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Sabo KG, Seifu BL, Kase BF, Asebe HA, Asmare ZA, Asgedom YS, Shibeshi AH, Tebeje TM, Lombebo AA, Fente BM, Mare KU. Factors influencing HIV testing uptake in Sub-Saharan Africa: a comprehensive multi-level analysis using demographic and health survey data (2015-2022). BMC Infect Dis 2024; 24:821. [PMID: 39138418 PMCID: PMC11320845 DOI: 10.1186/s12879-024-09695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) is a global health concern, causing over 35 million deaths, with 97% occurring in developing nations, particularly impacting Sub-Saharan Africa. While HIV testing is crucial for early treatment and prevention, existing research often focuses on specific groups, neglecting general adult testing rates. This study aims to identify predictors of HIV testing uptake among adults in Sub-Saharan Africa. METHOD Data were obtained from the official Demographic and Health Survey program database, which used a multistage cluster sampling technique to collect the survey data. In this study, a weighted sample of 283,936 adults was included from thirteen Sub-Saharan African countries. Multilevel multivariable logistic regression analysis was employed to identify predictors of HIV testing uptake. Akaike's information criteria guided model selection. Adjusted odds ratios and corresponding 95% confidence intervals determined significant predictor variables. RESULT Among adults in Sub-Saharan African countries, the prevalence of HIV testing uptake was 65.01% [95% CI (64.84%, 65.17%)]. Influential factors included male sex [AOR: 0.51, 95% CI (0.49,0.53)], varying odds ratios across age groups (20-24 [AOR: 3.3, 95% CI (3.21, 3.46) ], 25-29 [AOR: 4.4, 95% CI (4.23, 4.65)], 30-34 [AOR: 4.6, 95%CI (4.40, 4.87)], 35-39 [AOR: 4.0, 95%CI (3.82, 4.24)], 40-44 [AOR: 3.7, 95%CI (3.50, 3.91)], 45-49 [AOR: 2.7, 95%CI (2.55, 2.87)], 50+ [AOR: 2.7, 95%CI (2.50, 2.92)]), marital status (married [AOR: 3.3, 95%CI (3.16, 3.46)], cohabiting [AOR: 3.1, 95% CI (2.91, 3.28)], widowed/separated/divorced [AOR: 3.4, 95%CI (3.22, 3.63)]), female household headship (AOR: 1.28, 95%CI (1.24, 1.33)), education levels (primary [AOR: 3.9, 95%CI (3.72, 4.07)], secondary [AOR: 5.4, 95%CI (5.16, 5.74)], higher [AOR: 8.0, 95%CI (7.27, 8.71)]), media exposure (AOR: 1.4, 95%CI (1.32, 1.43)), wealth index (middle [AOR: 1.20, 95%CI (1.17, 1.27)], richer [AOR: 1.50, 95%CI (1.45, 1.62)]), Having discriminatory attitudes towards PLWHIV [AOR: 0.4; 95% CI (0.33, 0.37)], had multiple sexual partners [AOR: 1.2; 95% CI (1.11, 1.28)], had comprehensive knowledge about HIV [AOR: 1.6; 95% CI (1.55, 1.67)], rural residence (AOR: 1.4, 95%CI (1.28, 1.45)), and lower community illiteracy (AOR: 1.4, 95%CI (1.31, 1.50)) significantly influenced HIV testing uptake in the region. CONCLUSION This study highlights the need for tailored interventions to address disparities in HIV testing uptake among adults in Sub-Saharan Africa and progress towards the achievement of 95-95-95 targets by 2030. Thus, tailored interventions addressing key factors are crucial for enhancing testing accessibility and emphasizing awareness campaigns, easy service access, and targeted education efforts to improve early diagnosis, treatment, and HIV prevention in the region.
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Affiliation(s)
- Kebede Gemeda Sabo
- Department of Nursing, College of Health Sciences, Samara University, Afar, 132, Ethiopia.
| | - Beminate Lemma Seifu
- Department of Public Health, College of Health Sciences, Samara University, Afar, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Health Sciences, Samara University, Afar, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, College of Health Sciences, Samara University, Afar, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Afar, Ethiopia
| | - Tsion Mulat Tebeje
- School Of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Afework Alemu Lombebo
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Health Sciences, Samara University, Afar, 132, Ethiopia
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Niazi AG, Ahmed N, Kifayat S, Kifayat S, Niazi MA, Khan MS. Urban Churches Show an Increase in Attendance, Donations, and Finances During the COVID-19 Pandemic in the USA: Evidence from the United Methodist Church. JOURNAL OF RELIGION AND HEALTH 2024; 63:3206-3232. [PMID: 38709431 PMCID: PMC11319417 DOI: 10.1007/s10943-024-02046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/07/2024]
Abstract
The COVID-19 pandemic has had a significant impact on religion and its practice. This paper aims to examine how the pandemic affects religious activities, donations, and finances over time and across regions within the United Methodist Church (UMC) in the USA. To address this question, we analyze survey data collected during the pandemic from 2963 churches in the USA by United Methodist Communications. Our analysis utilizes several quantitative techniques, including Z-tests, one-way analysis of variance (ANOVA), and multinomial logistic regressions. The results indicate a decrease in church attendance over time, with a more pronounced effect observed in non-urban areas (suburban, small town, and rural). Similarly, while church donations and finances mitigate over time across churches, churches in urban areas experience a quicker rebound compared to those in non-urban areas. Lastly, we find that church attendance and donations positively affect finances. These findings hold important implications for churches in various regions, offering insights to develop strategies for navigating the challenges posed by the COVID-19 pandemic.
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Affiliation(s)
- Anum G Niazi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Shandana Kifayat
- Khyber Teaching Hospital, Khyber Medical University, Peshawar, Pakistan
| | | | | | - Muhammad Salar Khan
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA.
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Adu C, Adzigbli LA, Cadri A, Yeboah PA, Mohammed A, Aboagye RG. HIV testing and counselling among women in Benin: a cross-sectional analysis of prevalence and predictors from demographic and health survey data. BMJ Open 2023; 13:e068805. [PMID: 37055209 PMCID: PMC10106027 DOI: 10.1136/bmjopen-2022-068805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE To examine the uptake of HIV testing and counselling (HTC) and its associated factors among women in Benin. DESIGN We performed a cross-sectional analysis of data from the 2017-2018 Benin Demographic and Health Survey. A weighted sample of 5517 women was included in the study. We used percentages to present the results of the uptake of HTC. Multilevel binary logistic regression analysis was used to examine the predictors of HTC uptake. The results were presented using adjusted odds ratios (aORs), with 95% confidence intervals (CIs). SETTING Benin. PARTICIPANTS Women aged 15-49. OUTCOME MEASURE Uptake of HTC. RESULTS The overall uptake of HTC among women in Benin was found to be 46.4% (44.4%-48.4%). The odds of HTC uptake was higher among women covered by health insurance (aOR 3.04, 95% CI 1.44 to 6.43) and those with comprehensive HIV knowledge (aOR 1.77, 95% CI 1.43 to 2.21). The odds of HTC uptake increased with increasing level of education, with the highest odds among those in the secondary or higher level (aOR 2.06, 95% CI 1.64 to 2.61). Also, the age of the women, mass media exposure, region of residence, high community literacy level, and high community socioeconomic status were associated with higher odds of HTC uptake. Women residing in rural areas were less likely to use HTC. Religious affiliation, number of sexual partners, and place of residence were associated with lower odds of HTC uptake. CONCLUSION Our study has shown that the uptake of HTC among women in Benin is relatively low. There is a need to enhance efforts to empower women, as well as reduce health inequities as they all have a substantial impact on HTC uptake among women in Benin, taking into consideration the factors identified in this study.
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Affiliation(s)
- Collins Adu
- College of Public Health, Medical and Veterniary Sciences, James Cook University, Townsville, Queensland, Australia
- Center for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Leticia Akua Adzigbli
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Abdul Cadri
- Department of Social and Behavioural Science, University of Ghana, Legon, Ghana
- Department of Family Medicine, McGill University Montreal, Montréal, Quebec, Canada
| | - Paa Akonor Yeboah
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Aliu Mohammed
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Men's Endorsement of Intimate Partner Violence and HIV Testing Behavior Across Sub-Saharan Africa. AIDS Behav 2023; 27:454-461. [PMID: 36048291 DOI: 10.1007/s10461-022-03780-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
Despite an upward trend in HIV testing across sub-Saharan Africa, men continue to lag women in the use of HIV testing services. Inequitable gender attitudes held by some men may be implicated in their suboptimal HIV testing behaviors. We sought to ascertain the relationship between men?s endorsement of intimate partner violence (IPV), which is one manifestation of inequitable gender attitudes, and their lifetime and recent HIV testing, using nationally representative Demographic and Health Survey data from 23 sub-Saharan African countries. In a pooled analysis, we found that a unit increase in the IPV index scale is associated with 8% lower odds of lifetime HIV testing, and 6% lower odds of recent HIV testing. The strength of this relationship, however, varied across countries and regions. Our findings suggest that efforts to increase men?s HIV testing in the region should address the inequitable gender attitudes underpinning men?s endorsement of IPV, but that it is important to consider contextual variation.
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Schwitters A, McCracken S, Frederix K, Tierney R, Koto M, Ahmed N, Thin K, Dobbs T, Sithole S, Letsie M, Parekh B, Patel H, Birhanu S, Wiesner L, Low A. High HIV prevalence and associated factors in Lesotho: Results from a population-based survey. PLoS One 2022; 17:e0271431. [PMID: 35901094 PMCID: PMC9333200 DOI: 10.1371/journal.pone.0271431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Despite extensive global efforts, sub-Saharan Africa remains disproportionately affected by the HIV epidemic. This generalized epidemic can be seen in Lesotho which in 2014 the HIV prevalence rate of those aged 15-49 years was 24.6%, with and incidence of 1.9 new infections per 100-person-year exposures. To better understand the impact of Lesotho's national HIV response and significant predictors associated with HIV infection, the Lesotho Population-based HIV Impact Assessment was conducted. This survey provided a nationally representative sample of individuals aged 15-59 years old in which participants were tested for HIV and given an individual questionnaire that included socio-demographic and behavioral risk questions. The association of factors between survey questions and HIV incident was assessed using logistic regression. Multivariate logistic regression models for men and women were constructed for each outcome using variables known to be or plausibly associated with recent or chronic infection. Overall annualized incidence among people aged 15-49 was 1.19% (95% CI 0.73-1.65) per year. The overall prevalence of HIV was 25.6% with women having significantly higher prevalence. Multiple variables, including decreased wealth status, lower education levels, marital status, condom use at first sex, and circumcision (men only) were identified as being significantly associated with HIV infection for both men and women. In combination with improving the awareness of HIV status, an increased focus is needed on AGYW and men 35-49 years old to prevent new infections. HIV education and prevention programs should focus heavily on younger age groups prior to and soon after sexual debut to prevent HIV transmission. The findings of the survey showed significant room for improvement in increasing awareness of HIV status and reinforcing the need for continued HIV prevention and treatment efforts in Lesotho to prevent new infections.
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Affiliation(s)
| | - Stephen McCracken
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Koen Frederix
- ICAP in Lesotho, Mailman School of Public Health, Columbia University, Maseru, Lesotho
| | - Reese Tierney
- School of Public Health at Georgia State University, Atlanta, GA, United States of America
| | | | - Nahima Ahmed
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Kyaw Thin
- Lesotho Ministry of Health, Maseru, Lesotho
| | - Trudy Dobbs
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Sakhile Sithole
- ICAP in Lesotho, Mailman School of Public Health, Columbia University, Maseru, Lesotho
| | | | - Bharat Parekh
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Hetal Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Sehin Birhanu
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Pachena A, Musekiwa A. Trends in HIV Testing and Associated Factors among Adolescent Girls and Young Women in Zimbabwe: Cross-Sectional Analysis of Demographic and Health Survey Data from 2005 to 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5165. [PMID: 35564557 PMCID: PMC9104385 DOI: 10.3390/ijerph19095165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 01/27/2023]
Abstract
Adolescent girls and young women (AGYW), aged 15−24 years, experience higher HIV incidence compared to their male counterparts, especially in sub-Saharan Africa (SSA), where the HIV burden is highest. This study determined trends in self-reported HIV testing and associated factors among AGYW in Zimbabwe using the Zimbabwe DHS datasets for 2005/6, 2010/11, and 2015. The proportion of adolescents aged 15−19 years who had ever tested for HIV increased from 14.7% in 2005/6 to 26.5% in 2010/11 and 47.9% in 2015. Among young women, aged 20−24 years, the proportion increased from 34.8% in 2005/6 to 68.7% in 2010/11 and 84.8% in 2015. The odds of ever having an HIV test were significantly higher for those with a higher education (adjusted odds ratio [aOR] 12.49, 95% CI: 2.69 to 57.92, p = 0.001), comprehensive HIV knowledge (aOR 1.91, 95% CI: 1.31 to 2.78, p = 0.001), knowledge about mother-to-child transmission (MTCT) (aOR 2.09, 95% CI: 1.55 to 2.82, p < 0.001), non-discriminatory attitudes (aOR 1.60, 95% CI: 1.12 to 2.28, p = 0.010), three or more lifetime sexual partners (aOR 2.0, 95% CI: 1.09 to 3.66, p = 0.025), and a history of pregnancy (aOR 6.08, 95% CI: 4.22 to 8.75, p < 0.001). There is need to scale-up programmes targeting AGYW.
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Affiliation(s)
- Abgail Pachena
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa;
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Truong HHM, Guzé MA, Ouma D, Bushman D, Mocello AR, Kadede K, Bukusi EA, Odhiambo F, Cohen CR. Community-Based HIV Testing for Urban Youth in Western Kenya. AIDS Behav 2022; 26:814-821. [PMID: 34518938 PMCID: PMC10643049 DOI: 10.1007/s10461-021-03441-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
Youth aged 15-24 years comprise 48% of new HIV infections and 15% of persons living with HIV in Kisumu County, Kenya. We assessed factors associated with HIV infection among youth participating in the Community Health Initiative (CHI) implemented in an urban informal settlement in 2018. Predictors of HIV infection were assessed by multivariable logistic regression. CHI engaged 4,441 youth through community health campaigns and home-based HIV testing. HIV prevalence was 3.5% overall and 7.1% among young women aged 20-24. There were 24 youth newly identified as HIV-positive out of 157 total HIV-positive youth. HIV-positive status was positively associated with being female (aOR = 2.46; 95% CI 1.57, 3.84) and aged 20-24 (aOR = 2.40; 95% CI 1.52, 3.79), and inversely associated with secondary school education or higher (aOR = 0.27; 95% CI 0.16, 0.44). Our findings highlight the need for HIV prevention programs specially tailored for youth to further reduce new HIV infections in this priority population.
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Affiliation(s)
- Hong-Ha M Truong
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA.
| | - Mary A Guzé
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
| | - David Ouma
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Dena Bushman
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
| | - A Rain Mocello
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
| | | | - Elizabeth A Bukusi
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Craig R Cohen
- Department of Medicine, University of California, 550 16th Street 3rd Floor, San Francisco, CA, 94158, USA
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Predictors of HIV testing among youth aged 15–24 years in The Gambia. PLoS One 2022; 17:e0263720. [PMID: 35180256 PMCID: PMC8856544 DOI: 10.1371/journal.pone.0263720] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Worldwide, an estimated 38.0 million people lived with the human immunodeficiency virus in 2019, and 3.4 million young people aged 15~24 years were living with HIV. Sub-Saharan Africa carries a significant HIV burden with West and Central Africa most affected with HIV. Among the young people living with HIV in West and Central Africa, an estimated 810,000 were aged 15~24 years. This study aimed to assess predictors that influence the uptake of HIV testing among youth aged 15~24 years in The Gambia.
Methods
The 2013 Gambia Demographic and Health Survey data for youth aged 15~24 years was used. The Andersen behavioral model of health service use guided this study. A cross-sectional study design was used on 6194 subjects, among which 4730 were female. The analysis employed Chi-squared tests and hierarchical logistic regression.
Results
Less than one-quarter of the youth 1404 (22.6%) had ever been tested for HIV. Young people aged 20~24 years (adjusted odds ratio (aOR): 1.98), who were females (aOR: 1.13), married youth (aOR: 3.89), with a primary (aOR: 1.23), secondary or higher education (aOR: 1.46), and who were from the Jola/Karoninka ethnic group (aOR: 1.81), had higher odds of having been tested for HIV. Those with adequate HIV knowledge and those who were sexually active and had aged at first sex ≥15 years (aOR: 3.99) and those <15 years (aOR: 3.96) were more likely to have been tested for HIV compared to those who never had sex.
Conclusion
This study underscores the low level of model testing on HIV testing among youth (15~24 years) in The Gambia. Using Anderson’s Model of Health Service Utilization, the predisposing factors (socio-demographic and HIV knowledge) and the need-for-care factors (sexual risk behaviors) predict healthcare utilization services (HIV testing) in our study; however, only socio-demographic model explained most of the variance in HIV testing. The low effect of model testing could be related to the limited number of major variables selected for HIV knowledge and sexual risk behavior models. Thus, consideration for more variables is required for future studies.
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Agutu CA, Oduor TH, Hassan AS, Mugo PM, Chege W, de Wit TFR, Sanders EJ, Graham SM. Predictors of testing history and new HIV diagnosis among adult outpatients seeking care for symptoms of acute HIV infection in coastal Kenya: a cross-sectional analysis of intervention participants in a stepped-wedge HIV testing trial. BMC Public Health 2022; 22:280. [PMID: 35148720 PMCID: PMC8832653 DOI: 10.1186/s12889-022-12711-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background HIV testing is the first step to stop transmission. We aimed to evaluate HIV testing history and new diagnoses among adult outpatients in Kenya aged 18–39 years seeking care for symptoms of acute HIV infection (AHI). Methods The Tambua Mapema Plus study, a stepped-wedge trial, enrolled patients presenting to care at six primary care facilities with symptoms of AHI for a targeted HIV-1 nucleic acid (NA) testing intervention compared with standard provider-initiated testing using rapid antibody tests. Intervention participants underwent a questionnaire and NA testing, followed by rapid tests if NA-positive. Multinomial logistic regression was used to analyse factors associated with never testing or testing > 1 year ago (“late retesting”) relative to testing ≤ 1 year ago (“on-time testers”). Logistic regression was used to analyse factors associated with new diagnosis. All analyses were stratified by sex. Results Of 1,500 intervention participants, 613 (40.9%) were men. Overall, 250 (40.8%) men vs. 364 (41.0%) women were late retesters, and 103 (16.8%) men vs. 50 (5.6%) women had never tested prior to enrolment. Younger age, single status, lower education level, no formal employment, childlessness, sexual activity in the past 6 weeks, and > 1 sexual partner were associated with testing history among both men and women. Intimate partner violence > 1 month ago, a regular sexual partner, and concurrency were associated with testing history among women only. New diagnoses were made in 37 (2.5%) participants (17 men and 20 women), of whom 8 (21.6%) had never tested and 16 (43.2%) were late retesters. Newly-diagnosed men were more likely to have symptoms for > 14 days, lower education level and no religious affiliation and less likely to be young, single, and childless than HIV-negative men; newly-diagnosed women were more likely to report fever than HIV-negative women. Among men, never testing was associated with fivefold increased odds (95% confidence interval 1.4–20.9) of new diagnosis relative to on-time testers in adjusted analyses. Conclusion Most new HIV diagnoses were among participants who had never tested or tested > 1 year ago. Strengthening provider-initiated testing targeting never testers and late retesters could decrease time to diagnosis among symptomatic adults in coastal Kenya. Trial registration ClinicalTrials.gov Identifier: NCT03508908 registered on 26/04/2018.
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Affiliation(s)
- Clara A Agutu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Tony H Oduor
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Amin S Hassan
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peter M Mugo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Wairimu Chege
- Prevention Sciences Program, Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, MD, USA
| | - Tobias F Rinke de Wit
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Susan M Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, USA
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Rotsaert A, Sibanda E, Hatzold K, Johnson C, Corbett E, Neuman M, Cowan F. Did you hear about HIV self-testing? HIV self-testing awareness after community-based HIVST distribution in rural Zimbabwe. BMC Infect Dis 2022; 22:51. [PMID: 35027000 PMCID: PMC8895763 DOI: 10.1186/s12879-022-07027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Several trials of community-based HIV self-testing (HIVST) provide evidence on the acceptability and feasibility of campaign-style distribution to reach first-time testers, men and adolescents. However, we do not know how many remain unaware of HIVST after distribution campaigns, and who these individuals are. Here we look at factors associated with never having heard of HIVST after community-based campaign-style HIVST distribution in rural Zimbabwe between September 2016 and July 2017. METHODS Analysis of representative population-based trial survey data collected from 7146 individuals following community-based HIVST distribution to households was conducted. Factors associated with having never heard of HIVST were determined using multivariable mixed-effects logistic regression adjusted for clustered design. RESULTS Among survey participants, 1308 (18.3%) self-reported having never heard of HIVST. Individuals who were between 20 and 60 years old {20-29 years: [aOR = 0.74, 95% CI (0.58-0.95)], 30-39 years: [aOR = 0.56, 95% CI (0.42-0.74)], 40-49 years: [aOR = 0.50, 95% CI (0.36-0.68)], 50-59 years [aOR = 0.58, 95% CI (0.42-0.82)]}, who had attained at least ordinary level education [aOR = 0.51, 95% CI (0.34-0.76)], and who had an HIV test before [aOR = 0.30, 95% CI (0.25-0.37)] were less likely to have never heard of HIVST compared with individuals who were between 16 and 19 years old, who had a lower educational level and who had never tested for HIV before, respectively. In addition, non-household heads or household head representatives [aOR = 1.21, 95% CI (1.01-1.45)] were more likely to report never having heard of HIVST compared to household head and representatives. CONCLUSIONS Around one fifth of survey participants remain unaware of HIVST even after an intensive community-based door-to-door HIVST distribution. Of note, those least likely to have heard of self-testing were younger, less educated and less likely to have tested previously. Household heads appear to play an important role in granting or denying access to self-testing to other household members during door-to-door distribution. Differentiated distribution models are needed to ensure access to all. Trial registration PACTR, PACTR201607001701788. Registered 29 June 2016, https://pactr.samrc.ac.za/ PACTR201607001701788.
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Affiliation(s)
- Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Euphemia Sibanda
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Department of Clinical Research and Infection Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Corbett
- Department of Clinical Research and Infection Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Neuman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, UK
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11
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Kranzer K, Simms V, Dauya E, Olaru ID, Dziva Chikwari C, Martin K, Redzo N, Bandason T, Tembo M, Francis SC, Weiss HA, Hayes RJ, Mavodza C, Apollo T, Ncube G, Machiha A, Ferrand RA. Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study. BMC Infect Dis 2021; 21:1234. [PMID: 34879820 PMCID: PMC8653586 DOI: 10.1186/s12879-021-06937-4] [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: 09/18/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND : Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common bacterial sexually transmitted infections (STIs) worldwide. In the absence of affordable point-of-care STI tests, WHO recommends STI testing based on risk factors. This study aimed to develop a prediction tool with a sensitivity of > 90% and efficiency (defined as the percentage of individuals that are eligible for diagnostic testing) of < 60%. METHODS This study offered CT/NG testing as part of a cluster-randomised trial of community-based delivery of sexual and reproductive health services to youth aged 16-24 years in Zimbabwe. All individuals accepting STI testing completed an STI risk factor questionnaire. The outcome was positivity for either CT or NG. Backwards-stepwise logistic regression was performed with p ≥ 0.05 as criteria for exclusion. Coefficients of variables included in the final multivariable model were multiplied by 10 to generate weights for a STI risk prediction tool. A maximum likelihood Receiver Operating Characteristics (ROC) model was fitted, with the continuous variable score divided into 15 categories of equal size. Sensitivity, efficiency and number needed to screen were calculated for different cut-points. RESULTS From 3 December 2019 to 5 February 2020, 1007 individuals opted for STI testing, of whom 1003 (99.6%) completed the questionnaire. CT/NG prevalence was 17.5% (95% CI 15.1, 19.8) (n = 175). CT/NG positivity was independently associated with being female, number of lifetime sexual partners, relationship status, HIV status, self-assessed STI risk and past or current pregnancy. The STI risk prediction score including those variables ranged from 2 to 46 with an area under the ROC curve of 0.72 (95% CI 0.68, 0.76). Two cut-points were chosen: (i) 23 for optimised sensitivity (75.9%) and specificity (59.3%) and (ii) 19 to maximise sensitivity (82.4%) while keeping efficiency at < 60% (59.4%). CONCLUSIONS The high prevalence of STIs among youth, even in those with no or one reported risk factor, may preclude the use of risk prediction tools for selective STI testing. At a cut-point of 19 one in six young people with STIs would be missed.
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Affiliation(s)
- Katharina Kranzer
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe. .,Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany.
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe.,MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ioana D Olaru
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Kevin Martin
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Nicol Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe.,MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Gertrude Ncube
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rashida Abbas Ferrand
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
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12
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Patel HK, Duong YT, Birhanu S, Dobbs T, Lupoli K, Moore C, Detorio M, Sleeman K, Manjengwa J, Wray-Gordon F, Yavo D, Jackson K, Domaoal RA, Yufenyuy EL, Vedapuri S, Ndongmo CB, Ogollah FM, Dzinamarira T, Rubinstein P, Sachathep KK, Metz M, Longwe H, Saito S, Brown K, Voetsch AC, Parekh BS. A Comprehensive Approach to Assuring Quality of Laboratory Testing in HIV Surveys: Lessons Learned From the Population-Based HIV Impact Assessment Project. J Acquir Immune Defic Syndr 2021; 87:S17-S27. [PMID: 34166309 DOI: 10.1097/qai.0000000000002702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.
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Affiliation(s)
- Hetal K Patel
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Sehin Birhanu
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Trudy Dobbs
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Kathryn Lupoli
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Carole Moore
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Mervi Detorio
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Katrina Sleeman
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Floris Wray-Gordon
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Daniel Yavo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Keisha Jackson
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Robert A Domaoal
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Ernest L Yufenyuy
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Shanmugam Vedapuri
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Clement B Ndongmo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | | | | | | | | | | | | | - Kristin Brown
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Andrew C Voetsch
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Bharat S Parekh
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
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13
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Sukartini T, Nursalam N, Arifin H. The determinants of willingness to care for people living with HIV-AIDS: A cross-sectional study in Indonesia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:809-817. [PMID: 33639031 DOI: 10.1111/hsc.13318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
Acceptance and willingness to care for people living with HIV-AIDS (PLHA) in society is still a concern. The purpose of this study is to analyse the determinants of willingness to care for PLHA in Indonesia. A cross-sectional study was conducted to process the secondary data from the Indonesian Demographic Health Survey (IDHS) conducted in 2017. A total sample of 13,731 individuals was obtained by a two-stage stratified cluster sampling technique. The variables used were socioeconomic characteristics (age, sex, education, wealth quintile, residence, employment status and earnings), knowledge about HIV-AIDS, information about HIV-AIDS and willingness to care for PLHA. Binary logistic regressions were used to analyse the data. According to the data from IDHS 2017, 71.84% of total respondents in Indonesia are willing to care for PLHA. Female respondents, individuals in all wealth quintiles and those who have more information are more likely to care for PLHA. Respondents aged 35-49 years old and currently working are less likely to care for PLHA. However, level of education, level of knowledge, residence and earnings are not related willingness to care for PLHA. The dissemination of correct and accurate information about HIV-AIDS can help the community and society understand this condition. Thus, community members can accept PLHA and become more willing to provide care. The government can determine further policies for the appropriate dissemination of information, maximally and in accordance with recommendations. Collaborations among the government, health workers and the community are needed.
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Affiliation(s)
| | | | - Hidayat Arifin
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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14
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Diress G, Ahmed M, Adane S, Linger M, Alemnew B. Barriers and Facilitators for HIV Testing Practice Among Ethiopian Women Aged 15-24 years: Analysis of the 2016 Ethiopian Demographic and Health Survey. HIV AIDS (Auckl) 2021; 12:963-970. [PMID: 33447085 PMCID: PMC7801903 DOI: 10.2147/hiv.s280590] [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: 10/03/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In developing countries, youth women are most at risk of HIV infection. Center for Disease Control recommends that people who participate in high-risk behaviors get tested for HIV at least annually. In 2016, the Ethiopian Ministry of Health set goals to identify 90% of the people living with HIV by 2030. But undiagnosed HIV infections are still high in the country. To alleviate the problem, it is vital to identify the factors that hinder HIV testing practice. Therefore, this study aimed to identify the facilitators and barriers of HIV testing practice among Ethiopian youth women. METHODS The analysis was done on 6401 women aged 15-24 years using data from the 2016 Ethiopia Demographic Health Survey (EDHS). The main outcome variable was self-reported HIV testing practice. Multivariable logistic regression was used to identify the facilitators and barriers of HIV testing practice. RESULTS In this study, 37.7% [95% CI: (33.6, 39.1)] of youth women were tested for HIV in their life. Being married (AOR=4.7; 95% CI: (3.67, 6.01)), divorced [AOR=6.2; 95% CI: (3.98-9.54)], having primary level of education [AOR=2.4;95% CI: (1.79-3.13)], and secondary level of education [AOR=4.0; 95% CI: (2.87-5.63)], being rich [AOR=2.3;95% CI: (1.39-3.91)] and being in the highest wealth index catagory [AOR=2.6;95% CI: (1.30-5.16)] increase the odds of HIV testing. However, lack of media acccess [AOR = 0.7; 95 CI %: (0.54-0.87)], lack of comprehensive HIV knowledge [AOR = 0.68; 65% CI: (0.53-0.86)] and having discriminatory attitude towards PLHIV[AOR=0.79;95% CI: (0.64-0.97)] decrease the odds of HIV testing. CONCLUSION The practice of HIV testing among youth populations was low as compared to national recommendations. Lack of media access, lack of comprehensive knowledge about HIV, and having discriminatory attitudes were the barriers to HIV testing practice. Marriage, secondary or higher education attainment, and high wealth index category were the facilitators for HIV testing. Improving HIV-related knowledge, improving media access, and minimizing discriminatory attitudes are strongly recommended to promote HIV testing practice.
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Affiliation(s)
- Gedefaw Diress
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Seteamlak Adane
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Melese Linger
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Birhan Alemnew
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Woldia, Ethiopia
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15
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Truong HHM, Mocello AR, Ouma D, Bushman D, Kadede K, Ating'a E, Obunge D, Bukusi EA, Odhiambo F, Cohen CR. Community-based HIV testing services in an urban setting in western Kenya: a programme implementation study. Lancet HIV 2021; 8:e16-e23. [PMID: 33166505 PMCID: PMC10880946 DOI: 10.1016/s2352-3018(20)30253-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Some countries are struggling to reach the UNAIDS target of 90% of all individuals with HIV knowing their HIV status, especially among men and youth. To identify individuals who are unaware of their HIV-positive status and achieve testing saturation, we implemented a hybrid HIV testing approach in an urban informal settlement in western Kenya. In this study, we aimed to describe the uptake of HIV testing and linkage to care and treatment during this programme. METHODS The Community Health Initiative involved community mapping, household census, multidisease community health campaigns, and home-based tracking in the informal settlement of Obunga in Kisumu, Kenya. 52 multidisease community health campaigns were held throughout the programme coverage area, at which HIV testing by certified testing service counsellors was one of the health services available. Individuals aged 15 years or older who were not previously identified as HIV-positive, children younger than 15 years who reported being sexually active or for whom testing was requested by a parent or guardian, and individuals who tested HIV-negative within the past 3 months but who reported a recent risk were all eligible for testing. Health and counselling services were tailored for men and youth to encourage their participation. Individuals identified during the census who did not attend a community health campaign were tracked using global positioning system data and offered home-based HIV testing services. We calculated the previously unidentified fraction, defined as the number of individuals who were newly identified as HIV-positive as a proportion of all individuals previously identified and newly identified as HIV-positive. FINDINGS Between Jan 11 and Aug 29, 2018, the Community Health Initiative programme reached 23 584 individuals, of whom 11 526 (48·9%) were men and boys and 5635 (23·9%) were aged 15-24 years. Of 12 769 individuals who were eligible for HIV testing, 12 407 (97·2%) accepted testing, including 3917 (31·6%) first-time testers. 101 individuals were newly identified as HIV-positive out of 1248 total individuals who were HIV-positive, representing an 8·1% previously unidentified fraction. The previously unidentified fraction was highest among men (9·8%) and among people aged 15-24 years (15·3%). INTERPRETATION Community-based hybrid HIV testing was successfully implemented in an urban setting. Innovative approaches that make HIV testing more accessible and acceptable, particularly to men and young people, are crucial for achieving testing and treatment saturation. Focusing on identifying individuals who are unaware of their HIV-positive status in combination with monitoring the previously unidentified fraction has the potential to achieve the UNAIDS Fast Track commitment to end AIDS by 2030. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
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Affiliation(s)
- Hong-Ha M Truong
- Department of Medicine, University of California, San Francisco, CA, USA.
| | - A Rain Mocello
- Department of Obstetrics, Gynecology, and Reproductive Services, University of California, San Francisco, CA, USA
| | - David Ouma
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Dena Bushman
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | | | | | | | | | - Craig R Cohen
- Department of Obstetrics, Gynecology, and Reproductive Services, University of California, San Francisco, CA, USA
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16
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Dzinamarira T, Mulindabigwi A, Mashamba-Thompson TP. Co-creation of a health education program for improving the uptake of HIV self-testing among men in Rwanda: nominal group technique. Heliyon 2020; 6:e05378. [PMID: 33163663 PMCID: PMC7610321 DOI: 10.1016/j.heliyon.2020.e05378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study sought to collaborate with key stakeholders to reach a consensus regarding the predominant barriers preventing the uptake of HIV testing services (HTS) by men and co-create an acceptable educational program to improve the knowledge of HIV self-testing (HIVST) among men in Rwanda. Methods We employed the nominal group technique to identify a consensus regarding the predominant barriers currently impeding the male uptake of HTS. The health education program content was guided by the ranked barriers. We applied Mezirow's Transformational Learning Theory for curriculum development. Results Eleven key barriers currently impeding the male uptake of HTS were identified in the nominal group process. The stakeholders co-created an interactive, structured curriculum containing information on the health locus of control; HIV etiology, transmission, diagnosis, status disclosure benefits, care and treatment services; and an overview of the HIVST background and test procedure to address multiple barriers. Conclusion Key stakeholders co-created a comprehensive health education program tailored to men, which integrates education about health beliefs, HIV/AIDS and HIVST. Further studies to assess the effectiveness of the program are needed. It is anticipated that the intervention will improve the uptake of HIVST among men in Kigali, Rwanda.
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Affiliation(s)
- Tafadzwa Dzinamarira
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | | | - Tivani Phosa Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Department of Public Health, University of Limpopo, Polokwane, Limpopo Province, South Africa
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17
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Abstract
We examined the association of women empowerment and HIV testing in Nepalese women. Data from the 2012 Nepal Demographic and Health Survey provided a sample of 6,579 females ages 15-49 years. Women empowerment subcategories included participation in decision making, attitudes about safer sex negotiation, and sexual autonomy. Only 454 participants (6.9%) had been tested for HIV. Of note, 41.3% had high participation in decision making, 84.5% showed positive attitudes about safer sex negotiation, and 71.8% scored high in sexual autonomy. After adjusting potential confounders, the odds of being tested were higher for women with positive attitudes about safer sex negotiation (adjusted odds ratio = 1.444, 95% confidence interval: 1.006-2.072, p = .046) and high sexual autonomy (adjusted odds ratio = 3.138, 95% confidence interval: 1.375-7.164, p = .007). Age, education, and wealth were independent factors determining the women's HIV testing approach. Our study can be a guide for interventions and policies to empower women and encourage HIV testing in Nepal.
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18
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Meka AFZ, Billong SC, Diallo I, Tiemtore OW, Bongwong B, Nguefack-Tsague G. Challenges and barriers to HIV service uptake and delivery along the HIV care cascade in Cameroon. Pan Afr Med J 2020; 36:37. [PMID: 32774613 PMCID: PMC7392033 DOI: 10.11604/pamj.2020.36.37.19046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 01/19/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction The year 2017 marked a transition period with the end of the implementation of Cameroon´s 2014-2017 HIV/AIDS National Strategic Plan (NSP) and the development of the 2018-2022 NSP. We assessed barriers and challenges to service delivery and uptake along the HIV care cascade in Cameroon to inform decision making within the framework of the new NSP, to achieve the UNAIDS 90-90-90 target. Methods We conducted a cross sectional descriptive study nationwide, enrolling HIV infected patients and staff. Data were collected on sociodemographic characteristics, HIV testing, antiretroviral therapy and viral load testing delivery and uptake and factors that limit their access. Results A total of 137 staff and 642 people living with HIV (PLHIV) were interviewed. Of 642 PLHIV with known status, 339 (53%) repeated their HIV test at least once, with range: 1-10 and median: 2 (IQR: 1-3). Having attained secondary level of education (OR: 2.07, 95% CI: 1.04-4.14; P=0.04) or more (OR: 2.91, 95% CI: 1.16-7.28; P=0.02) were significantly associated with repeat testing. Psychological (refusal of service uptake and existence of HIV), community-level (stigmatization and fear of confidentiality breach) and commodity stock-outs “HIV test kits (21%), antiretrovirals (ARVs) (71.4%), viral load testing reagents (100%)” are the major barriers to service delivery and uptake along the cascade. Conclusion We identified individual, community-level, socio-economic and health care system related barriers which constitute persistent bottlenecks in HIV service delivery and uptake and a high rate of repeat testing by PLHIV with known status. Addressing all these accordingly can help the country achieve the UNAIDS 90-90-90 target.
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Affiliation(s)
| | - Serge Clotaire Billong
- National Aids Control Committee, Ministry of Public Health, Yaounde, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Ismael Diallo
- Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina-Faso.,Initiatives Conseil International-Santé (ICI-Santé), Ouagadougou, Burkina-Faso
| | | | - Brian Bongwong
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
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Haider MR, Brown MJ, Karim S, Siddiqi KA, Olatosi B, Li X. Factors associated with self-reported HIV testing in the Dominican Republic. Int J STD AIDS 2020; 31:560-567. [PMID: 32281487 PMCID: PMC7269088 DOI: 10.1177/0956462420913443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human immunodeficiency virus (HIV) testing is important for controlling the epidemic in low- and middle-income countries such as the Dominican Republic (DR) – a country in the Caribbean. This study aimed to examine factors associated with HIV testing in the DR. The study used HIV test data in the 2013 DR Demographic and Health Survey. HIV data were collected from 18,614 individuals aged 15–59 years. Wealth status, HIV-related stigma, and knowledge scales were constructed using factor analysis. Survey-weighted logistic regression was used to identify correlates of HIV testing in the DR. Results show that almost two-thirds (62.4%) of the participants reported ever having an HIV test. In the multivariable analysis, older age, higher education, female gender, richest wealth status, health insurance, married, higher HIV-knowledge, and lower HIV-related stigma increased the likelihood of getting an HIV test in the DR. People living in Norte/Cibao, which had a higher HIV prevalence, had a lower chance of having an HIV test than people living in the Este/Sureste region. Although HIV testing has increased in recent times, it is not yet satisfactory in the DR. Specific interventions building HIV awareness targeting specific sub-populations and regions will increase knowledge on HIV and reduce HIV-related stigma, and may increase HIV testing.
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Affiliation(s)
- Mohammad R Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Monique J Brown
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Khairul A Siddiqi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Kasymova S. Uptake of HIV testing among women of reproductive age in Tajikistan: An assessment of individual determinants. Cent Asian J Glob Health 2020; 9:e370. [PMID: 33062400 PMCID: PMC7538876 DOI: 10.5195/cajgh.2020.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Over the past decade, the incidence of human immunodeficiency virus (HIV) infections in Tajikistan increased significantly, with women particularly vulnerable to acquiring HIV. This research assessed individual determinants associated with HIV testing among women of reproductive age. Methods: Secondary data analysis was done using data from 5,867 females aged 15-49 years. Chi-square test, t-test, and multivariate analysis were applied to find associations between women's socio-demographic characteristics, reproductive health variables, and HIV testing uptake. Results: Overall, only 26% (1,501) of women in the present research reported HIV testing in the past. Multiple regression indicated that HIV testing was significantly associated with participants' age (25-34 age group: OR 0.7, p ≤ 0.001; 35-49 age group: OR 0.2, p ≤ 0.001), education (OR 2.2, p ≤ 0.001), area of residence (OR 0.6, p ≤ 0.001), marital status (OR 2.4, p ≤ 0.001), HIV knowledge (OR 1.1, p ≤ 0.001), and pregnancy history (OR 6.7, p ≤ 0.001). Conclusion: Results of this research suggest that there is a need for culturally acceptable interventions, including outreach to increase the overall HIV testing rate among women in Tajikistan.
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Mwaba K, Mannell J, Burgess R, Sherr L. Uptake of HIV testing among 15-19-year-old adolescents in Zambia. AIDS Care 2020; 32:183-192. [PMID: 32169008 DOI: 10.1080/09540121.2020.1739214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Adolescent HIV testing rates remain low with many unaware of their status. We explored factors associated with HIV testing uptake among adolescents aged 15-19 years using data from the Zambian Demographic Health Survey 2013-2014. The sample consisted of 7030 adolescents of which 42% reported ever testing for HIV. We found that as the age of a respondent increased so did their odds of testing (aOR = 1.26; 1.21-1.32); females had higher odds of testing than males (aOR = 1.719; 1.53-1.92); those with secondary or higher education (aOR = 3.64; 2.23-5.96) and those with primary education (aOR=1.97; 1.21-3.19) had higher odds of testing than those with no education; those who were formerly married or living with a partner (aOR = 4.99; 2.32-10.75) and those who were currently married or living with a partner (aOR = 4.76; 3.65-6.21) had higher odds of testing than those who were never married or lived with a partner; as the age at first sexual intercourse increased so did the odds of testing (aOR = 1.07; 1.06-1.08); and as HIV knowledge increased so did the odds of testing (aOR = 1.13; 1.06-1.19). The data points to population level social determinants that may be targeted to increase testing among adolescents.
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Affiliation(s)
- Kasonde Mwaba
- Department of Global Health, University College London, London, UK
| | | | - Rochelle Burgess
- Department of Global Health, University College London, London, UK
| | - Lorraine Sherr
- Department of Global Health, University College London, London, UK
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Rosenberg M, Gómez‐Olivé FX, Wagner RG, Rohr J, Payne CF, Berkman L, Kahn K, Tollman S, Bärnighausen T, Kobayashi LC. The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa. J Int AIDS Soc 2020; 23:e25457. [PMID: 32202047 PMCID: PMC7086300 DOI: 10.1002/jia2.25457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/02/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although HIV prevalence is exceptionally high in South Africa, HIV testing rates remain below targeted guidelines. Older adults living with HIV are substantially more likely to remain undiagnosed than younger people. Cognitive function and literacy could play key roles in HIV status knowledge due to the decision-making processes required around weighing the costs and benefits of testing, navigating testing logistics and processing results. We aimed to assess the independent relationships among each of cognitive function, literacy and education with HIV status knowledge in a population-based sample of older adults living in a rural South African community with high HIV prevalence. METHODS We analyzed data from a population-based study of 5059 men and women aged 40 years and older in rural South Africa (Health and Aging in Africa: A Longitudinal Study of an INDEPTH community (HAALSI)). HAALSI surveys, conducted between 2014 and 2015, queried self-reported literacy, educational attainment and HIV status knowledge. Laboratory tests were conducted to assess true HIV sero-status. Cognitive function was assessed with a battery of cognitive tests measuring time orientation, immediate and delayed recall, and numeracy and coded using confirmatory factor analysis as a z-standardized latent variable. We estimated the relationship between the outcome of HIV status knowledge and each of three exposures: (1) latent cognitive z-score, (2) literacy and (3) education, using confounder-adjusted modified Poisson regression models in the study population overall and stratified by HIV sero-status. RESULTS We found that HIV status knowledge was higher among those with higher cognitive z-scores (adjusted Prevalence Ratio (aPR) (95% CI): 1.18 (1.14, 1.21) per standard deviation unit), and among literate participants (aPR (95% CI): 1.24 (1.16, 1.32) vs. non-literate participants). Taken together, the associations with literacy and cognitive function completely attenuated the otherwise positive association between educational attainment and HIV status knowledge. The magnitudes of effect were generally similar among laboratory-confirmed HIV-negative and HIV-positive participants. CONCLUSIONS Campaigns that target older adults in rural South Africa with HIV testing messages should carefully consider the cognitive and literacy levels of the intended audience. Innovations to ease the cognitive load associated with HIV testing could prove fruitful to increase HIV status knowledge.
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Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and BiostatisticsIndiana University School of Public Health‐BloomingtonBloomingtonINUSA
| | - F. Xavier Gómez‐Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
- Umeå Centre for Global Health ResearchDivision of Epidemiology and Global HealthDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Julia Rohr
- Center for Population and Development StudiesHarvard UniversityCambridgeMAUSA
| | - Collin F. Payne
- School of Demography, Research School of Social SciencesAustralian National UniversityCanberraAustralia
| | - Lisa Berkman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Center for Population and Development StudiesHarvard UniversityCambridgeMAUSA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Till Bärnighausen
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Center for Population and Development StudiesHarvard UniversityCambridgeMAUSA
- Africa Health Research InstituteDurbanSouth Africa
- Heidelberg Institute of Global HealthFaculty of Medicine and University HospitalUniversity of HeidelbergHeidelbergGermany
| | - Lindsay C. Kobayashi
- Department of EpidemiologySchool of Public HealthUniversity of MichiganAnn ArborMIUSA
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Mudzviti T, Dhliwayo A, Chingombe B, Ngara B, Monera-Penduka TG, Maponga CC, Morse GD. Perspectives on oral pre-exposure prophylaxis use amongst female sex workers in Harare, Zimbabwe. South Afr J HIV Med 2020; 21:1039. [PMID: 32158559 PMCID: PMC7059237 DOI: 10.4102/sajhivmed.v21i1.1039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) could provide protection from human immunodeficiency virus (HIV) infection in sexually active persons at risk. Limited data are available in Zimbabwe with regard to the perceptions about PrEP amongst female sex workers (FSWs). OBJECTIVES The aim of this study was to evaluate the knowledge levels of oral PrEP and the likelihood of its use amongst FSWs. METHOD This was a cross-sectional study in the peri-urban areas of Harare, Zimbabwe. Human immunodeficiency virus-negative FSWs were interviewed to assess their awareness of and likelihood to use PrEP. The relative importance index was used to evaluate the levels of knowledge and the likelihood of, and barriers to, PrEP use. A set of 10 questions was designed and validated that evaluated participants' understanding of PrEP. A bivariate logistic regression model was utilised to identify predictors of PrEP use. RESULTS A total of 131 FSWs with a median age of 25 years (interquartile range: 21-31) participated in this study. Of the 71 (54%) FSWs who had heard about PrEP, 46 (35%) participants had adequate knowledge of its use. A total of 102 (78%) participants revealed that they would be willing to continuously use PrEP if it was provided free of cost. Increasing age of the participants was associated with an increase in the likelihood of using PrEP (r = 0.0033, p = 0.038). More knowledge about PrEP increased the likelihood of its use (r = 0.21, p = 0.0153). This likelihood increased amongst participants with an unprotected sexual intercourse encounter in the preceding 3 months (r = 0.0448, p = 0.026). CONCLUSION Knowledge of PrEP amongst FSWs was low. To increase the uptake of PrEP, there is a need to further sensitise FSWs about this intervention. Programmes should also promote awareness training in FSW subgroups that are less likely to use PrEP.
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Affiliation(s)
- Tinashe Mudzviti
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
- Newlands Clinic, Harare, Zimbabwe
| | - Anesu Dhliwayo
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
| | | | - Bernard Ngara
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Charles C. Maponga
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
- Population Services International, Harare, Zimbabwe
- Center for Integrated Global Biomedical Sciences, University at Buffalo, New York, United States
| | - Gene D. Morse
- Center for Integrated Global Biomedical Sciences, University at Buffalo, New York, United States
- Translational Pharmacology Research Core, University at Buffalo, New York, United States
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Lakhe NA, Diallo Mbaye K, Sylla K, Ndour CT. HIV screening in men and women in Senegal: coverage and associated factors; analysis of the 2017 demographic and health survey. BMC Infect Dis 2019; 20:1. [PMID: 31892320 PMCID: PMC6938616 DOI: 10.1186/s12879-019-4717-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/20/2019] [Indexed: 11/15/2022] Open
Abstract
Background Despite the adoption of the provider-initiated HIV testing strategy, the rate of HIV testing is still very low in sub-Saharan Africa. The aim of this study was to assess the factors associated with HIV testing among sexually active women and men in Senegal. Knowledge of HIV status is the gateway to antiretroviral treatment. Methods A secondary analysis of the 2017 Senegal Demographic and Health Survey (DHS) was performed, using data on sexually active women aged 15–49 and men aged 15–59. The outcome variable was the proportion of women and men who reported ever being tested for HIV in the last 12 months before the survey. Descriptive, bivariate, and multivariable logistic regression analyses were performed to identify the socio-demographic, HIV-knowledge, media exposure, and behavioral factors associated with HIV testing in Senegal. Results The study found that 61.1% (95%CI: 59.2–62.9) of women and 26.2% (95%CI: 24.2–28.3) of men were tested for HIV at the last 12 months. In multivariate analysis, among men the factors independently associated with being tested for HIV were: age groups 20–24 to 40–44 and age group 50–54; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having 2 or more lifetime sex partners and owning a mobile phone. Among women factors independently associated with HIV testing were: being in any age groups versus 15–19; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having any STI in last 12 months; fearing stigma; owning a mobile phone; and having any number of ANC visits, versus none. Conclusion Although HIV remains a public health threat, HIV testing’s prevalence is still low in Senegal, making it difficult to interrupt the transmission chain within the community and to reach the UNAIDS goal for 2020 of “90–90-90”. Innovative community-based strategies are needed to address barriers and improve access to HIV testing in Senegal, particularly for men and for the youngest and poorest populations.
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Affiliation(s)
- Ndeye Aïssatou Lakhe
- Clinic of Infectious and Tropical Diseases, Fann National University Hospital, PO: 5035-Fann, Dakar, Sénégal.
| | - Khardiata Diallo Mbaye
- Clinic of Infectious and Tropical Diseases, Fann National University Hospital, PO: 5035-Fann, Dakar, Sénégal
| | - Khadime Sylla
- Parasitology-Mycology Service, Medecine Faculty, Cheikh Anta Diop University, PO: 5005-Fann, Dakar, Sénégal
| | - Cheikh Tidiane Ndour
- Clinic of Infectious and Tropical Diseases, Fann National University Hospital, PO: 5035-Fann, Dakar, Sénégal.,Division for Fight Against HIV and Sexually Transmitted Infections, Ministry of Health, Dakar, Sénégal
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Truong HHM, Akama E, Guzé MA, Otieno F, Obunge D, Wandera E, Nsengiyumva NP, Obabo S, Bushman D, Kadede K, Bukusi EA, Oyaro P, Cohen CR. Implementation of a Community-Based Hybrid HIV Testing Services Program as a Strategy to Saturate Testing Coverage in Western Kenya. J Acquir Immune Defic Syndr 2019; 82:362-367. [PMID: 31658179 PMCID: PMC7148116 DOI: 10.1097/qai.0000000000002160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Knowledge of HIV status is the entry point for linkage to prevention, care, and treatment, and the first step toward achieving the UNAIDS 90-90-90 targets. Most countries rely on proxies for estimating testing saturation, including periodic population-based sampling and yield (number positive among those tested). We conducted a community-based "Hybrid" HIV testing services (HTS) program to identify persons unaware of their HIV-positive status. SETTING Homa Bay County, Kenya; July-September, 2016. METHODS We conducted community mapping, household census, multi-disease community health campaigns (CHCs), and home-based tracking. HIV testing eligibility was based on 2015 national guidelines. The previously unidentified fraction (PUF) was defined as the proportion of newly identified persons living with HIV (PLWH) out of all previously identified and newly identified PLWH. RESULTS The Hybrid HTS program reached 28,885 persons in total: 25,340 residents and 3545 nonresidents. There were 19,288 persons reached through CHCs and tracking. Of 11,316 individuals eligible for HIV testing, 9463 (83%) accepted testing, including 1230 (13%) first-time testers. There were 115 newly identified PLWH of 1589 total HIV-positive persons, representing a 7.2% PUF. Of 93 newly identified PLWH at the CHCs, 68% initiated same-day antiretroviral therapy. CONCLUSION The Hybrid HTS program identified persons previously unaware of their HIV-positive status, thereby enabling linkage to care and same-day treatment and reducing onward transmission risk. An approach focused on identifying persons unaware of their HIV-positive status in combination with ascertaining the PUF has the potential to better target testing strategies to identify >90% of PLWH in a community.
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Affiliation(s)
- Hong-Ha M. Truong
- Departments of Medicine, University of California, San Francisco, CA, USA
| | - Eliud Akama
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Mary A. Guzé
- Obstetrics, Gynecology & Reproductive Services, University of California, San Francisco, CA, USA
| | - Frankline Otieno
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Duncan Obunge
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Esther Wandera
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sammy Obabo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Dena Bushman
- Departments of Medicine, University of California, San Francisco, CA, USA
| | - Kevin Kadede
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Craig R. Cohen
- Obstetrics, Gynecology & Reproductive Services, University of California, San Francisco, CA, USA
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Impact of a Comprehensive Adolescent-Focused Case Finding Intervention on Uptake of HIV Testing and Linkage to Care Among Adolescents in Western Kenya. J Acquir Immune Defic Syndr 2019; 79:367-374. [PMID: 30063649 PMCID: PMC6203422 DOI: 10.1097/qai.0000000000001819] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Low HIV testing uptake prevents identification of adolescents living with HIV and linkage to care and treatment. We implemented an innovative service package at health care facilities to improve HIV testing uptake and linkage to care among adolescents aged 10–19 years in Western Kenya. Methods: This quasi-experimental study used preintervention and postintervention data at 139 health care facilities (hospitals, health centers, and dispensaries). The package included health worker capacity building, program performance monitoring tools, adolescent-focused HIV risk screening tool, and adolescent-friendly hours. The study population was divided into early (10–14 years) and late (15–19 years) age cohorts. Implementation began in July 2016, with preintervention data collected during January–March 2016 and postintervention data collected during January–March 2017. Descriptive statistics were used to analyze the numbers of adolescents tested for HIV, testing HIV-positive, and linked to care services. Preintervention and postintervention demographic and testing data were compared using the Poisson mean test. χ2 testing was used to compare the linkage to care rates. Results: During the preintervention period, 25,520 adolescents were tested, 198 testing HIV-positive (0.8%) compared with 77,644 adolescents tested with 534 testing HIV-positive (0.7%) during the postintervention period (both P-values <0.001). The proportion of HIV-positive adolescents linked to care increased from 61.6% to 94.0% (P < 0.001). The increase in linkage to care was observed among both age cohorts and within each facility type (both P-values <0.001). Conclusions: The adolescent-focused case finding intervention package led to a significant increase in both HIV testing uptake and linkage to care services among adolescents in Western Kenya.
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Masaka A, Dikeleko P, Moleta K, David M, Kaisara T, Rampheletswe F, Rwegerera GM. Determinants of comprehensive knowledge of mother to child transmission (MTCT) of HIV and its prevention among Zimbabwean women: Analysis of 2015 Zimbabwe Demographic and Health Survey. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1080/20905068.2019.1667114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Anthony Masaka
- Faulty of Health and Education, Dean’s office, Botho University, Gaborone, Botswana
| | - Paphani Dikeleko
- Faulty of Health and Education, Department of Health Information Management, Botho University, Gaborone, Botswana
| | - Keletso Moleta
- Faulty of Health and Education, Department of Health Information Management, Botho University, Gaborone, Botswana
| | - Morongwa David
- Faulty of Health and Education, Department of Health Information Management, Botho University, Gaborone, Botswana
| | - Tshephang Kaisara
- Faulty of Health and Education, Department of Health Information Management, Botho University, Gaborone, Botswana
| | - Fredah Rampheletswe
- Faulty of Health and Education, Department of Health Information Management, Botho University, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
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Sharma B, Nam EW. Role of Knowledge, Sociodemographic, and Behavioral Factors on Lifetime HIV Testing among Adult Population in Nepal: Evidence from a Cross-Sectional National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183311. [PMID: 31505776 PMCID: PMC6765858 DOI: 10.3390/ijerph16183311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 11/25/2022]
Abstract
Human immunodeficiency virus (HIV) testing is important to HIV prevention, treatment, and care. We aimed to assess the role of sociodemographic, behavioral factors and HIV knowledge on HIV testing among people aged 15–49 years in Nepal. The 2011 Nepal Demographic and Health Survey data was used for secondary data analysis. Herein, 9843 women and 3017 men who had experienced coitus were included. The respondents were asked if they underwent HIV testing and received the test results in their lifetime. Chi-square test and multivariate logistic regression analysis were applied at 5% level of significance. Adjusted odds ratios and 95% confidence intervals were computed separately for women and men. Of the total, 18.0% of men and 7.4% of women had been tested for HIV in their lifetime. As compared to the age of 15 to 24 years, males aged 25 to 29 years were more likely to report, whereas females aged 35 to 49 years were less likely to report HIV testing. Lower caste groups had more likelihood of reporting HIV testing than the other caste in both sexes. The odds of being tested for HIV were significantly higher among those who had higher education in both sexes. There was significant positive association between HIV testing and economic status in males whereas this association was reverse among females. The male respondents who spent more than one month away from home in the last 12 months were 1.68 times more likely to have been tested for HIV in their lifetime. Having multiple sexual partners was associated with higher odds of testing for HIV in both sexes. Having comprehensive HIV knowledge was independently associated with the reporting of higher odds of HIV testing in females. Promotion of HIV testing should consider sociodemographic factors, sexual behavior, and imparting comprehensive HIV knowledge.
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Affiliation(s)
- Bimala Sharma
- Department of Community Medicine, Gandaki Medical College, Pokhara 33700, Nepal
- Yonsei Global Health Center, Yonsei University, Wonju, Gangwon-Do 26493, Korea
| | - Eun Woo Nam
- Yonsei Global Health Center, Yonsei University, Wonju, Gangwon-Do 26493, Korea.
- Department of Health Administration, Graduate School, Yonsei University, Wonju, Gangwon-Do 26493, Korea.
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Ediru S, Wamala R, Kwagala B. Differences in HIV testing and receipt of results between adolescent and non-adolescent women in Uganda. AIDS Res Ther 2019; 16:18. [PMID: 31405385 PMCID: PMC6691533 DOI: 10.1186/s12981-019-0233-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
Despite notable increase in HIV testing among Uganda's women from 25% in 2006 to 71% in 2011, HIV testing among adolescent women remains very low at 45.5%. This study assesses differences in HIV testing and receipt of results (HTR) between adolescent and non-adolescent women in Uganda. The differences were decomposed into components attributed to variation in characteristics and variation in effects of characteristics in the two groups. The assessment was based on data sourced from 2011 Uganda Demographic Health Survey. Statistical analysis was done using a Non-linear Oaxaca' Blinder Multivariate Decomposition of the logistic regression. In the results, the difference in HIV testing and receipt of result between adolescent and non-adolescent women was significantly (P < 0.05) attributed to both variation in characteristics (57.2%) and variation in the effects of characteristics/coefficients (42.8%). In particular, the gap in HTR was mainly attributed to variation in characteristics such as ever had sex (34.7%) and ever given birth (31.6%) and variation in effects of characteristics such as education level (- 68.8%) and marital status (- 12.6%). Based on the findings of the study, government and other development partners need to scale up HIV testing programs targeting adolescents through tackling stigma, increasing on community outreach services and expanding adolescent friendly HIV services center.
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Wand H, Reddy T. Population-level impact of information sources on HIV testing uptake in South Africa: gender and age disparities. Int J STD AIDS 2019; 30:756-764. [PMID: 31072280 DOI: 10.1177/0956462419840859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In South Africa, mass media and interpersonal communication sources have been used extensively to increase awareness of human immunodeficiency virus (HIV)/AIDS. A sub-population of 10,565 black Africans who participated in the 2011–2012 household survey was analysed. Overall compared to men, a higher proportion of women had ever been tested for HIV (76% versus 60%). In age-specific analysis, men and women aged 25–49 years were more likely to be ever been tested compared to the youngest (<25 years) and the oldest age groups (50+ years). More than 80% of the study population was exposed to mass media tools, while exposure to interpersonal information sources was less common (16–72%). Among adolescents, 37% (men) and 41% (women) of the HIV tests were collectively associated with exposure to interpersonal programmes, while mass media tools had substantial contributions on HIV testing rates among the older individuals. Information sources to promote HIV/AIDS awareness should be tailored to reduce age–gender disparities.
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Affiliation(s)
- Handan Wand
- 1 Kirby Institute, University of New South Wales, Kensington, Australia
| | - Tarylee Reddy
- 2 Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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Conserve DF, Alemu D, Yamanis T, Maman S, Kajula L. "He Told Me to Check My Health": A Qualitative Exploration of Social Network Influence on Men's HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania. Am J Mens Health 2018; 12:1185-1196. [PMID: 29808781 PMCID: PMC6142152 DOI: 10.1177/1557988318777674] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as “camps” were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers’ risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men’s existing HIV testing encouragement strategies to promote HIVST among their peers.
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Affiliation(s)
- Donaldson F Conserve
- 1 Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Dawit Alemu
- 1 Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Thespina Yamanis
- 2 School of International Service, American University, Washington, DC, USA
| | - Suzanne Maman
- 3 Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lusajo Kajula
- 4 Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Iwelunmor J, Blackstone S, Jennings L, Converse D, Ehiri J, Curley J. Determinants of HIV testing and receipt of test results among adolescent girls in Nigeria: the role of assets and decision-making. Int J Adolesc Med Health 2018; 32:ijamh-2017-0152. [PMID: 29630514 DOI: 10.1515/ijamh-2017-0152] [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: 09/04/2017] [Accepted: 12/20/2017] [Indexed: 11/15/2022]
Abstract
Purpose Many adolescent girls in Nigeria do not test for HIV despite being at high risk. While the influence of psychosocial factors on HIV testing has been examined, there is less evidence regarding the impact of assets and control of assets on HIV testing. This study investigated the protective effects of specific adolescent girls' assets on decision-making regarding HIV testing. Methods Cross-sectional data from the 2013 Nigeria Demographic and Health Survey was analyzed. The main outcome variables were self-reports of having been tested for HIV and knowledge of a place that offers HIV testing. Binary logistic regression was used with employment, education, wealth index, home ownership, land ownership and decision making as potential predictors. Demographic characteristics were controlled in the analysis. Results Age [odds ratio (OR = 1.49)], employment (OR = 3.38), education (OR = 3.16), wealth index (OR = 1.33) and decision making (OR = 3.16) were positively associated with HIV testing. Age (OR = 1.20), employment (OR = 1.33), education (OR = 1.38), wealth (OR = 1.64), land ownership (OR = 1.42), and decision making (OR = 1.26) were positively associated with knowledge of an HIV testing location. Conclusion Our findings suggest that assets play an important role with HIV testing decisions for adolescent girls. Further research to elucidate the specific asset-based needs of adolescent girls will be needed to enhance decisions surrounding uptake of HIV testing and receipt of test results in Nigeria.
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Affiliation(s)
- Juliet Iwelunmor
- Saint Louis University, College for Public Health and Social Justice, St. Louis, MI, USA
| | - Sarah Blackstone
- Department of Health Sciences, James Madison University, 235 Martin Luther King Way MSC 4301, Harrisonburg, VA, USA
| | - Larissa Jennings
- John's Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donaldson Converse
- University of North Caroline Chapel Hill, School of Public Health, Chapel Hill, NC, USA
| | - John Ehiri
- University of Arizona, Health Promotion Sciences Department, Tucson, AZ, USA
| | - Jami Curley
- Saint Louis University, College for Public Health and Social Justice, St. Louis, MI, USA
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Abstract
This study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women's economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community. Important individual-level enabling and perceived need factors included high socioeconomic status, not having observed HIV-related stigma and knowledge of HIV status (based on a previous HIV test), such that these groups of individuals had a significantly higher likelihood of being tested for HIV during pregnancy than their counterparts of lower socioeconomic status, and who had observed HIV-related stigma or did not know their HIV status. The results further revealed that community HIV awareness is important for improving antenatal HIV testing, while stigma is associated with reduced testing uptake. Most contextual community-level factors were not found to have much effect on the uptake of antenatal HIV testing. Therefore, policies should focus on individual-level predisposing and enabling factors to improve the uptake of antenatal HIV testing in Zimbabwe.
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Staveteig S, Croft TN, Kampa KT, Head SK. Reaching the 'first 90': Gaps in coverage of HIV testing among people living with HIV in 16 African countries. PLoS One 2017; 12:e0186316. [PMID: 29023510 PMCID: PMC5638499 DOI: 10.1371/journal.pone.0186316] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND UNAIDS has recently proposed a set of three ambitious targets that, if achieved, are predicted to end the AIDS epidemic by 2030. The targets, known as 90-90-90, call for 90% of people living with HIV (PLHIV) to know their status, 90% of PLHIV to receive antiretroviral therapy, and 90% of those on antiretroviral therapy to achieve viral suppression by the year 2020. We examine the first of these targets, focusing on sub-Saharan Africa, the region of the world most affected by HIV, to measure the proportion of PLHIV estimated to know their HIV status, and to identify background and behavioral characteristics significantly associated with gaps in ever testing among PLHIV. METHODS AND FINDINGS We analyze cross-sectional population-based data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) fielded since 2010 in 16 sub-Saharan African countries where voluntary serological testing was recently conducted: Burkina Faso, Cameroon, Chad, Cote d'Ivoire, Ethiopia, Gabon, Lesotho, Malawi, Namibia, Rwanda, Sierra Leone, Tanzania, Togo, Uganda, Zambia, and Zimbabwe. Survey response rates averaged 95.0% (range 89.3-99.5%), while consent to serotesting averaged 94.9% (range 88.7-99.6%). This study, which includes more than 14,000 respondents living with HIV, finds that 69% of PLHIV in the average study country have ever been tested for HIV (range 34-95%). Based on timing of the last test and on ART coverage, we estimate that 54% of PLHIV in the average country are aware of their status (range 26-84%). Adjusted logistic regression finds that men (median adjusted odds ratio [AOR] = 0.38), adults with less than primary education (median AOR = 0.31), and adolescents (median AOR = 0.32) are consistently less likely to have ever been tested for HIV than women, adults with secondary and above education, and adults age 30-39, respectively. In most countries unadjusted logistic regression also finds significant gaps in testing among the poorest groups and those reporting never having had sex. CONCLUSION The fact that an average of 54% of PLHIV in these 16 countries are estimated to know their status reflects encouraging progress. However, not only is this average far short of the 90% target set by UNAIDS for 2020, but it also implies that in the average study country nearly one-half of PLHIV are unable to access lifesaving care and treatment because they are unaware that they are HIV-positive. Several gaps in HIV testing coverage exist, particularly among adolescents, the least educated, and men. While the need to target demographic groups at greatest risk of HIV continues, additional interventions focused on reaching men and on reaching socially vulnerable populations such as adolescents, the poorest, and the least educated are essential.
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Affiliation(s)
- Sarah Staveteig
- Avenir Health, Glastonbury, Connecticut, United States of America
- The Demographic and Health Surveys (DHS) Program, Rockville, Maryland, United States of America
- * E-mail:
| | - Trevor N. Croft
- The Demographic and Health Surveys (DHS) Program, Rockville, Maryland, United States of America
- International Health and Development Division, ICF, Rockville, Maryland, United States of America
| | - Kathryn T. Kampa
- Health, Research, Informatics & Technology Division, ICF, Atlanta, Georgia, United States of America
| | - Sara K. Head
- Independent Researcher, Washington, DC, United States of America
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Abstract
Objective: To determine the uptake of home-based HIV counselling and testing (HCT) in four HPTN 071 (PopART) trial communities (implementing a ‘full’ combination HIV prevention package that includes universal HIV testing and treatment) in Zambia. We also explore factors associated with uptake of HCT in these communities. Design: HPTN 071 (PopART) is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa evaluating the impact of a combination HIV prevention package, including universal HIV testing and treatment, on HIV incidence. Methods: Using a door-to-door approach that includes systematically revisiting households, individuals were offered participation in the intervention, and verbal consent was obtained. Data were analysed for the first 18 months of the intervention, December 2013 to June 2015 for individuals 18 years and older. Results: Among 121 130 enumerated household members, 101 102 (83.5%) accepted the intervention. HCT uptake was 72.2% (66 894/92 612), similar by sex but varied across communities. HCT uptake was associated with younger age, sex, community, being symptomatic for TB and sexually transmitted infections and longer time since previous HIV test. Knowledge of HIV status due to the intervention increased by 36% overall and by 66% among HIV positive participants; the highest impact was among 18–24 years old. Conclusion: Overall acceptance of HIV-testing through offering a door-to-door-based combination HIV prevention package was 72.2%. The intervention increased knowledge of HIV status from ∼50 to ∼90%. However, challenges still remain and a one-off intervention is unlikely to be successful but will require repeated visits and multiple strategies.
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