Differences in HIV testing and receipt of results between adolescent and non-adolescent women in Uganda

HIV testing among women of reproductive age in 28 sub-Saharan African countries: a multilevel modelling

BACKGROUND

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) remains one of the most significant public health challenges globally, particularly in sub-Saharan Africa (SSA). Although HIV testing is a vital step for both prevention and treatment, its uptake is still low in SSA. We therefore examined HIV testing in SSA and its individual/household and community factors among women of reproductive age groups (15-49 y).

METHODS

Demographic and Health Survey data collected between 2010 and 2020 from 28 SSA countries were used for this analysis. We analysed the coverage of HIV testing and individual/household and community factors on 384 416 women in the reproductive age groups (15-49 y). Bivariate and multivariable multilevel binary logistic regression analysis were conducted to select candidate variables and to identify significant explanatory variables associated with HIV testing and the results were presented using adjusted odd ratios (AORs) at 95% confidence intervals (CIs).

RESULTS

The pooled prevalence of HIV testing among women of reproductive age in SSA was 56.1% (95% CI 53.7 to 58.4), with the highest coverage found in Zambia (86.9%) and the lowest in Chad (6.1%). Age (45-49 y; AOR 0.30 [95% CI 0.15 to 0.62]), women's education level (secondary; AOR 1.97 [95% CI 1.36 to 2.84]) and economic status (richest; AOR 2.78 [95% CI 1.40 to 5.51]) were some of the individual/household factors associated with HIV testing. Similarly, religion (no religion; AOR 0.58 [95% CI 0.34 to 0.97]), marital status (married; AOR 0.69 [95% CI 0.50 to 0.95]) and comprehensive knowledge of HIV (yes; AOR 2.01 [95% CI 1.53 to 2.64]) were significantly associated individual/household factors for HIV testing. Meanwhile, place of residence (rural; AOR 0.65 [95% CI 0.45 to 0.94]) was found to be a significant community-level factor.

CONCLUSION

More than half of married women in SSA have been tested for HIV, with between-country variations. Both individual/household factors were associated with HIV testing. Stakeholders should therefore consider all above-mentioned factors to plan an integrated approach to enhancing HIV testing through health education, sensitization, counselling and empowering older and married women, those with no formal education, those who do not have comprehensive HIV/AIDS knowledge and those in rural areas.

“By the time they run into the hospital, their life is already at stake”: a qualitative study of healthcare professional perceptions on priorities for cervical cancer policy in Uganda

Background

Cervical cancer (CxCa) incidence in Uganda is three times the global average and a leading cause of mortality for women. While there is funding and infrastructure to support HIV control in Uganda, these are not in place for CxCa prevention and control. This study was conducted to explore the knowledge and perceptions of HIV professionals in Uganda to identify perceived barriers and facilitators to CxCa screening and treatment among women living with HIV (WLHIV) as a basis to guide and inform policies and programs for CxCa prevention and control, including service integration.

Methods

This study used qualitative interviews to obtain primary data from professionals working in the HIV field in Uganda conducted from September 2020 to January 2022. Participants were identified through purposive and snowball sampling and consulted with colleagues at local service and academic agencies in Kampala. Both written and verbal informed consent was obtained. Hour-long interviews were conducted virtually and in person and recorded. Interviews consisted of open-ended questions exploring perspectives on, knowledge about, and practices surrounding HPV and CxCa among WLHIV in Uganda. Transcripts were analyzed and coded via MAXQDA software to identify facilitators and barriers to HPV vaccination, CxCa screening and treatment.

Results

Fifty key informant (KI) interviews were conducted. Analysis revealed two themes regarding priorities for cervical cancer policy in Uganda after KIs reflected on improving barriers to CxCa care. These were: (1) decentralization of care through integration of services and (2) leadership on a national level by increasing funding and organizing advocacy initiatives. Practical recommendations identified by KI that derived from these themes included leveraging community institutions and mass media campaigns to target misconceptions surrounding screening, making CxCa screening opt-out and integrated with HIV care, strengthening a centralized database, organizing mass roll-out of self-testing, and organizing training of healthcare workers.

Conclusions

Key informants call for solutions that address individual, community, and national barriers of cervical cancer care and emphasize the need for a strong national cervical cancer policy to coordinate currently fragmented services and the political will to adequately fund these.

The first 90: the gateway to prevention and care: opening slowly, but not for all

PURPOSE OF REVIEW

Knowledge of HIV status is the gateway to HIV treatment and prevention, and optimizing this pillar is essential to bend the curve of the HIV epidemic toward zero new infections. This review will discuss the epidemiology of serostatus awareness, including disparities among key populations, and explore interventions and societal barriers.

RECENT FINDINGS

Rates of serostatus awareness have improved overall; however, progress is lagging in many regions, nations and populations, with substantial disparities seen among key populations. These populations and their partners now contribute the majority of new infections, fueling the epidemic. Data support a variety of interventions that have demonstrated effectiveness in increasing new diagnoses, particularly among underserved populations. Structural and societal barriers such as stigma, discriminatory laws and policies, and social determinants of health disproportionately affect key populations, and these must be addressed to achieve equity and end the epidemic.

SUMMARY

According to United Nations Programme on HIV/AIDS (UNAIDS), the pace of progress toward epidemic control has slowed. Achieving substantial increases in serostatus awareness to meet 2020 and 2030 UNAIDS goals will require attacking complex societal barriers while bringing evidence-based interventions to scale in each nation and key population. A robust advocacy effort is now needed as political will and funding wane.