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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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Gao B, Wang L, Santella AJ, Zhuang G, Huang R, Xu B, Liu Y, Xiao S, Wang S. HIV testing behaviors and willingness to receive oral rapid HIV testing among dental patients in Xi'an, China. PLoS One 2021; 16:e0248585. [PMID: 33765025 PMCID: PMC7993620 DOI: 10.1371/journal.pone.0248585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction HIV testing is an important strategy for controlling and ultimately ending the global pandemic. Oral rapid HIV testing (ORHT) is an evidence-based strategy and the evidence-based shows is favored over traditional blood tests in many key populations. The dental setting has been found to be a trusted, convenient, and yet untapped venue to conduct ORHT. This study assessed the HIV testing behaviors and willingness to receive ORHT among dental patients in Xi’an, China. Methods A cross-sectional survey of dental patients from Xi’an was conducted from August to September 2017. Dental patients were recruited using a stratified cluster sampling. A 44-item survey was used to measure HIV/AIDS knowledge, HIV testing behaviors, and willingness to receive ORHT. Results Nine hundred and nine dental patients completed the survey with a mean HIV/AIDS knowledge score of 10.7/15 (SD 2.8). Eighty-four participants (9.2%) had previously received an HIV test. Participants would have a high rate of HIV testing if they had higher monthly income (OR = 1.982, 95% CI: 1.251–3.140) and a higher HIV/AIDS knowledge score (OR = 1.137, 95% CI: 1.032–1.252). Five hundred and eighty-two participants (64.0%) were willing to receive ORHT before a dental treatment, 198 (21.8%) were not sure, and 129 (14.2%) were unwilling. Logistic regression showed that age (OR = 0.970, 95% CI: 0.959–0.982), HIV/AIDS knowledge score (OR = 1.087, 95% CI: 1.031–1.145), previous HIV test (OR = 2.057, 95% CI: 1.136–3.723), having advanced HIV testing knowledge (OR = 1.570, 95% CI: 1.158–2.128), and having advanced ORHT knowledge (OR = 2.074, 95%: CI 1.469–2.928) were the factors affecting the willingness to receive ORHT. Conclusions The majority of dental patients had not previously received an HIV test, although many were receptive to being tested in the dental setting. The dental setting as a venue to screen people for HIV needs further exploration, particularly because many people do not associate dentistry with chairside screenings. Increasing awareness of ORHT and reducing testing price can further improve the patient’s willingness to receive ORHT.
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Affiliation(s)
- Bei Gao
- Department of Orthodontics, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
- * E-mail:
| | - Anthony J. Santella
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, New York, United States of America
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Ruizhe Huang
- Department of Preventive Dentistry, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Boya Xu
- Department of Oral Implantology, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yujiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shuya Xiao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shifan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
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Anunsittichai O, Pongpirul K, Puthanakit T, Roowicha K, Kaewprasert J, Songtaweesin WN, Chaithongwongwattana S. Husband's willingness-to-pay for HIV and syphilis screening at antenatal care clinic under the Thai universal coverage scheme. BMC Public Health 2020; 20:480. [PMID: 32276624 PMCID: PMC7149847 DOI: 10.1186/s12889-020-08613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Screening for sexually transmitted infection (STI) especially HIV as early detection and treatment have been financially supported under the Thai Universal Coverage (UC) scheme since 2009 (THB140 for HIV). However, the implementation has not been evidence-based, strategic risk-based, nor economically evaluated whereas husbands who accompanied the pregnant women are likely to have a lower risk than those who did not come along. This study is aimed to determine the husband’s willingness-to-pay (WTP) for his HIV and syphilis screening tests and potential factors affecting STI screenings at the antenatal care (ANC) clinic of a tertiary hospital in Thailand. Methods A pilot open-ended interview was conducted among 50 participants to estimate the mean and standard deviation of WTP prices for HIV and syphilis screening tests. A questionnaire was developed to obtain demographics, STI knowledge and screening history, as well as two contingent valuation methods (bidding and payment scale), using the mean WTP prices identified from the pilot study as a starting WTP with ¼SD step-up/down. The survey of 200 randomly selected husbands of pregnant women was conducted at King Chulalongkorn Memorial Hospital from April to June 2018. Descriptive statistics and logistic regression were used for data analysis. Results During the study period, 597 pregnant women received their first ANC. Of 368 accompanying husbands, 200 were enrolled in the study. Their median age was 31 (IQR 27–36) years old and 67% had a first child. Eighty-eight percent of the participants were willing to test for the STIs. Based on the bidding method, WTP prices for HIV and syphilis screening tests were US$14.5 (IQR 12.4–14.5) and US$9.7 (IQR 10–12), respectively. The payment scale method suggested approximately three-quarters of the WTP prices from the bidding method. Conclusions The husbands who accompanied their pregnant wives to the ANC clinic showed positive behaviors according to the propitious selection theory. They tend to cooperate well with STI testing and are willing to pay at least two times the price of the STI screening tests. The financial support to promote STI screenings should be reconsidered to cover other groups with higher sexual behavior risks and less WTP.
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Affiliation(s)
- Orawan Anunsittichai
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd., Patumwan, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd., Patumwan, Bangkok, Thailand. .,Department of International Health and Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Thanyawee Puthanakit
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Koranit Roowicha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jirarat Kaewprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wipaporn Natalie Songtaweesin
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Surasith Chaithongwongwattana
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Liu Y, Wu G, Lu R, Ou R, Hu L, Yin Y, Zhang Y, Yan H, Zhao Y, Luo Y, Ye M. Facilitators and Barriers Associated with Uptake of HIV Self-Testing among Men Who Have Sex with Men in Chongqing, China: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051634. [PMID: 32138263 PMCID: PMC7084434 DOI: 10.3390/ijerph17051634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/12/2020] [Accepted: 02/29/2020] [Indexed: 12/31/2022]
Abstract
While studies on human immunodeficiency virus self-testing (HIVST) continue to accumulate after the World Health Organization’s recommendation of HIVST as an additional approach to HIV testing services in 2016, few studies have focused on men who have sex with men (MSM) in Chinese cities. A cross-sectional study was conducted to describe the HIVST status of MSM in Chongqing, China. MSM participants were recruited by random sampling, and qualified interviewers collected data, using confidential self-administered questionnaires. Blood specimens were collected for HIV antibody detection. The survey evaluated the uptake and accuracy of HIVST kits and identified factors that may be associated with HIVST. The proportion of HIVST uptake was 15.6%. The sensitivity and specificity of HIVST were 74.2% (95% confidence interval [CI] 66.6%–80.7%) and 99.0% (95% CI 96.9%–99.7%), respectively. The consistency between the HIVST kit and antibody detection results was 90.5% (95% CI 87.5%–93.0%), and the Kappa value was 0.777 (p < 0.001). The positive predictive value of self-testing kits is 80.9% and the negative predictive value is 17.7%. Having been tested ≥2 times in the last year, higher educational levels, and higher scores of basic HIV/AIDS knowledge facilitated higher uptake of HIVST. Self-reported existing barriers for HIVST uptake included older age, marital status, and having resided in Chongqing for more than two years.
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Affiliation(s)
- Ying Liu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.L.); (L.H.); (Y.Z.); (Y.L.)
- The Second Clinical College, Chongqing Medical University, Chongqing 400016, China
| | - Guohui Wu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing 400042, China; (G.W.); (R.L.)
| | - Rongrong Lu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing 400042, China; (G.W.); (R.L.)
| | - Rong Ou
- Department of Medical Informatics, Library, Chongqing Medical University, Chongqing 400016, China;
| | - Ling Hu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.L.); (L.H.); (Y.Z.); (Y.L.)
| | - Yiping Yin
- Mechanical Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.Y.); (H.Y.); (Y.Z.)
| | - Yangchang Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.L.); (L.H.); (Y.Z.); (Y.L.)
| | - Hongjia Yan
- Mechanical Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.Y.); (H.Y.); (Y.Z.)
| | - Yong Zhao
- Mechanical Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.Y.); (H.Y.); (Y.Z.)
| | - Yetao Luo
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.L.); (L.H.); (Y.Z.); (Y.L.)
| | - Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.L.); (L.H.); (Y.Z.); (Y.L.)
- Mechanical Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.Y.); (H.Y.); (Y.Z.)
- Correspondence: ; Tel.: +86-153-1093-9053
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Wang X, Tang Z, Wu Z, Nong Q, Li Y. Promoting oral HIV self-testing via the internet among men who have sex with men in China: a feasibility assessment. HIV Med 2019; 21:322-333. [PMID: 31849177 DOI: 10.1111/hiv.12830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The HIV prevalence among Chinese men who have sex with men (MSM) is high, while the HIV testing rate is low. HIV self-testing (HIVST) is a promising means of scaling up HIV testing among MSM in China, as the ability to test in private is appealing to many individuals. We evaluated the feasibility of promoting oral HIVST via the internet in the MSM population. METHODS From April 2013 to April 2014, MSM in two major cities in China were recruited for an observational study with assessment at baseline and follow-up. Data were collected via questionnaire, oral HIVST, and clinic-based HIV confirmatory testing. RESULTS A total of 510 MSM were recruited at baseline and 279 (54.7%) returned for a clinic follow-up visit. Compared to MSM recruited via peer referral, those recruited via the internet were better educated, had a higher monthly income, sought and met male sex partners online more frequently, had less often tested or orally tested for HIV before, and being more likely to seek HIV knowledge or HIV intervention information online. The sensitivity of oral HIVST among MSM recruited via the internet was 92.9%, and the specificity was 96.8%. A total of 19.0% of MSM sought both male sex partners and HIV intervention programmes online. The associated factors were > 10 past male sex partners and ever testing for HIV using an oral self-test kit. All MSM who were followed up re-administered oral HIVST, yet fewer MSM recruited via the internet accepted blood retesting than other MSM. CONCLUSIONS Promoting oral HIVST via the internet could be a feasible and promising approach to facilitate HIV testing among MSM in China.
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Affiliation(s)
- X Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Z Tang
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Z Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Q Nong
- The Eighth People's Hospital of Nanning, Nanning, China
| | - Y Li
- Fengtai District Center for Disease Control and Prevention, Beijing, China
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Zhu X, Zhang W, Operario D, Zhao Y, Shi A, Zhang Z, Gao P, Perez A, Wang J, Zaller N, Yang C, Sun Y, Zhang H. Effects of a Mobile Health Intervention to Promote HIV Self-testing with MSM in China: A Randomized Controlled Trial. AIDS Behav 2019; 23:3129-3139. [PMID: 30852728 PMCID: PMC6733671 DOI: 10.1007/s10461-019-02452-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study tested a mobile health (mHealth) intervention program entitled WeTest, delivered via the WeChat mobile app, to promote oral HIV self-testing (HIVST) among MSM in Hefei, China. A total of 100 MSM participants enrolled, completed baseline assessment, were randomly assigned to intervention or control, and completed 6-month follow-up surveys. Intervention participants (n = 50) received two oral HIVST kits and access to WeTest, a private WeChat group which provided app-based messages and referrals to health services related to HIV. Control participants (n = 50) received two oral HIVST kits only. All participants received instructions to upload photographic results of their oral HIVST, which were sent to the project counselor via a secure WeChat online portal; immediate contact and referrals were made to any participants who tested HIV-positive. In GEE analyses adjusting for time effects and baseline confounders, intervention participants had significantly higher rates of HIV testing (adjusted rate ratio RR = 1.99, 95% confidence interval (CI) 1.07–3.84) and, in particular, higher rates of testing via oral HIVST (adjusted RR = 2.17, 95% CI 1.08–4.37) compared with the control group. Significant time effects were also found such that all participants, regardless of group allocation, had significantly higher rates of reporting consistent condom use with main partners (adjusted RR = 18.13, 95% CI 5.19–63.31) and with non-main partners (adjusted RR = 5.33, 95% CI 2.35–12.08). Findings from this study provide evidence for the feasibility, acceptability and preliminary effects of this mHealth approach to promoting oral HIVST among MSM in China.
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Fisher DG, Hess KL, Reynolds GL, Alonzo TA, Huckabay LM, Van Otterloo L, Hosmer DW. Comparisons of New HIV Rapid Test Kit Performance. AIDS Behav 2019; 23:313-317. [PMID: 29943123 DOI: 10.1007/s10461-018-2204-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The development of rapid point-of-care tests for HIV infection has greatly reduced the problem of failure to return for test results. Test manufacturers are now developing test kits that can test for two or even three diseases at the same time, multiple-disease test kits. This study reports on the sensitivity and specificity of HIV tests when included on multi-disease test kits. 1029 participants were recruited from 2011 to 2014. HIV test kit sensitivities ranged from 91.1 to 100%, and the HIV test kit specificities from 99.5 to 100%. The two HIV kits which used oral fluid instead of blood performed well.
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Affiliation(s)
- Dennis G Fisher
- Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, CA, USA.
- Department of Psychology, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840, USA.
| | - Kristen L Hess
- Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, CA, USA
| | - Grace L Reynolds
- Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, CA, USA
| | - Todd A Alonzo
- Children's Oncology Group, Department of Preventive Medicine, University of Southern California, Monrovia, CA, USA
| | - Loucine M Huckabay
- School of Nursing, California State University, Long Beach, Long Beach, CA, USA
| | - Lucy Van Otterloo
- School of Nursing, California State University, Long Beach, Long Beach, CA, USA
| | - David W Hosmer
- Department of Mathematics and Statistics, University of Vermont, Stowe, VT, USA
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Flores JA, Brown B, León SR, Sánchez H, Galea JT. Individual-level characteristics associated with oral HIV test acceptability among Peruvian men who have sex with men and transgender women: a cross-sectional study. Sex Transm Infect 2018; 94:528-533. [PMID: 29574465 DOI: 10.1136/sextrans-2017-053388] [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] [Received: 08/30/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Peruvian men who have sex with men (MSM) and transgender women (TGW) are highly vulnerable to HIV infection (HIV), but stigma, access issues and fear of venipuncture hamper testing. The oral HIV test-which uses oral fluids and provides results in 20 minutes-could reduce these barriers. The objective of this study was to determine the acceptability of the oral HIV test and the individual-level factors associated with its acceptability among MSM and TGW. METHODS We conducted a cross-sectional secondary analysis among Peruvian MSM and TGW attending a community-based health centre between February 2012 and February 2013 to determine the individual-level factors associated with oral HIV test acceptability. RESULTS Of 334 participants, 88% were MSM and 12% TGW. Overall, 85% of participants indicated their acceptability of the oral HIV test. Acceptability was higher in MSM than TGW (85.7% vs 80.0%) but this difference was not significant. Factors associated with acceptability in MSM were: tertiary or higher education (prevalence ratio (PR)=1.18, 95% CI 1.06 to 1.32 and PR=1.16, 95% CI 1.03 to 1.30, respectively); sex with drug use (PR=1.19, 95% CI 1.05 to 1.36); believing that HIV is transmitted by saliva (PR=1.20, 95% CI 1.08 to 1.33); and potential use of the oral test at home (PR=1.56, 95% CI 1.32 to 1.85). The only factor associated with lower acceptability was having had first anal intercourse between 14 and 19 years of age (PR=0.89, 95% CI 0.80 to 0.98). CONCLUSIONS We identified the individual factors associated with oral HIV test acceptability among Peruvian MSM and TGW. Expanded use of the oral HIV test to increase testing rates among Peruvian MSM and TGW is recommended. TRIAL REGISTRATION NUMBER NCT01387412, post-results.
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Affiliation(s)
- Juan A Flores
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Perú.,Socios En Salud Sucursal Perú, Lima, Perú
| | - Brandon Brown
- Department of Social Medicine and Population Health, Center for Healthy Communities, University of California, Riverside, California, USA
| | | | | | - Jerome T Galea
- Socios En Salud Sucursal Perú, Lima, Perú.,Epicentro Salud, Lima, Perú.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Xu Y, Chen X, Yu B, Joseph V, Stanton B. The effects of self-efficacy in bifurcating the relationship of perceived benefit and cost with condom use among adolescents: A cusp catastrophe modeling analysis. J Adolesc 2017; 61:31-39. [DOI: 10.1016/j.adolescence.2017.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/11/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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10
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Ren XL, Wu ZY, Mi GD, McGoogan JM, Rou KM, Zhao Y, Zhang N. HIV care-seeking behaviour after HIV self-testing among men who have sex with men in Beijing, China: a cross-sectional study. Infect Dis Poverty 2017; 6:112. [PMID: 28655340 PMCID: PMC5488343 DOI: 10.1186/s40249-017-0326-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) has become the group with the fastest growing HIV epidemic in China. Since many Chinese MSM are conducting HIV self-testing, we aimed to determine the rate of HIV care seeking after self-testing, examine characteristics of "seekers" compared to "non-seekers," and explore factors associated with HIV care-seeking behaviour. METHODS A cross-sectional study design was used and an online survey was conducted in Beijing, China in 2016, among users of a popular Chinese gay networking smart phone application. Chi-square test was used to compare characteristics of those who sought HIV care ("seekers") and those who did not ("non-seekers"). Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking. RESULTS Among 21,785 screened, 2383 participants (10.9%) were included in the study. A total of 380 participants (15.9%) reported seeking HIV care after HIV self-testing while 2003 (84.1%) did not. Lack of knowledge of the "window period" (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [95% CI] = 0.47-0.97, P = 0.04) was associated with reduced odds of seeking HIV care, while lower monthly income (AOR = 1.29, 95% CI = 1.03-1.62, P = 0.03) and obtaining HIV self-testing kits from health facilities (AOR = 2.40, 95% CI = 1.81-3.17, P < 0.001), and non-governmental organizations (AOR = 2.44, 95% CI = 1.79-3.34, P < 0.001) was associated with increased odds of seeking HIV care. Among those who sought HIV care, a large majority (92.4%) had non-reactive HIV self-testing results. Only 29 out of 265 with reactive, uncertain, or unknown results sought HIV care. CONCLUSIONS We found a very low rate of HIV care seeking among our sample of urban Chinese MSM. The observation that most with reactive, uncertain, or unknown results did not seek HIV care is a cause for concern. These people should be paid more attention and helped to enter the care cascade. Our findings highlight that interventions aimed at improving linkage to care after HIV self-testing are urgently needed. However, further study is required to inform the design and implementation of future interventions aiming to encourage HIV care-seeking behaviour.
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Affiliation(s)
- Xian-Long Ren
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Zun-You Wu
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
| | - Guo-Dong Mi
- Office of the Director, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Jennifer M McGoogan
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Ke-Ming Rou
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Yan Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Nanci Zhang
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
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11
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Estem KS, Catania J, Klausner JD. HIV Self-Testing: a Review of Current Implementation and Fidelity. Curr HIV/AIDS Rep 2016; 13:107-15. [PMID: 26879653 DOI: 10.1007/s11904-016-0307-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Oral HIV self-testing is an innovative and potentially high-impact means to increase HIV-case identification globally. As a screening test, oral HIV self-testing offers the potential for increased adoption through greater convenience and privacy, and the potential to increase the proportion of the population who test regularly. Research on how best to translate the innovation of oral self-testing to high-risk populations is underway. Currently only one oral HIV self-test kit is FDA-approved (OraQuick In-Home HIV Test) and available for retail sale. In the present report we review recent studies on the dissemination, adoption, and implementation of oral HIV testing. Prior work has focused primarily on adoption, but recent studies have begun to identify methods for improving dissemination and problems associated with self-implementation. At present a major barrier to wider adoption is the relatively high retail cost of the oral HIV test kit. Significant but minor barriers are represented by overly complex instructional materials for some population segments, and dissemination programs of unknown efficacy. Theoretical and practical suggestions for conducting research on dissemination, adoption, and implementation of oral HIV testing are discussed.
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Affiliation(s)
- Kristecia S Estem
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, WS 21-64, Queens, NY, 11101, USA
| | - Joseph Catania
- Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, 401 Waldo Hall, Corvallis, OR, 97331, USA
| | - Jeffrey D Klausner
- Department of Medicine, Division of Infectious Diseases, UCLA David Geffen School of Medicine and Department of Epidemiology, Fielding School of Public Health, 10920 Wilshire Blvd, Suite #350, Los Angeles, CA, 90024, USA.
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Bien CH, Muessig KE, Lee R, Lo EJ, Yang LG, Yang B, Peeling RW, Tucker JD. HIV and syphilis testing preferences among men who have sex with men in South China: a qualitative analysis to inform sexual health services. PLoS One 2015; 10:e0124161. [PMID: 25875336 PMCID: PMC4395264 DOI: 10.1371/journal.pone.0124161] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 03/13/2015] [Indexed: 11/23/2022] Open
Abstract
Background Health services for men who have sex with men (MSM) are inadequate in many areas around the world. HIV and syphilis test uptake remain suboptimal among MSM in China and many other regions. To inform the development of more comprehensive sexually transmitted disease (STD) testing programs among MSM, we collected descriptive data on MSM testing practices and preferences. Methods MSM in two large urban Chinese cities were recruited through community-based organizations and clinics to participate in semi-structured interviews. We purposively sampled MSM across a range of sociodemographic characteristics and testing history, and assessed preferences for HIV and syphilis testing in the context of facilitators and barriers to testing and previous testing experiences. Each interview transcript was coded and thematically analyzed using Atlas.ti 7.0. Results 35 MSM were interviewed. Confidentiality and privacy were the most important factors influencing participants’ decisions about whether and where to get tested. Men preferred rapid testing (results available within 30 minutes) compared to conventional tests where results take several hours or days to return. Participants described concerns about quality and accuracy of rapid tests offered in non-clinical settings such as community-based organizations. Men preferred testing service providers who were MSM-friendly, non-discriminatory, and medically trained. Preferred service center environments included: convenient but discrete location, MSM-friendly atmosphere, and clean/standard medical facilities. Conclusion Our data highlight the need for HIV/syphilis testing services that are confidential and inclusive of MSM. Rapid testing in decentralized (i.e. peripheral health facilities and community-level, non-clinical venues) settings provides an opportunity to reach individuals who have not been tested before, but must be accompanied by quality assurance systems and technical competence. Implementation research could further evaluate HIV/syphilis testing programs responsive to MSM preferences. Short Summary A qualitative study of MSM in South China found that men preferred rapid STD testing at MSM-focused test centers, but were concerned about test quality assurance and confidentiality.
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Affiliation(s)
- Cedric H. Bien
- University of North Carolina-Project China, Guangzhou, China
- Mount Sinai School of Medicine, New York, United States of America
| | - Kathryn E. Muessig
- University of North Carolina-Project China, Guangzhou, China
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Ramon Lee
- Harvard Medical School, Boston, United States of America
| | - Elaine J. Lo
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Li Gang Yang
- Guangdong Provincial STD Control Center, Guangzhou, China
| | - Bin Yang
- Guangdong Provincial STD Control Center, Guangzhou, China
| | | | - Joseph D. Tucker
- University of North Carolina-Project China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Medicine, University of North Carolina, Chapel Hill, United States of America
- * E-mail:
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Zhao Y, Zhang L, Zhang H, Xia D, Pan SW, Yue H, Lu H, Xing H, He X, Shao Y, Ruan Y. HIV testing and preventive services accessibility among men who have sex with men at high risk of HIV infection in Beijing, China. Medicine (Baltimore) 2015; 94:e534. [PMID: 25674755 PMCID: PMC4602732 DOI: 10.1097/md.0000000000000534] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The HIV epidemic among men who have sex with men (MSM) has been increasing at an alarming rate in most areas of China in recent years. Many Chinese MSM still lack sufficient access to HIV prevention services, despite ongoing scale-up of comprehensive HIV testing and intervention services. The purpose of this study was to investigate utilization of HIV testing and prevention services, and related factors that influence the MSM people to access HIV test or other services to prevent HIV among MSM in Beijing, China.Three successive cross-sectional surveys of MSM were conducted in Beijing from September 2009 to January 2010, September 2010 to January 2011, and September 2011 to January 2012. Demographic and behavioral data were collected and analyzed. Blood samples were tested for HIV and syphilis. Three models were established to analyze factors associated with HIV testing and preventive services.Of the 1312 participants, prevalence of HIV and syphilis was 7.9% and 15.4%, respectively. Sixty-nine percent ever had an HIV test, 56.2%, 78.7%, and 46.1% received HIV test, free condom/lubricants, and sexually transmitted infection services in the past 12 months (P12M), respectively. MSM with larger social networks and who knew someone infected with HIV were more likely to receive HIV testing and preventive services; lower degrees of stigma and discriminatory attitudes toward HIV/AIDS were positively associated with having an HIV test, whereas unprotected anal intercourse in the past 6 months (P6M) was associated with less preventive services participation. The most reported barriers to HIV testing were fear of testing HIV positive (79.3%) and perceiving no risk for HIV (75.4%). Almost all participants felt that ensuring confidentiality would encourage more MSM to have an HIV test. The two main reasons for not seeking HIV test was not knowing where to go for a test (63.2%) and perceiving low risk of HIV infection (55.1%).Given a high prevalence of HIV, syphilis, and risky behaviors and a relatively low HIV testing rate among MSM in Beijing, more efforts are urgently needed to address barriers to HIV testing and improve accessibility of prevention services.
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Affiliation(s)
- Yuejuan Zhao
- From the Beijing Center for Disease Control and Prevention (YZ, LZ, DX, HY, HL, XH); State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China (HZ, HX, YS, YR); The School of Population and Public Health University of British Columbia, Vancouver, BC, Canada (SWP)
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HIV self-testing among online MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr 2015; 67:216-21. [PMID: 24991972 DOI: 10.1097/qai.0000000000000278] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
HIV self-testing offers an alternative to facility-based testing that could expand HIV testing among men who have sex with men (MSM). We organized an online survey of MSM in China to better understand the frequency and correlates of HIV self-testing. A total of 1342 individuals completed the survey. About 20.3% of MSM reported previous HIV self-testing. Self-testing was correlated with being married, having 6 or greater male anal sex partners in the past 3 months, and having HIV tested within 12 months in the multivariable analysis. Our study suggests that HIV self-testing may be able to reach subgroups of high-risk MSM and enable more frequent HIV testing.
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Tao J, Li MY, Qian HZ, Wang LJ, Zhang Z, Ding HF, Ji YC, Li DL, Xiao D, Hazlitt M, Vermund SH, Xiu X, Bao Y. Home-based HIV testing for men who have sex with men in China: a novel community-based partnership to complement government programs. PLoS One 2014; 9:e102812. [PMID: 25051160 PMCID: PMC4106852 DOI: 10.1371/journal.pone.0102812] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/23/2014] [Indexed: 11/18/2022] Open
Abstract
Background The coverage of HIV testing among Chinese men who have sex with men (MSM) remains low after the scale-up of free HIV testing at government-sponsored testing sites. We evaluated the feasibility of home-based HIV self-testing and the willingness to be HIV tested at community-based organizations (CBO). Methods We recruited MSM via on-line advertisement, where they completed an on-line informed consent and subsequent questionnaire survey. Eligible MSM received HIV rapid testing kits by mail, performed the test themselves and reported the result remotely. Results Of the 220 men taking a home-based HIV self-testing, 33 MSM (15%) were seropositive. Nearly 65% of the men reported that they were willing to take HIV testing at CBO, while 28% preferred receiving free HIV testing in the government programs at local Centers for Disease Control and Prevention (CDC). Older and lower-income MSM, those who self-reported homosexual orientation, men with no history of sexually transmitted diseases and a lower number of sexual partners in the past six months were associated with preference for taking HIV testing at CBOs. The top three self-reported existing barriers for HIV testing were: no perception of HIV risk (56%), fear of an HIV positive result being reported to the government (41%), and fear of a positive HIV test result (36%). Conclusion Home-based HIV self-testing is an alternative approach for increasing the coverage of HIV testing among Chinese MSM. CBO-based HIV testing is a potential alternative, but further studies are needed to evaluate its feasibility.
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Affiliation(s)
- Jun Tao
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Ming-ying Li
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail: (H-ZQ); (YB)
| | - Li-Juan Wang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Zheng Zhang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Hai-Feng Ding
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Ya-Cheng Ji
- Heibei Medical University, Shijiazhuang, Hebei, China
| | - Dong-liang Li
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Dong Xiao
- Chaoyang Chinese AIDS Volunteer Group, Beijing, China
| | - Melissa Hazlitt
- Meharry Medical College, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Xiangfei Xiu
- AHF-China Program, AIDS Healthcare Foundation (AHF), Beijing, China
| | - Yugang Bao
- AHF-China Program, AIDS Healthcare Foundation (AHF), Beijing, China
- School of Public Health, Central South University, Changsha, Hunan, China
- * E-mail: (H-ZQ); (YB)
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Marley G, Kang D, Wilson EC, Huang T, Qian Y, Li X, Tao X, Wang G, Xun H, Ma W. Introducing rapid oral-fluid HIV testing among high risk populations in Shandong, China: feasibility and challenges. BMC Public Health 2014; 14:422. [PMID: 24884431 PMCID: PMC4045859 DOI: 10.1186/1471-2458-14-422] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/25/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This study was conducted to ascertain the feasibility of using rapid oral fluid testing as an alternative HIV testing method in China. METHOD This is a mixed-method study among men who have sex with men (MSM), female sex workers (FSW) and VCT clients, conducted in 4 cities in Shandong Province. A pre-tested questionnaire was administered to 1137 participants through face-to-face interview to assess demographic characteristics, HIV testing histories and willingness to accept rapid oral fluid testing. VCT clients were provided with the saliva test kits for a screening test and errors in operation were recorded. Testing results were compared between oral and blood testing. Short feedback questionnaire was administered to 200 FSW who had undergone oral testing. RESULTS The rate of willingness to take oral-fluid HIV testing among MSM, FSW and VCT clients was 72.8%, 72.1% and 67.4% respectively. Common errors recorded during test kit operation by the 229 VCT clients included: unpreparedness, wrong swab sampling, wrong dilution, wrong testing and inability to read test results. Advantages of oral testing listed by participants included: less intrusive, painlessness, easy self- testing and privacy. Disadvantages included perceived unreliable results (55.5%) and not nationally recognised (9%). Comparison of saliva and the blood testing results recorded a consistency rate of 0.970 (χ2 = 153.348, P < 0.001), implying an excellent consistency. CONCLUSION Introduction of oral rapid fluid testing as an alternative HIV testing method in China is highly feasible but with some challenges including low recognition and operation errors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wei Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, #44 West Wenhua Road, Jinan 250012, Shandong Province, PR China.
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HIV prevention services and testing utilization behaviors among men who have sex with men at elevated risk for HIV in Chongqing, China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:174870. [PMID: 24783195 PMCID: PMC3982458 DOI: 10.1155/2014/174870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/05/2013] [Accepted: 12/21/2013] [Indexed: 11/24/2022]
Abstract
Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services.
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Getting to zero HIV deaths: progress, challenges and ways forward. J Int AIDS Soc 2013; 16:18927. [PMID: 24314398 PMCID: PMC3854118 DOI: 10.7448/ias.16.1.18927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/18/2013] [Indexed: 11/12/2022] Open
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Xun H, Kang D, Huang T, Qian Y, Li X, Wilson EC, Yang S, Jiang Z, Gong C, Tao X, Zhang X, Wang G, Song Y, Xu Z, Marley G, Huai P, Ma W. Factors associated with willingness to accept oral fluid HIV rapid testing among most-at-risk populations in China. PLoS One 2013; 8:e80594. [PMID: 24260432 PMCID: PMC3834295 DOI: 10.1371/journal.pone.0080594] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 10/04/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The availability of oral fluid HIV rapid testing provides an approach that may have the potential to expand HIV testing in China, especially among most-a-risk populations. There are few investigations about the acceptability of oral fluid HIV testing among most-at-risk populations in China. METHOD A cross-sectional study with men who have sex with men (MSM), female sex workers (FSW) and voluntary counseling and testing (VCT) clients was conducted in three cities of Shandong province, China from 2011 to 2012. Data were collected by face-to-face questionnaire. RESULTS About 71% of participants were willing to accept the oral fluid HIV rapid testing, and home HIV testing was independently associated with acceptability of the new testing method among MSM, FSW and VCT clients (AOR of 4.46, 3.19 and 5.74, respectively). Independent predictors of oral fluid HIV rapid testing acceptability among MSM were having ever taken an oral fluid HIV rapid test (AOR= 15.25), having ever taken an HIV test (AOR= 2.07), and education level (AOR= 1.74). Engagement in HIV-related risk behaviors (AOR= 1.68) was an independent predictor of acceptability for FSW. Having taken an HIV test (AOR= 2.85) was an independent predictor of acceptability for VCT clients. The primary concern about the oral fluid HIV testing was accuracy. The median price they would pay for the testing ranged from 4.8 to 8.1 U.S. dollars. CONCLUSION High acceptability of oral fluid HIV rapid testing was shown among most-at-risk populations. Findings provide support for oral rapid HIV testing as another HIV prevention tool, and provide a backdrop for the implementation of HIV home testing in the near future. Appropriate pricing and increased public education through awareness campaigns that address concerns about the accuracy and safety of the oral fluid HIV rapid testing may help increase acceptability and use among most-at-risk populations in China.
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Affiliation(s)
- Huanmiao Xun
- School of Public Health, Shandong University, Jinan, China
| | - Dianmin Kang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Tao Huang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Yuesheng Qian
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Xiufang Li
- The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Erin C. Wilson
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Shan Yang
- Yantai Municipal Center for Disease Control and Prevention, Yantai, China
| | - Zhenxia Jiang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Cuihua Gong
- Zibo Municipal Center for Disease Control and Prevention, Zibo, China
| | - Xiaorun Tao
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Xijiang Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Guoyong Wang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Yapei Song
- School of Public Health, Shandong University, Jinan, China
| | - Zhijian Xu
- School of Public Health, Shandong University, Jinan, China
| | - Gifty Marley
- School of Public Health, Shandong University, Jinan, China
| | - Pengcheng Huai
- School of Public Health, Shandong University, Jinan, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
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