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Ayinde O, Jackson L, Phattey J, Ross JDC. STI testing and subsequent clinic attendance amongst test negative asymptomatic users of an internet STI testing service; one-year retrospective study. PLoS One 2023; 18:e0281359. [PMID: 36753507 PMCID: PMC9907837 DOI: 10.1371/journal.pone.0281359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023] Open
Abstract
AIM To explore the characteristics of online STI test users, and assess the frequency and factors associated with subsequent service use following a negative online STI test screen in individuals without symptoms. METHODS One-year retrospective study of online and clinic STI testing within a large integrated sexual health service (Umbrella in Birmingham and Solihull, England) between January and December 2017. A multivariable analysis of sociodemographic and behavioural characteristics of patients was conducted. Sexual health clinic appointments occurring within 90 days of a negative STI test, in asymptomatic individuals who tested either online or in clinic were determined. Factors associated with online STI testing and subsequent clinic use were determined using generalized estimating equations and reported as odds ratios (OR) with corresponding 95% confidence intervals (CI). RESULTS 31 847 online STI test requests and 40 059 clinic attendances incorporating STI testing were included. 79% (25020/31846) of online STI test users and 49% (19672/40059) of clinic STI test takers were asymptomatic. Online STI testing was less utilised (p<0.05) by men who have sex with men (MSM), non-Caucasians and those living in neighborhoods of greater deprivation. Subsequent clinic appointments within 90 days of an asymptomatic negative STI test occurred in 6.2% (484/7769) of the online testing group and 33% (4960/15238) for the clinic tested group. Re-attendance following online testing was associated with being MSM (aOR 2.55[1.58 to 4.09]-MSM vs Female) and a recent prior history of STI testing (aOR 5.65[4.30 to 7.43] 'clinic tested' vs 'No' recent testing history). CONCLUSIONS Subsequent clinic attendance amongst online STI test service users with negative test results was infrequent, suggesting that their needs were being met without placing an additional burden on clinic based services. However, unequal use of online services by different patient groups suggests that optimised messaging and the development of online services in partnership with users are required to improve uptake.
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Affiliation(s)
- Oluseyi Ayinde
- Sexual Health and HIV, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
- * E-mail:
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jara Phattey
- Sexual Health and HIV, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Jonathan D. C. Ross
- Sexual Health and HIV, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
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2
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Camara H, Nosi S, Munnull G, Badman SG, Bolgna J, Kuk J, Mola G, Guy R, Vallely AJ, Kelly-Hanku A. Women's acceptability of a self-collect HPV same-day screen-and-treat program in a high burden setting in the Pacific. BMC Health Serv Res 2022; 22:1514. [PMID: 36510192 PMCID: PMC9746197 DOI: 10.1186/s12913-022-08842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A field trial to evaluate a self-collect point-of-care HPV screen-and-treat (HPV S&T) program was implemented in two Well Women Clinics in Papua New Guinea (Papua New Guinea). Assessing the acceptability of a health intervention is a core element of evaluation. In this study, we examined women's acceptability of both self-collection and HPV S&T intervention in Papua New Guinea. METHODS: Sixty-two semi-structured interviews were conducted with women who had undergone cervical screening in the same-day self-collected HPV screen-and-treat program in Madang and Western Highlands Provinces, Papua New Guinea. Data were thematically analysed using the Theoretical Framework of Acceptability (TFA) and managed using NVivo 12.5. RESULTS Most women agreed that self-collection was transformative: it helped circumvent the culturally embarrassing pelvic examination and increased their self-efficacy, especially due to the provision of health education, instructions, and pictorial aids. The availability of same-day results, and treatment if indicated, was particularly valued by the women because it reduced the financial and temporal burden to return to the clinic for results. It also meant they did not need to wait anxiously for long periods of time for their results. Women also appreciated the support from, and expertise of, health care workers throughout the process and spoke of trust in the HPV-DNA testing technology. Most women were willing to pay for the service to ensure its sustainability and timely scale-up throughout Papua New Guinea to support access for women in harder to reach areas. CONCLUSION This study reported very high levels of acceptability from a field trial of self-collection and HPV same-day screen-and-treat. The program was deemed culturally congruent and time efficient. This innovative cervical screening modality could be the 'solution' needed to see wider and more immediate impact and improved outcomes for women in Papua New Guinea and other high-burden, low-resource settings.
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Affiliation(s)
- Hawa Camara
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Somu Nosi
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Gloria Munnull
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea ,Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Steven G. Badman
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - John Bolgna
- Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Joseph Kuk
- Mt Hagen Provincial Hospital, PO Box 36, Mt Hagen, WHP 281 Papua New Guinea
| | - Glen Mola
- grid.412690.80000 0001 0663 0554School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD Papua New Guinea
| | - Rebecca Guy
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Andrew J. Vallely
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Angela Kelly-Hanku
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
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French CE, Denford S, Brooks-Pollock E, Wehling H, Hickman M. Low uptake of COVID-19 lateral flow testing among university students: a mixed methods evaluation. Public Health 2022; 204:54-62. [PMID: 35176622 PMCID: PMC8755476 DOI: 10.1016/j.puhe.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate COVID-19 lateral flow testing (LFT) among asymptomatic university students. STUDY DESIGN This study was a mixed methods evaluation of LFT among University of Bristol students. METHODS We conducted (1) an analysis of testing uptake and exploration of demographic variations in uptake using logistic regression; (2) an online student survey about views on university testing; and (3) qualitative interviews to explore participants' experiences of testing and subsequent behaviour, analysed using a thematic approach. RESULTS A total of 12,391 LFTs were conducted on 8025 of 36,054 (22.3%) students. Only one in 10 students had the recommended two tests. There were striking demographic disparities in uptake with those from ethnic minority groups having lower uptake (e.g. 3% of Chinese students were tested vs 30.7% of White students) and variations by level and year of study (ranging from 5.3% to 33.7%), place of residence (29.0%-35.6%) and faculty (15.2%-32.8%). Differences persisted in multivariable analyses. A total of 436 students completed the online survey, and 20 in-depth interviews were conducted. Barriers to engagement with testing included a lack of awareness, knowledge and understanding, and concerns about the accuracy and safety. Students understood the limitations of LFTs but requested further information about test accuracy. Tests were used to inform behavioural decisions, often in combination with other information, such as the potential for exposure to the virus and perceptions of vulnerability. CONCLUSIONS The low uptake of testing brings into question the role of mass LFT in university settings. Innovative strategies may be needed to increase LFT uptake among students.
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Affiliation(s)
- C E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - S Denford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK; School of Psychological Science, University of Bristol, Bristol BS8 1TU, UK.
| | - E Brooks-Pollock
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK; Bristol Veterinary School, University of Bristol, Langford BS40 5DU, UK
| | - H Wehling
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK; Behavioural Science & Insights Unit, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Green MA, García-Fiñana M, Barr B, Burnside G, Cheyne CP, Hughes D, Ashton M, Sheard S, Buchan IE. Evaluating social and spatial inequalities of large scale rapid lateral flow SARS-CoV-2 antigen testing in COVID-19 management: An observational study of Liverpool, UK (November 2020 to January 2021). THE LANCET REGIONAL HEALTH. EUROPE 2021; 6:100107. [PMID: 34002172 PMCID: PMC8114854 DOI: 10.1016/j.lanepe.2021.100107] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Large-scale asymptomatic testing of communities in Liverpool (UK) for SARS-CoV-2 was used as a public health tool for containing COVID-19. The aim of the study is to explore social and spatial inequalities in uptake and case-detection of rapid lateral flow SARS-CoV-2 antigen tests (LFTs) offered to people without symptoms of COVID-19. METHODS Linked pseudonymised records for asymptomatic residents in Liverpool who received a LFT for COVID-19 between 6th November 2020 to 31st January 2021 were accessed using the Combined Intelligence for Population Health Action resource. Bayesian Hierarchical Poisson Besag, York, and Mollié models were used to estimate ecological associations for uptake and positivity of testing. FINDINGS 214 525 residents (43%) received a LFT identifying 5192 individuals as positive cases of COVID-19 (1.3% of tests were positive). Uptake was highest in November when there was military assistance. High uptake was observed again in the week preceding Christmas and was sustained into a national lockdown. Overall uptake were lower among males (e.g. 40% uptake over the whole period), Black Asian and other Minority Ethnic groups (e.g. 27% uptake for 'Mixed' ethnicity) and in the most deprived areas (e.g. 32% uptake in most deprived areas). These population groups were also more likely to have received positive tests for COVID-19. Models demonstrated that uptake and repeat testing were lower in areas of higher deprivation, areas located further from test sites and areas containing populations less confident in the using Internet technologies. Positive tests were spatially clustered in deprived areas. INTERPRETATION Large-scale voluntary asymptomatic community testing saw social, ethnic, digital and spatial inequalities in uptake. COVID-19 testing and support to isolate need to be more accessible to the vulnerable communities most impacted by the pandemic, including non-digital means of access. FUNDING Department of Health and Social Care (UK) and Economic and Social Research Council.
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Affiliation(s)
- Mark A. Green
- Senior Lecturer in Health Geography, Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Marta García-Fiñana
- Professor of Health Data Science, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Professor in Applied Public Health Research, Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Girvan Burnside
- Senior Lecturer in Biostatistics, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Christopher P. Cheyne
- Research Associate, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - David Hughes
- Lecturer in Health Data Science, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Matthew Ashton
- Director of Public Health, Liverpool City Council, Liverpool, UK
| | - Sally Sheard
- Andrew Geddes and John Rankin Professor of Modern History, Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Iain E. Buchan
- Chair in Public Health and Clinical Informatics, Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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5
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Roche R, Simmons R, Logan L, Ledesma J, Sabin C, Ijaz S, Mandal S. Prevalence of hepatitis B immunity and infection in home self-sampling HIV service users. Sex Transm Infect 2021; 98:286-292. [PMID: 34193528 PMCID: PMC9120376 DOI: 10.1136/sextrans-2021-055071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives Although hepatitis B virus (HBV) vaccination for high-risk groups including gay, bisexual and other men who have sex with men (MSM) is recommended in the UK, data on HBV immunisation coverage are limited. This study aimed to understand the prevalence of HBV infection, susceptibility and immunity due to immunisation among a high-risk population of MSM and heterosexuals who are less likely to attend sexual health services. Methods Residual HIV-negative serology samples archived from a national HIV self-sampling service in 2016 were tested for HBV markers using an unlinked anonymous approach. Prevalence of HBV infection, evidence of immunisation and susceptibility were calculated and stratified by individuals’ characteristics. Multinomial logistic regression was used to estimate relative risk ratios (RRRs) associated with covariates. Results Of 2172 samples tested, 1497 (68.9%) were from MSM and 657 (30.2%) were from heterosexuals. Susceptibility to HBV infection was 66.1% among MSM and 77.0% among heterosexuals. Only 29.9% of MSM and 17.4% of heterosexuals had serological evidence of immunisation. Current infection was 1.1% in heterosexuals and 0.2% in MSM. Adjusted analysis showed evidence of immunisation was lower among heterosexuals (RRR 0.66, 95% CI 0.50 to 0.86) and those with no previous HIV test (RRR 0.41, 95% CI 0.31 to 0.54), and higher in those of other white or other ethnicity. Conclusions Among MSM and heterosexual users of a self-sampling HIV service, evidence of immunisation to HBV infection was low and susceptibility to infection was comparatively high, suggesting suboptimal delivery of HBV immunisation in sexual health services.
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Affiliation(s)
- Rachel Roche
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, National Infection Service, Public Health England Colindale, London, UK .,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, NIHR, London, UK
| | - Ruth Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, National Infection Service, Public Health England Colindale, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, NIHR, London, UK
| | - Louise Logan
- Sexual Health, Reproductive Health and HIV, Priorities and Programmes Division, Health Improvement Directorate, Public Health England, London, UK
| | - Juan Ledesma
- Virus Reference Department, National Infection Service, Public Health England Colindale, London, UK
| | - Caroline Sabin
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, NIHR, London, UK.,Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Samreen Ijaz
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, NIHR, London, UK.,Virus Reference Department, National Infection Service, Public Health England Colindale, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, National Infection Service, Public Health England Colindale, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, NIHR, London, UK
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6
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Day S, Khan K, Kelly AM, Jones S, Kinsella R. Characteristics of newly diagnosed HIV-positive service users using a pan-London e-sexually transmitted infection screening service. Int J STD AIDS 2021; 32:1036-1042. [PMID: 33978539 DOI: 10.1177/09564624211014729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Maximising opportunities and removing barriers to HIV testing can help reduce the undiagnosed HIV population. Digital STI/HIV screening services have increased in availability and can improve access and testing coverage. We identified the characteristics of individuals who tested HIV positive using a regional, integrated, self-sampling STI service. The e-notes of service users with reactive HIV screening results were reviewed. Between 8 January 2018 and 31 December 2019, 0.097% (144/148,257) users received a reactive HIV result, 30/144 (20.8%) of whom had previously diagnosed HIV infection. All of the remaining 114 users were notified of their screening result, an estimated 109/114 (95.6%) received confirmatory testing (CT) at a sexual health clinic (SHC) and the confirmatory outcome was documented in 102/114 (89.5%) of cases: 34/114 (29.8%)were HIV positive, 68/114 (59.6%) HIV were negative and the result was unknown in 12/114 (10.5%). All new diagnoses transitioned to HIV outpatient care. These individuals were median age 28 years; 94.1% (32/34) male; 88.2% (30/34) men who have sex with men and 11.8% (4/34) heterosexual; 58.8% (20/34) of white/'white other' ethnicity and 42.2% of Black, Asian and minority ethnic group; 50%(17/34) had a concurrent STI; 9% and 21% had never tested for HIV or attended a SHC before. n HIV test reactivity rate of 0.1%(95% CI) was observed. Confirmed new HIV diagnoses comprised 0.023% of all HIV tests performed. All individuals where CT confirmed a new HIV diagnosis transitioned to HIV specialist care.
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Affiliation(s)
- Sara Day
- 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kaywaan Khan
- 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Adrian M Kelly
- Lead Commissioner Sexual Health e-Service, The City of London Corporation, Guildhall, London, UK
| | - Sophie Jones
- 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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7
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Matovu JKB, Nambuusi A, Wanyenze RK, Serwadda D. Peer-leaders' experiences and challenges in distributing HIV self-test kits in a rural fishing community, Rakai, Uganda. BMC Public Health 2021; 21:708. [PMID: 33845811 PMCID: PMC8042983 DOI: 10.1186/s12889-021-10804-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Distribution of HIV self-test kits by trained lay people in the community has resulted in increased uptake of HIV testing services among the targeted populations. However, little data exists on the experiences and challenges faced by trained lay people while distributing the kits. Methods This qualitative study was conducted in Kasensero fishing community, Rakai, Uganda, in September 2019. We purposely selected 18 out of 34 peer-leaders that participated in a peer-led HIV self-testing intervention to participate in a post-intervention qualitative evaluation. The main intervention included identification and training of lay people in the community (‘peer-leaders’) to distribute HIV self-test kits to pre-selected members of their social network. Data for this study were collected at the end of the intervention. Data were collected on peer-leaders’ experiences in distributing the kits, challenges experienced during distribution and suggestions on how to improve peer-led HIV self-testing in typical fishing communities in the future. Data were analyzed manually following a thematic framework approach. Results Of the 18 peer-leaders, eleven (61.1%) were aged 20–24 years while thirteen (72.2%) had secondary education. Most (n = 15) of the peer-leaders reported that they found it easier to distribute the kits to their social network members, with most of them distributing the kits at the social network members’ homes or at their own homes. HIV self-test kits were distributed at varying times (e.g. in the afternoon) depending on the agreement reached between the peer-leader and their social network member. A few peer-leaders reported that some of their social network members initially hesitated to accept the kits while other peer-leaders reported that they spent a ‘lot of time’ explaining the HIV self-testing procedures to some of their illiterate members. Peer-leaders argued for supervised HIV self-testing for illiterate people and the need to continuously follow-up social network members to check if they tested for HIV. Conclusion A majority of the peer-leaders successfully distributed the kits to their social network members save for a few who experienced challenges. These findings suggest that lay people can be trained as effective HIV self-test kits distributors to improve the distribution of kits in the community. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10804-x.
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Affiliation(s)
- Joseph K B Matovu
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda. .,Busitema University Faculty of Health Sciences, Mbale, Uganda.
| | - Aminah Nambuusi
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - David Serwadda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
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8
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Affiliation(s)
- Catherine Dodds
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Ibidun Fakoya
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Witzel TC, Gabriel MM, McCabe L, Weatherburn P, Gafos M, Speakman A, Pebody R, Burns FM, Bonell C, Lampe FC, Dunn DT, Ward D, Harbottle J, Phillips AN, McCormack S, Rodger AJ. Pilot phase of an internet-based RCT of HIVST targeting MSM and transgender people in England and Wales: advertising strategies and acceptability of the intervention. BMC Infect Dis 2019; 19:699. [PMID: 31391003 PMCID: PMC6686516 DOI: 10.1186/s12879-019-4247-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SELPHI study (An HIV Self-Testing Public Health Intervention) is an online randomised controlled trial (RCT) of HIV self-testing (HIVST). The aim of this study was to assess the feasibility of recruiting UK men who have sex with men (cis and trans) and trans women who have sex with men to the SELPHI pilot, and the acceptability of the HIVST intervention used among those randomised to receive a kit. METHODS A mixed-methods approach to assessing trial feasibility and intervention acceptability was taken, using quantitative data from advertising sources and RCT surveys alongside qualitative data from a nested sub-study. RESULTS Online recruitment and intervention delivery was feasible. The recruitment strategy led to the registration of 1370 participants of whom 76% (1035) successfully enrolled and were randomised 60/40 to baseline testing vs no baseline testing. Advertising platforms performed variably. Reported HIVST kit use increased from 83% at two weeks to 96% at three months. Acceptability was very high across all quantitative measures. Participants described the instructions as easy to use, and the testing process as simple. The support structures in SELPHI were felt to be adequate. Described emotional responses to HIVST varied. CONCLUSIONS Recruiting to a modest sized HIVST pilot RCT is feasible, and the recruitment, intervention and HIVST kit were acceptable. Research on support needs of individuals with reactive results is warranted.
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Affiliation(s)
- T Charles Witzel
- Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | | | | | - Peter Weatherburn
- Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mitzy Gafos
- MRC Clinical Trials Unit at UCL, London, UK.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Fiona M Burns
- Institute for Global Health, UCL, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Chris Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Alison J Rodger
- Institute for Global Health, UCL, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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10
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Young I, Davis M, Flowers P, McDaid LM. Navigating HIV citizenship: identities, risks and biological citizenship in the treatment as prevention era. HEALTH RISK & SOCIETY 2019; 21:1-16. [PMID: 31105468 PMCID: PMC6494283 DOI: 10.1080/13698575.2019.1572869] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs - and bodies - were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.
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Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lisa M McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Dodds C, Mugweni E, Phillips G, Park C, Young I, Fakoya I, Wayal S, McDaid L, Sachikonye M, Chwaula J, Flowers P, Burns F. Correction to: Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study. BMC Public Health 2018; 18:866. [PMID: 30001193 PMCID: PMC6043976 DOI: 10.1186/s12889-018-5775-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
It has been highlighted that in the original article [1] there is a typesetting mistake in the name of I. Fakoya. This was incorrectly captured as F. Fakoya. This correction article clarifies the correct name of the author.
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Affiliation(s)
- C Dodds
- London School of Hygiene and Tropical Medicine, London, UK. .,University of Glasgow, Glasgow, UK.
| | - E Mugweni
- University College London, London, UK
| | - G Phillips
- University of Glasgow, Glasgow, UK.,University of Edinburgh, Edinburgh, UK
| | - C Park
- University of Glasgow, Glasgow, UK
| | - I Young
- University of Glasgow, Glasgow, UK.,University of Edinburgh, Edinburgh, UK
| | - I Fakoya
- University College London, London, UK
| | - S Wayal
- University College London, London, UK
| | - L McDaid
- University of Glasgow, Glasgow, UK
| | - M Sachikonye
- UK Community Advisory Board for HIV and iBase, London, UK
| | | | - P Flowers
- Glasgow Caledonian University, Glasgow, UK
| | - F Burns
- University College London, London, UK
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