographic factors, the limited exploration of psychosocial correlates, and inconsistencies in the definition of late presentation that make it difficult to compare findings across different studies. Perspectives based on experiences from resource limited settings are underreported. Greater exploration of psychosocial predictors of late HIV diagnosis is advocated for, to guide future intervention research and to inform public policy and practice targeted at 'difficult to reach' populations.