Uptake of HIV testing and counseling, risk perception and linkage to HIV care among Thai university students

HIV Voluntary Counselling and Testing Utilisation among School of Healthcare Sciences Undergraduate Students at the University of Limpopo

Existing evidence indicates that South African university students have low utilisation of Human Immunodeficiency Virus (HIV) Voluntary Counselling and Testing (VCT). A cross-sectional survey was conducted to determine the utilisation of HIV VCT among undergraduate students in the School of Healthcare Sciences. Structured questionnaires were used to collect data through Google Forms. The results are presented through descriptions and percentages and illustrated in tables. Out of 389 undergraduate students, only 324 completed the questionnaire. The majority (97.2%) were aware of the health centre on campus, while only (74.7%) knew about the HIV VCT services offered on campus. Despite the awareness, many (36.7%) do not utilise the campus HIV VCT services, and some (9.6%) have never tested for HIV. There was an association between awareness of Voluntary Counselling and Testing of HIV services offered at the campus health and wellness centre and utilisation of HIV Voluntary Counselling and Testing at (<0.001). Therefore, it is imperative to urgently escalate the level of HIV/AIDS education in higher institutions of learning and emphasise the mounting danger of HIV infection and the immense importance of regular HIV testing. The findings of this study could serve as a foundation for creating HIV prevention and control programmes for youth, particularly in higher education institutions.

Risk Perception About HIV Among University Students in One of the Last Hotspots for HIV Transmission in Europe

BACKGROUND

HIV testing in the Northern Kosovo province is challenging, because the infrastructure is being rebuilt after the ethnic conflict. The purpose of this research was to examine self-perceived risk for acquiring HIV infection and factors associated with risk assessment among university students.

METHODS

Students completed a questionnaire on socio-demographic data, knowledge about HIV prevention and transmission, attitudes toward people living with (PLHIV) and self-perceived risk for HIV infection. The self-perceived risk was categorized as low, unknown and high.

RESULTS

The majority of students (72.5%) assessed their risk as low, 8.5% assessed their risk as high and 19.1% did not know their risk. Compared to low self-perceived risk, high self-perceived HIV risk was associated with being male, having lower knowledge about HIV prevention, less strong Segregation and protection attitude toward PLHIV, stronger Ignorance and indifference attitude toward PLHIV and positive opinion about gays/lesbians. Students who perceived own risk for acquiring HIV as high had lower knowledge about HIV transmission and prevention. However, those who were previously tested for HIV, despite their poorer knowledge about HIV prevention, assess their HIV-related risk as low.

CONCLUSIONS

Students assessed their risk of HIV infection mostly as low. Still, lower knowledge of HIV prevention has been consistently associated with a high and unknown risk of HIV. Moreover, being ignorant and indifferent about PLHIV was associated with increased self-perceived HIV risk. These findings highlight the need for continuous specialized HIV-related education to reduce fear and stigma of PLHIV and HIV testing as well as risky behaviors.

HIV and AIDS-related knowledge, HIV risk perception, uptake of HIV testing and its predictors among prison inmates in Bauchi State, Nigeria: a cross-sectional study

Introduction

globally, HIV infection among prison inmates is significantly higher than in the general population. Therefore, it is important to identify inmates-living-with-HIV, through HIV-testing, in keeping with the target of UNAIDS vision 90-90-90. We assessed HIV/AIDS-related knowledge, HIV-risk perception and predictors of HIV-testing-uptake in Bauchi Prison.

Methods

we conducted a cross-sectional study among 310 inmates selected with 2 stage sampling. Data was collected using a pretested, structured, interviewer-administered questionnaire. Inmates that consented to HIV-test were tested. We estimated inmates' knowledge about HIV/AIDS, the level of HIV testing uptake and predictors of HIV testing-uptake using multiple logistic regression at 5% significant level.

Results

the mean age (SD) was 32.3 (±9.4) years and 94.8% were males, 47.1% (95% CI: 41.6-52.7) of the respondents had good knowledge of HIV/AIDS. Fifty-five percent (95% CI: 49.9-60.9) felt they were not at risk of contracting HIV. Uptake of HIV-testing was 58.1% (95% CI: 52.5-63.4). Independent predictors for the uptake of HIV-testing were age 35-44 years (aOR= 3.3; 95% CI: 1.4-7.7), positive risk perception (aOR= 3.3; 95% CI: 1.8-6.2), good knowledge of HIV (aOR= 9.6; CI: 5.1-18.0) and knowing someone who had died of AIDS (aOR= 4.1; 95% CI: 1.9-6.4).

Conclusion

good knowledge of HIV/AIDS and HIV-testing-uptake was low among the inmates. We recommended the development and implementation of targeted HIV-testing interventions that cater to the specific needs of different age-groups within the prison population. The prison authority should develop prison-specific health education programme and awareness campaigns aimed at promoting accurate HIV-risk perception, improving their knowledge and help inmates make informed decisions that will prevent them from contracting HIV.

Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs)

Background

Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design.

Objectives

The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research.

Methods

This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added.

Selection Criteria

To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes.

Results

This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied.

Conclusion

This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.

A systematic review and meta-analysis of the evidence for community-based HIV testing on men's engagement in the HIV care cascade

OBJECTIVE

Men with HIV are less likely than women to know their status, be on antiretroviral therapy, and be virally suppressed. This review examined men's community-based HIV testing services (CB-HTS) outcomes.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched seven databases and conference abstracts through July 2018. We estimated pooled proportions and/or risk ratios (for meta-analyses) for each outcome using random effects models.

RESULTS

188 studies met inclusion criteria. Common testing models included targeted outreach (e.g. mobile testing), home-based testing, and testing at stand-alone community sites. Across 25 studies reporting uptake, 81% (CI: 75-86%) of men offered testing accepted it. Uptake was higher among men reached through CB-HTS than facility-based HTS (RR = 1.39; CI: 1.13-1.71). Over 69% (CI: 64-71%) of those tested through CB-HTS were men, across 184 studies. Across studies reporting new HIV-positivity among men (n = 18), 96% were newly diagnosed (CI: 77-100%). Across studies reporting linkage to HIV care (n = 8), 70% (CI: 36-103%) of men were linked to care. Across 57 studies reporting sex-disaggregated data for CB-HTS conducted among key populations, men's uptake was high (80%; CI: 70-88%) and nearly all were newly diagnosed and linked to care (95%; CI: 94-100%; and 94%; CI: 88-100%, respectively).

CONCLUSION

CB-HTS is an important strategy for reaching undiagnosed men with HIV from the general population and key population groups, particularly using targeted outreach models. When compared to facility-based HIV testing services, men tested through CB-HTS are more likely to uptake testing, and nearly all men who tested positive through CB-HTS were newly diagnosed. Linkage to care may be a challenge following CB-HTS, and greater efforts and research are needed to effectively implement testing strategies that facilitate rapid ART initiation and linkage to prevention services.

Attitudes About Analytic Treatment Interruption (ATI) in HIV Remission Trials with Different Antiretroviral Therapy (ART) Resumption Criteria

HIV remission trials often require temporary stopping of antiretroviral therapy (ART)-an approach called analytic treatment interruption (ATI). Trial designs resulting in viremia raise risks for participants and sexual partners. We conducted a survey on attitudes about remission trials, comparing ART resumption criteria (lower-risk "time to rebound" and higher-risk "sustained viremia") among participants from an acute HIV cohort in Thailand. Analyses included Wilcoxon-Ranks and multivariate logistic analysis. Most of 408 respondents supported ATI trials, with slightly higher approval of, and willingness to participate in, trials using time to rebound versus sustained viremia criteria. Less than half of respondents anticipated disclosing trial participation to partners and over half indicated uncertainty or unwillingness about whether partners would be willing to use PrEP. Willingness to participate was higher among those who rated higher trial approval, lower anticipated burden, and those expecting to make the decision independently. Our findings support acceptability of ATI trials among most respondents. Participant attitudes and anticipated behaviors, especially related to transmission risk, have implications for future trial design and informed consent.

Human Immunodeficiency Virus Continuum of Care in 11 European Union Countries at the End of 2016 Overall and by Key Population: Have We Made Progress?

Background

High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region.

Methods

A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit.

Results

We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries.

Conclusions

The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control.

Provider-Initiated HIV Testing in Puerto Rico from Data of the National HIV Behavioral Surveillance-Heterosexual Cycle (NHBS-HET) 2016: National Cross-Sectional Survey (Preprint)

Background

According to the Centers for Disease Control and Prevention and World Health Organization guidelines, all individuals aged 13-64 years should get screened for HIV infection as part of their routine medical examinations. Individuals at high risk should get tested annually.

Objective

This study aimed to identify the sociodemographic, health care, and sexual behavioral characteristics of provider-initiated HIV testing using data from the Puerto Rico National HIV Behavioral Surveillance 2016 cycle, directed toward heterosexual individuals at increased risk of HIV infection.

Methods

A sample of 358 eligible participants were recruited through respondent-driven sampling, where sociodemographic characteristics, health care use, and HIV test referral were used to assess a description of the study sample. Pearson chi-square and Fisher tests were used to evaluate proportional differences. Multivariate logistic regression models were performed to determine the association between independent variables and HIV test referral. Adjusted prevalence ratios by sex and age with their 95% CIs were determined using a statistical significance level of .05.

Results

Despite 67.9% (243/358) of participants showing high-risk sexual behavioral practices and 67.4% (236/350) reporting a low perceived risk of HIV infection among those who visited a health care provider within the last 12 months, 80.7% (289/358) of the study sample did not receive an HIV test referral at a recent medical visit. Multivariate analysis showed that the estimated prevalence of the participants who received an HIV test referral among those who reported being engaged in high-risk sexual behaviors was 41% (adjusted prevalence ratio .59, 95% CI .39-.91; P=.02) lower than the estimated prevalence among those who did not engage in high-risk sexual behavior.

Conclusions

This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico.

Perceptions of an HIV self-testing intervention and its potential role in addressing the barriers to HIV testing among at-risk heterosexual men: a qualitative analysis

Objectives

Voluntary HIV testing rates are still low in several Asian countries including Singapore. HIV self-testing (HIVST) has the potential to increase testing, leading to earlier diagnosis and better prognosis. However, the views of at-risk individuals, especially heterosexual men (HSM), who are not coming forward for testing are still poorly understood. In this study, we examined the barriers and facilitators to and delivery preferences for HIVST in order to implement an effective intervention in Singapore.

Methods

From May 2017 to June 2018, 48 in-depth interviews were conducted with HSM aged 21–66 years and at risk of HIV infection. Participants were purposively sampled based on ethnicity, age and testing behaviour. Recruitment was done mainly at brothels and entertainment establishments in Singapore. Participants gave their views on HIV testing, factors affecting HIVST use and their preferred HIVST service delivery model.

Results

Most participants preferred HIVST over conventional testing for its convenience, privacy, anonymity and autonomy, but older men still preferred conventional testing. Low self-perceived risk, low awareness and self-efficacy for HIVST, and non-comprehensive test for other STIs were reported as barriers to HIVST. There were mixed opinions on kit preference. A blood-based kit was favoured for higher accuracy, while the oral-fluid-based kit was favoured for ease of use. Participants wanted a human touch for post-test counselling and linkage to care only if they self-tested positive. Traditional media, internet and social media, and venue-based outreach were potential advertising platforms mentioned.

Conclusions

A locally acceptable and feasible HIVST intervention must address the barriers and facilitators of using HIVST in order to improve HIV testing rates among this at-risk population who might otherwise delay or fail to present for testing.

Achieving the first of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets: understanding the influence of HIV risk perceptions, knowing one's partner's status and discussion of HIV/sexually transmitted infections with a sexual partner on uptake of HIV testing

This study assessed how HIV risk perceptions, knowledge of one's partner's status and discussion of HIV/sexually transmitted infections (STIs) with one's sexual partner influence the uptake of HIV testing. Data were obtained from 833 young adults, selected using stratified random sampling in a South African university in 2018. Adjusted and unadjusted logistic regression models were employed to examine determinants of HIV testing uptake. The majority of students (69.9%) had previously tested for HIV, but only 58.4% tested for HIV in the last year. Being highly concerned about contracting HIV/STIs was positively associated with having tested for HIV (adjusted OR [AOR]: 4.28; CI: 2.50 to 7.34) and getting an HIV test in the past year (AOR: 1.83; CI: 1.20 to 2.80). Knowing one's partner's status was associated with a higher probability of ever having been tested for HIV (AOR: 3.07; CI: 1.89 to 4.97) or having received an HIV test in the previous year (AOR: 2.66; CI: 1.77 to 3.99). Discussion of HIV/STIs was associated with higher odds of having ever been tested for HIV (AOR: 3.81; CI: 2.44 to 5.96) and recent HIV testing (AOR: 3.22; CI: 2.17 to 4.77). HIV testing was below the Joint United Nations Programme on HIV/AIDS UNAIDS 90-90-90 target. Being concerned about contracting HIV, discussion of HIV/STIs with a sexual partner and knowing one's partner's HIV status were associated with the uptake of HIV testing.

Concerns about contracting HIV, knowing partners' HIV sero-status and discussion of HIV/STI with sexual partners as determinants of uptake of HIV testing

Worldwide, adolescents and young adults (aged 15-25 years) account for the highest proportion of new HIV infections, yet the uptake of HIV testing among this cohort is sub-optimal. Understanding factors that predict the uptake of HIV testing among adolescents and young adults is critical for designing effective and relevant interventions to increase testing. Drawing from the psychosocial constructs of the Health Belief Model, the study examined the effects of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake among adolescents and young adults in two Nigerian universities. The study was conducted in 2018 and was cross-sectional in design, with a final sample of 784 male and female students selected using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the effect of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake. Only 50.6% of participants had ever tested for HIV with 30.7% being tested in the last year, with no significant differences by sex. After controlling for other covariates (age, sex and being sexually active), knowing partners' HIV status, having discussed HIV with partners and being very concerned about contracting HIV were found to be significantly associated with ever being tested for HIV and recent HIV testing uptake. Uptake of HIV testing was found to be low in the study setting and fell short of the first '90%' UNAIDS target. Age-appropriate strategies, targeting open communication on HIV/STIs and disclosure of sero-status between sexual partners are required to promote uptake of HIV testing among young adults and adolescents in Nigeria.

HIV cascade of care in Greece: Useful insights from additional stages

Background

Aiming to eliminate HIV infection, UNAIDS has set a global “90-90-90” target by 2020. We sought to construct a 6-stages HIV Cascade of Care (CoC) in Greece, overall and by risk group, to assess risk-group and stage-specific progress in achieving the UNAIDS target.

Patients and methods

Combining data from the HIV/AIDS surveillance system and a population-based HIV cohort study, the CoC included: i) number of people living with HIV (PLHIV) by end of 2013; ii) proportion of PLHIV ever diagnosed; iii) proportion of diagnosed linked-to-care iv) proportion of linked-to-care ever initiating antiretroviral therapy (ART); v) proportion of treated who retained-in-care vi) proportion of those retained-in-care who were virally suppressed (≤200 copies/mL) at their last visit (01/07/2012-31/12/2013).

Results

In 2013, 14147 PLHIV were in Greece. Overall, proportions of each stage in the cascade were: 78.4% diagnosed; 86% linked-to-care; 78.5% initiated ART; 86.4% retained-in-care, and 87.1% virally suppressed. Totally, 42.6% of all PLHIV were virally suppressed. The percentage diagnosed was lower among heterosexual men and women (heterosexuals) than in MSM (men who have sex with men) or PWID (people who inject drugs). Most MSM were linked to care (97.2% of diagnosed) while a substantial proportion of PWID were not (80.8% of diagnosed). Once treated, PWID remained in care in similar proportions to MSM. Unlike PWID, a high proportion of the retained in care MSM and heterosexuals achieved viral suppression.

Conclusions

At the end of 2013, we identified gaps in the HIV CoC in Greece, which differed across risk groups. Targeted interventions are critical in optimizing early diagnosis and timely linkage. A 6-stage CoC, stratified by risk group, can inform strategic public health planning in improving HIV treatment outcomes.

Prevalence and correlates of HIV testing among adolescents 10-19 years in a post-conflict pastoralist community of Karamoja region, Uganda

Background

Adolescents are a priority group in HIV prevention and treatment. This study sought to determine the prevalence and correlates of HIV testing services (HTS) among adolescents in the pastoralist post-conflict area of Karamoja sub region, Uganda.

Methods

A cross sectional study of 1439 adolescents aged 10–19 years, attending nine public health facilities in five of the seven districts of Karamoja, was conducted between August to September 2016. Adolescents were consecutively selected and interviewed using structured interviewer administered questionnaires. All respondents who had never tested for HIV were offered HTS. The main outcome was ever tested for HIV. Correlates of ever tested were analysed using multivariate logistic regression model.

Results

Of the 1439 adolescents, 904 (62.8%) were females, 1203 (83.6%) were aged 15–19 years, 618 (43.0%) had attained primary education and 885 (61.5%) had ever had sex. Overall 1177 (81.8%) had ever tested and received HIV results. Older age (15–19 years) (adj.OR = 2.71, 95% CI: 1.85–3.96), secondary level education or higher (adj.OR = 2.33, 95% CI: 1.33–4.10), and ever had sex (adj.OR = 2.03, 95% CI: 1.42–2.90) were associated with higher odds of HIV testing. Of the 262 who had never tested, 169 (64.5%) accepted testing and 2.4% were HIV positive. Reasons for not accepting the test included fear of being tested and not ready for an HIV test because of perceived suffering HIV positive clients go through.

Conclusion

Awareness of HIV status and uptake of HTS among adolescents in this hard-to-reach post-conflict region was high and close to the global UNAIDS target of 90%. However, the HIV prevalence of 2.4% among the non-testers who accepted to be tested was high and emphasises the need for targeted testing to reach the undiagnosed HIV infected adolescents in this region.

HIV Risk perception and eligibility for pre-exposure prophylaxis in women involved in the criminal justice system

Women involved in the criminal justice system (WICJ) are at high risk of acquiring HIV and would benefit from HIV pre-exposure prophylaxis (PrEP) but there are no studies in this population to inform PrEP implementation programs. We conducted a cross-sectional survey of HIV-uninfected, cis-gender women on probation, parole and/or recently released from prison/jail to assess PrEP awareness, eligibility, potential barriers to uptake, and the PrEP care continuum. The 125 WICJ surveyed reported high rates of HIV risk behaviors including recent transactional sex (22.4%) and unsafe injection practices (14.4%). Despite 33% (n = 42) meeting eligibility criteria for PrEP, only 25% were aware of PrEP and one person was currently using it. Just 16.7% of those who were PrEP eligible perceived they were at risk for HIV. Following a brief explanation of PrEP, 90% said they would try it if recommended by their physician. Compared to those not PrEP eligible (n = 83), PrEP eligible women were less likely to be stably housed or have a primary care provider, and were more likely to be violence-exposed, charged with drug possession, have lifetime substance use, or living with Hepatitis C infection. WICJ frequently engage in HIV risk behaviors that make them eligible for PrEP. Uptake may be limited by lack of PrEP awareness or underestimation of personal HIV risk. WICJ report receptiveness to PrEP and represent an important population for targeted PrEP implementation programs.

Importance of Risk Perception: Predictors of PrEP Acceptance Among Thai MSM and TG Women at a Community-Based Health Service

BACKGROUND

HIV prevalence among Thai men who have sex with men (MSM) and transgender women (TG) are 9.15% and 11.8%, respectively, compared with 1.1% in the general population. To better understand early adopters of pre-exposure prophylaxis (PrEP) in Thailand, we analyzed biobehavioral and sociodemographic characteristics of PrEP-eligible MSM and TG.

SETTING

Four Thai urban community clinics between October 2015 and February 2016.

METHODS

Sociodemographics, HIV risk characteristics, and PrEP knowledge and attitudes were analyzed in association with PrEP initiation among eligible Thai MSM and TG. Adjusted analysis explored factors associated with PrEP acceptance. We then analyzed HIV risk perception, which was strongly associated with PrEP initiation.

RESULTS

Of 297 participants, 55% accepted PrEP (48% of MSM, 54% of TG). Perceived HIV risk levels were associated with PrEP acceptance [odds ratio (OR): 4.3; 95% confidence interval (95% CI): 1.5 to 12.2. OR: 6.3; 95% CI: 2.1 to 19.0. OR: 14.7; 95% CI: 3.9 to 55.1; for minimal, moderate, and high perceived risks, respectively]. HIV risk perception was associated with previous HIV testing (OR: 2.2; 95% CI: 1.4 to 3.5); inconsistent condom use (OR: 1.8; 95% CI: 1.1 to 2.9); amphetamine use in the past 6 months (OR: 3.1; 95% CI: 1.1 to 8.6); and uncertainty in the sexually transmitted infection history (OR: 2.3; 95% CI: 1.4 to 3.7). Approximately half of those who reported either inconsistent condom use (46%), multiple partners (50%), group sex (48%), or had baseline bacterial sexually transmitted infection (48%) perceived themselves as having no or mild HIV risk.

CONCLUSIONS

HIV risk perception plays an important role in PrEP acceptance. Perception does not consistently reflect actual risk. It is therefore critical to assess a client's risk perception and provide education about HIV risk factors that will improve the accuracy of perceived HIV risk.