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Khezri M, Goldmann E, Tavakoli F, Karamouzian M, Shokoohi M, Mehmandoost S, Ghalekhani N, Haghdoost AA, Des Jarlais D, Mirzazadeh A, Sharifi H. Awareness and willingness to use HIV self-testing among people who inject drugs in Iran. Harm Reduct J 2023; 20:145. [PMID: 37805505 PMCID: PMC10560425 DOI: 10.1186/s12954-023-00881-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Most people who inject drugs (PWID) in Iran have not undergone recent HIV testing. While PWID face barriers when seeking HIV testing at health facilities, HIV self-testing (HIVST) could be a promising approach to improve HIV testing uptake. We examined the awareness and willingness to use HIVST among PWID in Iran. We also identified participants' characteristics associated with a higher willingness to use HIVST. METHODS PWID were recruited in 11 cities using a respondent-driven sampling method. Willingness to use HIVST was defined as a binary variable (very low/low willingness vs. high/very high willingness). We performed multivariable modified Poisson regression to examine associated factors and report adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS Of 2,252 PWID, 362 (16.2%; 95% CI 14.7, 17.8) had ever heard of HIVST; however, 1,658 (73.6%; 95% CI 71.7, 75.4) reported high/very high willingness to use HIVST. Willingness to use HIVST was higher among PWID who reported having a high/moderate HIV risk perception (aPR 1.22; 95% CI 1.09, 1.37), ever experiencing homelessness (aPR 1.15; 95% CI 1.03, 1.28), > 10 years of injecting history (aPR 1.16; 95% CI 1.00, 1.34), and high injection frequency in the last three months (aPR 1.18; 95% CI 1.05, 1.32). CONCLUSION Most PWID in Iran, particularly those experiencing homelessness, have a longer injecting history, engage in more frequent injection practices, and possess a heightened perception of HIV risk would be willing to adopt HIVST. Enhancing HIVST awareness through increased access to HIVST and health education programs are needed. Additionally, conducting implementation science studies to effectively design and run HIVST programs in Iran can also increase PWID's access to HIV testing.
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Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Emily Goldmann
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Algarin AB, Lara MV, Chapin-Bardales J, Baruch-Dominguez R, Sanchez TH, Hernandez-Avila M, Smith LR. Examining Geographical Differences in the HIV Care Continuum Among Men Who Have Sex with Men in Mexico. AIDS Behav 2023; 27:772-782. [PMID: 36156172 PMCID: PMC9511456 DOI: 10.1007/s10461-022-03809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
We analyzed data collected by the Encuesta de Sexo Entre Hombres study from 15,233 Mexican men who have sex with men (MSM) between May-July 2017 to examine differences in the HIV care continuum. Data were stratified into 6 geographical regions. Prevalence ratios assessed associations between region and care outcomes. Among participants never testing HIV positive (n = 13,583), 66.1% had ever been tested and 43.0% in the past year. Among HIV-positive persons (n = 1,650), 83.9% reported counseling post-diagnosis, 61.9% timely linkage to care, 42.4% timely CD4/viral load results, 38.2% timely access to antiretroviral therapy (ART), and 87.7% were currently on ART. The Ciudad de México /Estado de México region had significantly superior care continuum outcomes in ever and recent HIV testing, linkage to care, CD4/viral load results, and current ART use. Understanding geographical variations in HIV care for MSM in Mexico is one important step to inform efforts for ending HIV/AIDS by 2030 in Latin America.
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Affiliation(s)
- Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 92093-0507, La Jolla, CA, USA
| | | | | | | | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 92093-0507, La Jolla, CA, USA.
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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
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.
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Wiginton JM, Murray SM, Algarin AB, Baral SD, Sanchez TH, Smith LR. Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses. BMC Infect Dis 2022; 22:690. [PMID: 35964006 PMCID: PMC9375942 DOI: 10.1186/s12879-022-07672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: "stigma from family and friends" (α = 0.65), "anticipated healthcare stigma" (α = 0.84), and "general social stigma" (α = 0.70). External construct validity was indicated through each subscale's strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.
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Affiliation(s)
- John Mark Wiginton
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
- Department of Medicine, University of California-San Diego, San Diego, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA, San Diego, USA
| | - Stefan D Baral
- Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Travis H Sanchez
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA, San Diego, USA
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Elorreaga OA, Torres TS, Vega-Ramirez EH, Konda KA, Hoagland B, Benedetti M, Pimenta C, Diaz-Sosa D, Robles-Garcia R, Grinsztejn B, Caceres CF, Veloso VG. Awareness, willingness and barriers to HIV Self-testing (HIVST) among Men who Have Sex with Men (MSM) in Brazil, Mexico, and Peru: A web-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000678. [PMID: 36962436 PMCID: PMC10021908 DOI: 10.1371/journal.pgph.0000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.
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Affiliation(s)
- Oliver A Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | - Kelika A Konda
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Cristina Pimenta
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Dulce Diaz-Sosa
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico DF, Mexico
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Carlos F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad Sida y Sociedad, UPCH, Lima, Peru
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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Rivera AS, Hernandez R, Mag-Usara R, Sy KN, Ulitin AR, O'Dwyer LC, McHugh MC, Jordan N, Hirschhorn LR. Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review. PLoS One 2021; 16:e0250434. [PMID: 33939722 PMCID: PMC8092786 DOI: 10.1371/journal.pone.0250434] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. METHODS We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. RESULTS AND DISCUSSION Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. CONCLUSIONS Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.
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Affiliation(s)
- Adovich S Rivera
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ralph Hernandez
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Regiel Mag-Usara
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Karen Nicole Sy
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Allan R Ulitin
- Institute of Health Policy and Development Studies, National Institutes for Health, Manila, Philippines
| | - Linda C O'Dwyer
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Megan C McHugh
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Neil Jordan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, United States of America
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Uptake and acceptability of assisted and unassisted HIV self-testing among men who purchase sex in brothels in Indonesia: a pilot intervention study. BMC Public Health 2020; 20:730. [PMID: 32429950 PMCID: PMC7238614 DOI: 10.1186/s12889-020-08812-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background Along with sexual partners of other high-risk groups, men who purchase sex (MWPS) represented 18% of new HIV diagnoses worldwide in 2018. They are therefore an important population for HIV prevention globally. Despite very low HIV testing coverage among MWPS in many countries, the role of HIV self-testing to increase testing coverage has not been explored. We, therefore, conducted a pilot intervention study to evaluate the uptake and acceptability of assisted and unassisted HIV self-testing among MWPS in Indonesia. Methods MWPS attending seven brothels in Bali between December 2017 and January 2018 were recruited by lay health providers to participate in a brief health survey, and then invited to have a HIV self-test (assisted or unassisted) with an OraQuick® ADVANCE Rapid HIV-1/2 Antibody Test and complete a post-test acceptability survey. Results A total of 292 men completed the health survey (response rate: 70%) and 188 (64.6%) accepted HIV self-testing. Of these men, 13.3% had ever tested for HIV and 58.9% reported condom use at their last sexual encounter with a brothel-based female sex worker. Nearly all men (98.9%) who accepted a HIV self-test preferred assisted HIV self-testing – of whom 83.9% preferred to be fully assisted and 16.1% opted to be partially assisted and read their results privately. Of the men who accepted the test and showed the result to the lay health providers, 4 (2.1%) received reactive results. Linkage following HIV self-test is a concern, as none of the four men with a reactive result attended HIV testing at the recommended referral HIV testing clinic over a two-month follow-up period. Conclusions This study is the first to investigate the acceptance of HIV self-testing when offered to MWPS in brothels by lay health providers. The high uptake of HIV self-testing suggests that this testing model is acceptable and could increase the very low HIV testing coverage among MWPS. The strong preference for fully assisted HIV self-testing highlights the importance of involving lay health providers in future testing programs. When scaling up HIV self-testing programmatically, strategies to improve linkage-to-care should be considered and evaluated.
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Adaptation of a Health Education Program for Improving the Uptake of HIV Self-Testing by Men in Rwanda: A Study Protocol. MEDICINA-LITHUANIA 2020; 56:medicina56040149. [PMID: 32225045 PMCID: PMC7230617 DOI: 10.3390/medicina56040149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/22/2022]
Abstract
Background and objectives: Available evidence shows a low uptake of HIV services among men in Rwanda. HIV self-testing (HIVST), a new intervention, may have the potential to improve the uptake of HIV testing services among men. The current study aims to adapt a health education program (HEP) for improving the uptake of HIVST among men in Rwanda. Materials and Methods: We propose a mixed method study, which will be conducted in four phases. In Phase 1, we will conduct a scoping review to map the available evidence on health education programs for men in low- and middle-income countries (LMICs). In Phase 2, we will conduct interviews with stakeholders in the Rwanda HIV response and healthcare providers to determine their perspectives on implementation of HIVST in Rwanda. In Phase 3, a cross-sectional survey will be used to assess HIVST awareness and acceptability among men in Rwanda. Guided by findings from Phases 1, 2, and 3, we will employ the nominal group technique to develop and optimize the HEP for improving the uptake of HIVST among men in Rwanda. In Phase 4, we will use a pragmatic pilot randomized controlled trial to assess the preliminary impact of the HEP for men in Rwanda and assess the feasibility of a later, larger study. We will employ the Stata version 16 statistical package and NVivo version 12 for the analysis of quantitative and qualitative data, respectively. We anticipate that the findings of this study will inform implementers and policy makers to guide strategies on the implementation of HIVST in Rwanda and ultimately accomplish goals set forth in the Rwanda 2019–2024 Fourth Health Sector Strategic Plan on scaling up the number of men who know their HIV status. Conclusion: It is anticipated that this study will proffer solutions and strategies that are applicable not only in Rwanda but also in similar settings of LMICs.
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HIV self-testing in Rwanda: awareness and acceptability among male clinic attendees in Kigali, Rwanda: A cross-sectional survey. Heliyon 2020; 6:e03515. [PMID: 32181390 PMCID: PMC7063164 DOI: 10.1016/j.heliyon.2020.e03515] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background The Rwandan Ministry of Health recently (in February 2017) recommended the use of HIV self-testing (HIVST) as an additional strategy for hard-to-reach populations such as men. However, the level of awareness and acceptability of this testing strategy among this population in Rwanda is not known. The main objective of this study is to assess the level of awareness and acceptability of HIVST among male clinic attendees in Kigali, Rwanda. Methods A cross-sectional survey was employed to systematically sample and interview 579 male health-facility attendees over a seven-week period. We employed a pretested interviewer questionnaire to collect data. The chi-square test was used to determine associations between explanatory variables. Univariate binary logistic regression analysis was carried out to obtain preliminary insight into the unconditional association of each independent variable and dependent variables (awareness and acceptability). Multiple logistic regression was employed to determine explanatory variables associated with awareness or acceptability status while adjusting for other study variables. All statistical analyses were performed using Stata version 11.2. Results Of the 579 men interviewed, only 21% were aware of HIVST, while 74% found it acceptable. Logistic regression analysis identified the following as factors significantly (p < 0.05) associated with HIVST awareness: having paid or received money for sex in the past month, health-seeking behavior, HIVST knowledge, HIVST attitude, and HIV risk perception. Factors associated with HIVST acceptability include the following: health-seeking behavior, HIVST knowledge, HIVST attitude, and condom use after taking drugs and alcohol. Conclusion The findings reveal low awareness and high acceptability of HIVST among men in Rwanda. Our findings accentuate the need to promote awareness of HIVST as an important intervention for improving the uptake of HIV testing among men, a traditionally hard-to-reach population in Rwanda.
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Hidayat R, Marguari D, Hairunisa N, Suparno H, Magnani R. Community HIV Screening Among MSM in Three Indonesian Cities. Curr HIV Res 2020; 17:65-71. [PMID: 30907323 DOI: 10.2174/1570162x17666190321115419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Indonesia lags behind its peers with regard to ART coverage of PLHIV. Insufficient HIV testing among MSM and other key affected populations remains a barrier to increasing ART coverage. OBJECTIVE This report presents the results of the first government-endorsed implementation research study of a community screening approach to increasing the rate of HIV testing among MSM in three cities. METHODS All new MSM outreach contacts meeting eligibility criteria during March-June 2017 were included in the study. HIV testing at a government health facility, which is required to qualify for government-supported ART, was advised for all new contacts. Men refusing formal testing were offered an HIV screening test in a community setting using a saliva-based rapid test and advised to get a confirmatory test at a health facility. All outreach contacts and testing activities were recorded on individual client records. RESULTS Of 1,149 eligible MSM, 27% were willing to be referred to receive HIV testing at a health facility, among which 83% were confirmed to have been tested. Of the 838 study subjects refusing health facility testing, 38% accepted community screening. The screening positivity rate was 14.8%. Only 38% of men with reactive screening tests received a confirmatory test at a health facility, along with 8% of those with non-reactive tests. CONCLUSION While community screening resulted in more MSM knowing their HIV status, reluctance to avail government health facility-based services, or indeed to be tested at all, must be addressed if community screening is to accelerate progress in getting HIV-positive MSM onto treatment.
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Affiliation(s)
| | | | - Nany Hairunisa
- Yayasan Spiritia, Jakarta, Indonesia.,Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Heru Suparno
- Health Research Center, University of Indonesia, Jakarta, Indonesia
| | - Robert Magnani
- AIDS Research Center, Atma Jaya Catholic University, Jakarta, Indonesia
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De Boni RB, Veloso VG, Fernandes NM, Lessa F, Corrêa RG, Lima RDS, Cruz M, Oliveira J, Nogueira SM, de Jesus B, Reis T, Lentini N, Miranda RL, Bingham T, Johnson CC, Barbosa Junior A, Grinsztejn B. An Internet-Based HIV Self-Testing Program to Increase HIV Testing Uptake Among Men Who Have Sex With Men in Brazil: Descriptive Cross-Sectional Analysis. J Med Internet Res 2019; 21:e14145. [PMID: 31373276 PMCID: PMC6694730 DOI: 10.2196/14145] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Approximately 30% of people living with HIV worldwide are estimated to be unaware of their infection. HIV self-testing (HIVST) is a strategy recommended by the World Health Organization to increase access to and uptake of testing among key populations who are at high risk for HIV infection. OBJECTIVE This study aimed to describe the development and feasibility of a free, anonymous, internet-based HIVST strategy designed for men who have sex with men in Curitiba, Brazil (electronic testing [e-testing]). METHODS The project was developed under the scope of the "A Hora é Agora" (The Time is Now) program. Individuals aiming to request an HIVST package (two tests each) answered an anonymous 5-minute questionnaire regarding inclusion criteria and sexual risk behavior. Eligible individuals could receive one package every 6 months for free. Website analytics, response to online questionnaires, package distribution, and return of test results were monitored via a platform-integrated system. RESULTS Between February 2015 and January 2016, the website documented 17,786 unique visitors and 3218 completed online questionnaires. Most individuals self-reported being white (77.0%), young (median age: 25 years, interquartile range: 22-31 years), educated (87.3% completed secondary education or more), and previously tested for HIV (62.5%). Overall, 2526 HIVST packages were delivered; of those, 542 (21.4%) reported a result online or by mail (23 reactive and 11 invalid). During the study period, 37 individuals who reported using e-testing visited the prespecified health facility for confirmatory testing (30 positive, 7 negative). CONCLUSIONS E-testing proved highly feasible and acceptable in this study, thus supporting scale-up to additional centers for men who have sex with men in Brazil.
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Affiliation(s)
- Raquel Brandini De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Nilo Martinez Fernandes
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Flavia Lessa
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Renato Girade Corrêa
- National Department of STI, AIDS, and Viral Hepatitis, Ministry of Health, Brailia, Brazil
| | - Renato De Souza Lima
- National Department of STI, AIDS, and Viral Hepatitis, Ministry of Health, Brailia, Brazil
| | - Marly Cruz
- Escola Nacional de Saúde Pública, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Beto de Jesus
- Escola Nacional de Saúde Pública, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Nena Lentini
- Centers for Disease Control and Prevention-Brazil, Brasilia, Brazil
| | | | - Trista Bingham
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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12
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Reisner SL, Perez-Brumer A, Oldenburg CE, Gamarel KE, Malone J, Leung K, Mimiaga MJ, Rosenberger JG, Biello KB. Characterizing HIV risk among cisgender men in Latin America who report transgender women as sexual partners: HIV risk in Latin America men. Int J STD AIDS 2019; 30:378-385. [PMID: 30537903 PMCID: PMC9897015 DOI: 10.1177/0956462418802687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Kingsley Leung
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Center for Health Equity Research, Brown University, Providence, RI
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13
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Campbell CK, Lippman SA, Moss N, Lightfoot M. Strategies to Increase HIV Testing Among MSM: A Synthesis of the Literature. AIDS Behav 2018; 22:2387-2412. [PMID: 29550941 DOI: 10.1007/s10461-018-2083-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.
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Affiliation(s)
- Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA.
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Nicholas Moss
- Division of Communicable Disease Control & Prevention, Alameda County Public Health Department, Oakland, CA, USA
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
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14
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Devez PE, Epaulard O. Perceptions of and intentions to use a recently introduced blood-based HIV self-test in France. AIDS Care 2018; 30:1223-1227. [PMID: 29888616 DOI: 10.1080/09540121.2018.1485837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
An estimated 28,000 French people infected with HIV remain undiagnosed, leading to HIV transmission and late-stage HIV infections. An over-the-counter HIV self-test has been available since September 2015. We thus aimed to explore people's perceptions of and intentions to use the test. An anonymous online questionnaire, targeting the general population and men who have sex with men (MSM) was distributed between November 2015 and January 2016. It explored at-risk sexual behavior, perceptions of the HIV self-test, and past and intended future use. A total of 1,082 participants completed ≥90% of the questionnaire (67.1% male, 32.4% female, 0.5% other; mean age 32.8 ± 12 years). 44.8% were MSM. 41.5% declared that they did not always use or make their partner use a condom in the case of penetration with someone other than their usual partner (if applicable). 9.9% had already used the HIV self-test, with this proportion being higher in multivariate analysis for individuals with a monthly income exceeding €1,000 and those declaring to be informed about HIV. 38.5% stated their intention to use the self-test in the coming month or year; in multivariate analysis, this proportion was lower for MSM and higher for those who did not always use or make their partner use a condom in the case of penetration with someone other than their usual partner. The majority (68.4%) underestimated the testing delay to rule out HIV infection. The most frequently cited concerns were that self-test does not test for other sexually transmitted infections (49.5%) and is not free of charge (44.4%), and that users are left alone with the result (41.0%). The HIV self-test was identified as a useful tool by different at-risk populations; it may therefore enhance the number of diagnoses. The test delay must be appropriately communicated to users, while a lower purchase price may increase usage.
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Affiliation(s)
- Paul-Emmanuel Devez
- a Comité de Coordination de la Lutte contre le VIH (COREVIH) Arc Alpin , Grenoble , France.,b Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France
| | - Olivier Epaulard
- a Comité de Coordination de la Lutte contre le VIH (COREVIH) Arc Alpin , Grenoble , France.,b Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France.,c Infectious Disease Unit , Centre hospitalier Universitaire Grenoble Alpes , Grenoble , France.,d Team "HIV and Other Persistent Human Viruses" , Institut de Biologie Structurale, UMR5075 CEA-CNRS-UGA , Grenoble , France
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15
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Use of expenditure analysis to enhance returns on investments in HIV services. Curr Opin HIV AIDS 2017. [PMID: 28639989 DOI: 10.1097/coh.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Globally, the response to the HIV epidemic is at a crisis point. International investments in the HIV response have been essentially flat for 8 years and domestic budgets in low and middle-income countries - still recovering from the global recession - have not been able to fill the resource gap to drive a full-fledged HIV response. Still, efficiencies and prioritization of evidence-based interventions enable a significant scale-up of treatment, but millions more people remain without treatment. This review looks at recent data and research to evaluate interventions that may help close gaps in service provision that undermine testing and treatment programs. RECENT FINDINGS The President's Emergency Plan for AIDS Relief recently began publicly releasing vast programmatic and expenditure data. These data reveal potential efficiency gaps in testing and treatment programs, particularly in the area of linkage and retention. Interventions such as HIV self-testing have been proposed to help, but whether they can deliver better results remains unclear. Same-day initiation on treatment improves initiation, retention, and viral suppression rates. SUMMARY Near real-time analysis of data and active response is critical in improving efficiencies in programs. More investment in implementation research is necessary to improve linkage to care and treatment to reach 90-90-90 goals.
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