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Hopkins KL, Hlongwane KE, Otwombe K, Dietrich J, Cheyip M, Khanyile N, Doherty T, Gray GE. Level of adult client satisfaction with clinic flow time and services of an integrated non-communicable disease-HIV testing services clinic in Soweto, South Africa: a cross-sectional study. BMC Health Serv Res 2020; 20:404. [PMID: 32393224 PMCID: PMC7212607 DOI: 10.1186/s12913-020-05256-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND While HIV Testing Services (HTS) have increased, many South Africans have not been tested. Non-communicable diseases (NCDs) are the top cause of death worldwide. Integrated NCD-HTS could be a strategy to control both epidemics. Healthcare service strategies depends partially on positive user experience. We investigated client satisfaction of services and clinic flow time of an integrated NCD-HTS clinic. METHODS This prospective, cross-sectional study evaluated HTS client satisfaction with an HTS clinic at two phases. Phase 1 (February-June 2018) utilised standard HTS services: counsellor-led height/weight/blood pressure measurements, HIV rapid testing, and symptoms screening for sexually transmitted infections/Tuberculosis. Phase 2 (June 2018-March 2019) further integrated counsellor-led obesity screening (body mass index/abdominal circumference measurements), rapid cholesterol/glucose testing; and nurse-led Chlamydia and human papilloma virus (HPV)/cervical cancer screening. Socio-demographics, proportion of repeat clients, clinic flow time, and client survey data (open/closed-ended questions using five-point Likert scale) are reported. Fisher's exact test, chi-square analysis, and Kruskal Wallis test conducted comparisons. Multiple linear regression determined predictors associated with clinic time. Content thematic analysis was conducted for free response data. RESULTS Two hundred eighty-four and three hundred thirty-three participants were from Phase 1 and 2, respectively (N = 617). Phase 1 participants were significantly older (median age 36.5 (28.0-43.0) years vs. 31.0 (25.0-40.0) years; p = 0.0003), divorced/widowed (6.7%, [n = 19/282] vs. 2.4%, [n = 8/332]; p = 0.0091); had tertiary education (27.9%, [n = 79/283] vs. 20.1%, [n = 67/333]; p = 0.0234); and less female (53.9%, [n = 153/284] vs 67.6%, [n = 225/333]; p = 0.0005), compared to Phase 2. Phase 2 had 10.2% repeat clients (n = 34/333), and 97.9% (n = 320/327) were 'very satisfied' with integrated NCD-HTS, despite standard HTS having significantly shorter median time for counsellor-led HTS (36.5, interquartile range [IQR]: 31.0-45.0 vs. 41.5, IQR: 35.0-51.0; p < 0.0001). Phase 2 associations with longer clinic time were clients living together/married (est = 6.548; p = 0.0467), more tests conducted (est = 3.922; p < 0.0001), higher overall satisfaction score (est = 1.210; p = 0.0201). Those who matriculated experienced less clinic time (est = - 7.250; p = 0.0253). CONCLUSIONS It is possible to integrate counsellor-led NCD rapid testing into standard HTS within historical HTS timeframes, yielding client satisfaction. Rapid cholesterol/glucose testing should be integrated into standard HTS. Research is required on the impact of cervical cancer/HPV screenings to HTS clinic flow to determine if it could be scaled up within the public sector.
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Affiliation(s)
- Kathryn L Hopkins
- Perinatal HIV Research Unit, Faculty of Clinical Medicine, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Khuthadzo E Hlongwane
- Perinatal HIV Research Unit, Faculty of Clinical Medicine, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Clinical Medicine, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Clinical Medicine, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mireille Cheyip
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | - Tanya Doherty
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Clinical Medicine, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
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Okal J, Lango D, Matheka J, Obare F, Ngunu-Gituathi C, Mugambi M, Sarna A. "It is always better for a man to know his HIV status" - A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya. PLoS One 2020; 15:e0231645. [PMID: 32294124 PMCID: PMC7159816 DOI: 10.1371/journal.pone.0231645] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/28/2020] [Indexed: 01/20/2023] Open
Abstract
HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of ≥500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, health-care system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.
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Affiliation(s)
- Jerry Okal
- Population Council, Nairobi, Kenya
- * E-mail:
| | | | | | | | | | - Mary Mugambi
- National HIV and STI Control Programme (NASCOP), Nairobi, Kenya
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Liu Y, Osborn CY, Qian HZ, Yin L, Xiao D, Ruan Y, Simoni JM, Zhang X, Shao Y, Vermund SH, Amico KR. Barriers and Facilitators of Linkage to and Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study. AIDS Patient Care STDS 2016; 30:70-7. [PMID: 26784360 DOI: 10.1089/apc.2015.0296] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Linking and engaging HIV-positive patients in care is the key bridging step to glean the documented health and prevention advantages of antiretroviral therapy (ART). In China, HIV transmission among men who have sex with men (MSM) is surging, yet many HIV-positive MSM do not use HIV care services. We conducted a qualitative study in order to help positive interventions to promote linkage-to-care in this key population. Four focus group discussions (FGD) were held among HIV-positive MSM in Beijing, China, to ascertain knowledge, beliefs, attitudes, and practices related to HIV care. FGD participates highlighted six major barriers of linkage to/engagement in HIV care: (1) perceived discrimination from health care workers; (2) lack of guidance and follow-up; (3) clinic time or location inconvenience; (4) privacy disclosure concerns; (5) psychological burden of committing to HIV care; and (6) concerns about treatment. Five major sub-themes emerged from discussions on the facilitators of linkage to/engagement in care: (1) peer referral and accompaniment; (2) free HIV care; (3) advocacy from HIV-positive MSM counselors; (4) extended involvement for linking MSM to care; and (5) standardization of HIV care (i.e., reliable high quality care regardless of venue). An understanding of the barriers and facilitators that may impact the access to HIV care is essential for improving the continuum of care for MSM in China. Findings from our study provide research and policy guidance for how current HIV prevention and care interventions can be enhanced to link and engage HIV-positive MSM in HIV care.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Chandra Y. Osborn
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dong Xiao
- Chaoyang Chinese Aids Volunteer Group, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington
| | - Xiangjun Zhang
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- Chaoyang Chinese Aids Volunteer Group, Beijing, China
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
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Liu Y, Sun X, Qian HZ, Yin L, Yan Z, Wang L, Jiang S, Lu H, Ruan Y, Shao Y, Vermund SH, Amico KR. Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China. AIDS Patient Care STDS 2015; 29:481-9. [PMID: 26186029 DOI: 10.1089/apc.2015.0083] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diagnosis of HIV is the entry point into the continuum of HIV care; a well-recognized necessary condition for the ultimate prevention of onward transmission. In China, HIV testing rates among men who have sex with men (MSM) are low compared to other high risk subgroups, yet experiences with HIV testing among MSM in China are not well understood. To address this gap and prepare for intervention development to promote HIV testing and rapid linkage to treatment, six focus groups (FGs) were conducted with MSM in Beijing (40 HIV-positive MSM participated in one of four FGs and 20 HIV-negative or status unknown MSM participated in one of two FGs). Major themes reported as challenges to HIV testing included stigma and discrimination related to HIV and homosexuality, limited HIV knowledge, inconvenient clinic times, not knowing where to get a free test, fear of positive diagnosis or nosocomial infection, perceived low service quality, and concerns/doubts about HIV services. Key facilitators included compensation, peer support, professionalism, comfortable testing locations, rapid testing, referral and support after diagnosis, heightened sense of risk through engagement in high-risk behaviors, sense of responsibility to protect self, family and partner support, and publicity via social media. Themes and recommendations were generally consistent across HIV-positive and negative/status unknown groups, although examples of enacted stigma were more prevalent in the HIV-positive groups. Findings from our study provide policy suggestions for how to bolster current HIV prevention intervention efforts to enhance 'test-and-treat' strategies for Chinese MSM.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Xiaoyun Sun
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine (Division of Epidemiology), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Zheng Yan
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Lijuan Wang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Shulin Jiang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Lu
- Beijing City Center for Disease Control and Prevention, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics (Division of Infectious Diseases), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
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Lewis NM, Gahagan JC, Stein C. Preferences for rapid point-of-care HIV testing in Nova Scotia, Canada. Sex Health 2014; 10:124-32. [PMID: 23369262 DOI: 10.1071/sh12100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 10/01/2012] [Indexed: 11/23/2022]
Abstract
Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates of clients receiving test results, numbers of individuals aware of their status and timely access to care for those who test positive. In addition, several studies have shown that rapid POC testing for HIV is highly acceptable to clients in a variety of clinical and community-based health care settings. Most acceptability studies conducted in North America, however, have been conducted in large, urban environments where concentrations of HIV testing sites and testing innovations are greatest. Using a survey of client preferences at a sexual health clinic in Halifax, Nova Scotia, we suggest that HIV test seekers living in a region outside of Canada's major urban HIV epicentres find rapid POC testing highly acceptable. We compare the results of the Halifax survey with existing acceptability studies of rapid POC HIV testing in North America and suggest ways in which it might be of particular benefit to testing clients and potential clients in Nova Scotia and other regions of Canada that currently have few opportunities for anonymous or rapid testing. Overall, we found that rapid POC HIV testing was highly desirable at this study site and may serve to overcome many of the challenges associated with HIV prevention and testing outside of well-resourced metropolitan environments.
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Affiliation(s)
- Nathaniel M Lewis
- Gender and Health Promotion Studies Unit, Health Promotion Division, School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Kalichman SC, Zohren L, Eaton LA. Setting the bar high or setting up to fail? Interpretations and implications of the EXPLORE Study (HPTN 015). AIDS Behav 2014; 18:625-33. [PMID: 23989823 DOI: 10.1007/s10461-013-0603-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Controlled studies show that HIV risk reduction counseling significantly increases condom use, reduces unprotected sex and prevents sexually transmitted infections. Nevertheless, without evidence of reducing HIV incidence, these interventions are generally discarded. One trial, the EXPLORE study, was designed to test whether ten sessions of risk reduction counseling could impact HIV incidence among men who have sex with men in six US cities. Based on epidemiologic models to define effective HIV vaccines, a 35 % reduction in HIV incidence was set a priori as the benchmark of success in this behavioral intervention trial. Results demonstrated a significant effect of the intervention, with more than a 35 % reduction in HIV incidence observed during the initial 12-18 months following counseling. Over an unprecedented 48-month follow-up, however, the effect of counseling on HIV incidence declined to 18 %. The current review examined how the scientific literature has thus far judged the outcomes of the EXPLORE study as well as the policy implications of these judgments. We identified 127 articles that cited the EXPLORE study since its publication. Among articles that discuss the HIV incidence outcomes, 20 % judged the intervention effective and 80 % judged the intervention ineffective. The overwhelmingly negative interpretation of the EXPLORE study outcomes is reflected in public policies and prevention planning. We conclude that using a vaccine standard to define success led to a broad discrediting of the benefits of behavioral counseling and, ultimately, adversely impacted policies critical to the field of HIV prevention.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA,
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Soares PDS, Brandão ER. O aconselhamento e a testagem anti-HIV como estratégia preventiva: uma revisão da literatura internacional, 1999-2011. SAUDE E SOCIEDADE 2012. [DOI: 10.1590/s0104-12902012000400013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Com base em revisão bibliográfica discute-se a literatura produzida nos anos de 1999 a 2011, no campo da saúde coletiva, sobre uma importante estratégia de prevenção da transmissão do HIV: o aconselhamento e testagem anti-HIV. O artigo realiza um balanço da literatura internacional, analisando criticamente os aspectos mais assinalados pela comunidade científica, apontando divergências e convergências entre os estudos e identificando lacunas que possam estimular o desenvolvimento de novas pesquisas neste campo temático. Como resultado, evidenciou-se que os processos de decisão de realizar um teste e a experiência da testagem são discutidos na literatura com abordagens fragmentadas, sejam de ordem individual ou institucional. Para compreender diversas dimensões implicadas na adoção de uma prática preventiva como o teste HIV, é preciso contemplar indicadores sociais tais como gênero, religião, identidade sexual, raça/cor, e relacioná-los às políticas públicas e à operacionalização dos serviços de saúde. O uso expressivo do conceito de risco (aliado às categorias de grupo, comportamento, percepção) e de escalas quantitativas para aferir a percepção individual do risco como uma barreira para a realização do teste ilustra o foco excessivo sobre uma dimensão individual e parcial do problema.
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[Proposal of HIV, HBV and HCV targeted screening: short period feasibility study in a free-access outpatient medical structure]. Presse Med 2012; 41:e517-23. [PMID: 22464893 DOI: 10.1016/j.lpm.2012.01.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 01/20/2012] [Accepted: 01/26/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In France, patients coming from sub-Saharan Africa, French Indies and French Guiana are frequently missed HIV, HBV and HCV diagnosis, despite high prevalence of these infections. METHODS Targeted proposal of HIV, HBV and HCV screening, using sensitive enzyme immunoassays, to any adult patient originating of the above mentioned areas, with/without medical insurance, consulting for a medical issue in outpatients' department. Monocentric prospective study in a hospital in Paris during 28 consecutive days in 2010. RESULTS Among the 272 eligible patients, 166 were tested (patients' acceptance: 61%). 180/272 (66%) alleged being tested previously for HIV, women (66/87, 76%) more frequently than men (114/185, 62%), P=0.02. Patients' acceptance seemed higher in patients mentioning no previous test than in patients reporting previous test. Among the patients who refused being tested, reporting a previous negative HIV test, more than a quarter has been tested more than 1 year ago. Among the 166 tested patients, 120 (72%) came back to get their results, men (89/113, 79%) more frequently than women (31/53, 58.5%), P=0.009; recently metropolitan patients more frequently than longer metropolitan patients, P=0.01; patients without any job more frequently than patients with a job, P=0.01. Three (1.8%) HIV tests returned positive; HBsAg was positive in 13 (7.8%) patients; 54 patients (32.7%) had a negative hepatitis B screening (anti-HBcAb+HBsAg+anti-HBsAb), attesting to sensitivity to this infection, only 18 patients (10.9%) showed isolated anti-HBsAb at protective levels. Eighty-one patients (49.1%) exhibited anti-HBcAb, confirming the high prevalence of HBV infection in the areas the patients came from. Six patients (3.6%) had anti-HCVAb. There was no co-infection. CONCLUSION Targeted HIV, HBV and HCV screening to patients coming from high prevalence areas in outpatients' department appears a very cost-effective strategy.
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Hayes R, Sabapathy K, Fidler S. Universal testing and treatment as an HIV prevention strategy: research questions and methods. Curr HIV Res 2011; 9:429-45. [PMID: 21999778 PMCID: PMC3520051 DOI: 10.2174/157016211798038515] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 07/15/2011] [Accepted: 07/29/2011] [Indexed: 02/07/2023]
Abstract
Achieving high coverage of antiretroviral treatment (ART) in resource-poor settings will become increasingly difficult unless HIV incidence can be reduced substantially. Universal voluntary counselling and testing followed by immediate initiation of ART for all those diagnosed HIV-positive (universal testing and treatment, UTT) has the potential to reduce HIV incidence dramatically but would be very challenging and costly to deliver in the short term. Early modelling work in this field has been criticised for making unduly optimistic assumptions about the uptake and coverage of interventions. In future work, it is important that model parameters are realistic and based where possible on empirical data. Rigorous research evidence is needed before the UTT approach could be considered for wide-scale implementation. This paper reviews the main areas that need to be explored. We consider in turn research questions related to the provision of services for universal testing, services for immediate treatment of HIV-positives and the population-level impact of UTT, and the research methods that could be used to address these questions. Ideally, initial feasibility studies should be carried out to investigate the acceptability, feasibility and uptake of UTT services. If these studies produce promising results, there would be a strong case for a cluster-randomised trial to measure the impact of a UTT intervention on HIV incidence, and we consider the main design features of such a trial.
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Affiliation(s)
- Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Lyu SY, Morisky DE, Yeh CY, Twu SJ, Peng EYC, Malow RM. Acceptability of rapid oral fluid HIV testing among male injection drug users in Taiwan, 1997 and 2007. AIDS Care 2011; 23:508-14. [PMID: 21271392 DOI: 10.1080/09540121.2010.516331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rapid oral fluid HIV testing (rapid oral testing) is in the process of being adapted in Taiwan and elsewhere given its advantages over prior HIV testing methods. To guide this process, we examined the acceptability of rapid oral testing at two time points (i.e., 1997 and 2007) among one of the highest risk populations, male injection drug users (IDUs). For this purpose, an anonymous self-administered survey was completed by HIV-negative IDUs involved in the criminal justice system in 1997 (N (1)=137 parolees) and 2007 (N (2)=106 prisoners). A social marketing model helped guide the design of our questionnaire to assess the acceptability of rapid oral testing. This included assessing a new product, across four marketing dimensions: product, price, promotion, and place. Results revealed that in both 1997 and 2007, over 90% indicated that rapid oral testing would be highly acceptable, particularly if the cost was under US$6, and that a pharmacy would be the most appropriate and accessible venue for selling the rapid oral testing kits. The vast majority of survey respondents believed that the cost of rapid oral testing should be federally subsidized and that television and newspaper advertisements would be the most effective media to advertise for rapid oral testing. Both the 1997 and 2007 surveys suggested that rapid oral HIV testing would be particularly accepted in Taiwan by IDUs after release from the criminal justice system.
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Affiliation(s)
- Shu-Yu Lyu
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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Song Y, Li X, Zhang L, Fang X, Lin X, Liu Y, Stanton B. HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China. AIDS Care 2011; 23:179-86. [PMID: 21259130 DOI: 10.1080/09540121.2010.487088] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous studies suggested a rapid increase of HIV prevalence among men who have sex with men (MSM) in China in recent years, from 0.4% in 2004 to 5.8% in 2006. However, some MSM had never been tested for HIV. In order to expand the accessibility to HIV testing, understanding HIV-testing behavior and barriers among MSM is important. Using data collected from 307 young migrant MSM (aged 18-29 years) in 2009 in Beijing, we aimed to identify psychological and structural barriers to HIV testing. MSM were recruited through peer outreach, informal social networks, Internet outreach, and venue-based outreach. Participants completed a confidential self-administered questionnaire. Results show that about 72% of MSM ever had an HIV test. Logistic regression analysis indicated that the HIV-testing behavior was associated with sexual risk behaviors (e.g., multiple sexual partners and inconsistent condom use for anal sex) and history of sexually transmitted diseases. Eighty four MSM (28%) who never had an HIV test reported that the psychological barriers mainly were perceived low risk of HIV infection and fears of being stigmatized. The structural barriers reported inconvenience of doing test and lack of confidentiality. Future HIV prevention programs should be strengthened among MSM to increase their awareness of HIV risk. Efforts are needed to increase access to quality and confidential HIV testing among MSM and reduce stigma against MSM.
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Affiliation(s)
- Yan Song
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
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Bogart LM, Howerton D, Lange J, Setodji CM, Becker K, Klein DJ, Asch SM. Provider-related barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs) and hospitals. AIDS Behav 2010; 14:697-707. [PMID: 18770022 DOI: 10.1007/s10461-008-9456-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 08/22/2008] [Indexed: 10/21/2022]
Abstract
We examined provider-reported barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs), and hospitals. 12 primary metropolitan statistical areas (PMSAs; three per region) were sampled randomly, with sampling weights proportional to AIDS case reports. Across PMSAs, all 671 hospitals and a random sample of 738 clinics/CBOs were telephoned for a survey on rapid HIV test availability. Of the 671 hospitals, 172 hospitals were randomly selected for barriers questions, for which 158 laboratory and 136 department staff were eligible and interviewed in 2005. Of the 738 clinics/CBOs, 276 were randomly selected for barriers questions, 206 were reached, and 118 were eligible and interviewed in 2005-2006. In multivariate models, barriers regarding translation of administrative/quality assurance policies into practice were significantly associated with rapid HIV testing availability. For greater rapid testing diffusion, policies are needed to reduce administrative barriers and provide quality assurance training to non-laboratory staff.
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Swendeman D, Rotheram-Borus MJ. Innovation in sexually transmitted disease and HIV prevention: internet and mobile phone delivery vehicles for global diffusion. Curr Opin Psychiatry 2010; 23:139-44. [PMID: 20087189 PMCID: PMC2881840 DOI: 10.1097/yco.0b013e328336656a] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Efficacious behavioral interventions and practices have not been universally accepted, adopted, or diffused by policy makers, administrators, providers, advocates, or consumers. Biomedical innovations for sexually transmitted disease (STD) and HIV prevention have been embraced but their effectiveness is hindered by behavioral factors. Behavioral interventions are required to support providers and consumers for adoption and diffusion of biomedical innovations, protocol adherence, and sustained prevention for other STDs. Information and communication technology such as the Internet and mobile phones can deliver behavioral components for STD/HIV prevention and care to more people at less cost. RECENT FINDINGS Recent innovations in STD/HIV prevention with information and communication technology-mediated behavioral supports include STD/HIV testing and partner interventions, behavioral interventions, self-management, and provider care. Computer-based and Internet-based behavioral STD/HIV interventions have demonstrated efficacy comparable to face-to-face interventions. Mobile phone STD/HIV interventions using text-messaging are being broadly utilized but more work is needed to demonstrate efficacy. Electronic health records and care management systems can improve care, but interventions are needed to support adoption. SUMMARY Information and communication technology is rapidly diffusing globally. Over the next 5-10 years smart-phones will be broadly disseminated, connecting billions of people to the Internet and enabling lower cost, highly engaging, and ubiquitous STD/HIV prevention and treatment support interventions.
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Feldacker C, Torrone E, Triplette M, Smith JC, Leone PA. Reaching and retaining high-risk HIV/AIDS clients through the Internet. Health Promot Pract 2010; 12:522-8. [PMID: 20160022 DOI: 10.1177/1524839909349178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Internet is a popular way for people to meet casual sex partners. However, online outreach remains largely unexplored to promote voluntary counseling and testing for HIV. The Student Health Action Coalition's HIV testing program (SHAC-HIV) targets high-risk clients through tailored Internet outreach via chat rooms, social networking sites, and online forums. The SHAC-HIV model also demonstrates that nontraditional testing sites can provide low-cost, client-centered, high-quality services to support increased demand for HIV-testing services. Within the clinic, SHAC-HIV's testing model includes four major components: (a) reliance on a team of well-trained health sciences student volunteers; (b) rapid oral-fluid HIV tests; (c) universal, consent-based testing with client-centered health education and counseling; and (d) coordinated referrals for follow-up testing, treatment, and care. This approach reaches high-risk clients as well as undiagnosed infections. In 2007, there were nine confirmed positive results out of 389 tests, yielding a 2.3% positivity rate. This positivity percentage is higher than any other nontraditional testing site in North Carolina. This article describes the SHAC-HIV outreach and voluntary counseling and testing program with the aim of encouraging adoption of the model by other nontraditional testing sites.
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Affiliation(s)
- Caryl Feldacker
- Student Health Action Coalition HIV Services, Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, 123 West Franklin Street, Chapel Hill, NC 27516-2524, USA.
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Holt M, Keen P. Challenges in rolling out rapid HIV testing in Australia. Sex Health 2009; 6:101-2. [PMID: 19634256 DOI: 10.1071/sh09036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Martin Holt
- National Centre in HIV Social Research, The University of New South Wales, Kensington, NSW 2052, Australia.
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Rotheram-Borus MJ, Swendeman D, Chovnick G. The past, present, and future of HIV prevention: integrating behavioral, biomedical, and structural intervention strategies for the next generation of HIV prevention. Annu Rev Clin Psychol 2009; 5:143-67. [PMID: 19327028 DOI: 10.1146/annurev.clinpsy.032408.153530] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the past 25 years, the field of HIV prevention research has been transformed repeatedly. Today, effective HIV prevention requires a combination of behavioral, biomedical, and structural intervention strategies. Risk of transmitting or acquiring HIV is reduced by consistent male- and female-condom use, reductions in concurrent and/or sequential sexual and needle-sharing partners, male circumcision, and treatment with antiretroviral medications. At least 144 behavioral prevention programs have been found effective in reducing HIV transmission acts; however, scale up of these programs has not occurred outside of the United States. A series of recent failures of HIV-prevention efficacy trials for biomedical innovations such as HIV vaccines, treating herpes simplex 2 and other sexually transmitted infections, and diaphragm and microbicide barriers highlights the need for behavioral strategies to accompany biomedical strategies. This challenges prevention researchers to reconceptualize how cost-effective, useful, realistic, and sustainable prevention programs will be designed, delivered, tested, and diffused. The next generation of HIV prevention science must draw from the successes of existing evidence-based interventions and the expertise of the market sector to integrate preventive innovations and behaviors into everyday routines.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Semel Institute for Neuroscience and Human Behavior, University of California-Los Angeles, CA 90024-6521, USA.
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HIV partner notification: predictors of discussion and agreements from provider reports. AIDS Behav 2009; 13:573-81. [PMID: 19184394 DOI: 10.1007/s10461-009-9522-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
This study examines organizational, provider, client, and test-event level predictors of HIV partner notification (PN) discussion and agreements based on providers' most recent HIV-positive post-test counseling session. Staff (n = 621) were sampled from for-profit, nonprofit, and county government HIV testing organizations (N = 159) in Los Angeles County from 2003 to 2007. Among providers who conducted an HIV-positive post-test counseling session (n = 204), 65% discussed PN but only 10% had confirmed agreement to provider-involved PN (PIPN). In multi-level regression analyses PN discussion was predicted by provider HIV-test training and knowledge, and patients requesting a test while presenting HIV/AIDS symptoms. The strongest predictor of PIPN agreement was public health HIV testing settings followed by counseling by program managers or infectious disease specialists across settings. None of the injecting drug users or patients presenting with AIDS, but not requesting a test, agreed to PIPN. Organizational and provider-level interventions on PN will be needed to realize cost-effective benefits of expanded HIV testing and counseling.
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Bogart LM, Howerton D, Lange J, Becker K, Setodji CM, Asch SM. Scope of rapid HIV testing in urban U.S. hospitals. Public Health Rep 2008; 123:494-503. [PMID: 18763412 DOI: 10.1177/003335490812300411] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The present study examined the scope of rapid human immunodeficiency virus (HIV) testing in urban U.S. hospitals. METHODS In a multistage national probability sample, 12 primary metropolitan statistical areas (three per region) were sampled randomly, with weights proportionate to acquired immunodeficiency syndrome (AIDS) populations. All 671 eligible hospitals within areas were selected. Laboratory staff from 584 hospitals (87%) were interviewed by telephone in 2005. RESULTS About 52% reported rapid HIV test availability (50% in occupational health, 29% in labor and delivery, and 13% in emergency department/urgent care), and 86% of hospitals offering rapid tests processed them in the laboratory. In multivariate models, rapid test availability was more likely in hospitals serving more patients, and located in high-poverty, high-AIDS prevalence areas, and in the South or Midwest vs. West. It was less likely in hospitals serving areas with large percentages of people who were black/African American or Hispanic/Latino (p<0.05). CONCLUSIONS Rapid HIV testing is increasing across urban U.S. hospitals, primarily for occupational exposure and in hospitals with greater resources and need. To achieve routine HIV screening, policies should encourage greater breadth of diffusion of rapid testing at the point of care, especially in smaller facilities, the West, and communities with racial/ethnic diversity.
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Bogart LM, Howerton D, Lange J, Becker K, Setodji CM, Asch SM. Scope of rapid HIV testing in private nonprofit urban community health settings in the United States. Am J Public Health 2008; 98:736-42. [PMID: 18309135 DOI: 10.2105/ajph.2007.111567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined patterns of rapid HIV testing in a multistage national random sample of private, nonprofit, urban community clinics and community-based organizations to determine the extent of rapid HIV test availability outside the public health system. METHODS We randomly sampled 12 primary metropolitan statistical areas in 4 regions; 746 sites were randomly sampled across areas and telephoned. Staff at 575 of the sites (78%) were reached, of which 375 were eligible and subsequently interviewed from 2005 to 2006. RESULTS Seventeen percent of the sites offered rapid HIV tests (22% of clinics, 10% of community-based organizations). In multivariate models, rapid test availability was more likely among community clinics in the South (vs West), clinics in high HIV/AIDS prevalence areas, clinics with on-site laboratories and multiple locations, and clinics that performed other diagnostic tests. CONCLUSIONS Rapid HIV tests were provided infrequently in private, nonprofit, urban community settings. Policies that encourage greater diffusion of rapid testing are needed, especially in community-based organizations and venues with fewer resources and less access to laboratories.
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Affiliation(s)
- Laura M Bogart
- RAND Corp, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Tolou-Shams M, Payne N, Houck C, Pugatch D, Beausoleil N, Brown LK. HIV testing among at-risk adolescents and young adults: a prospective analysis of a community sample. J Adolesc Health 2007; 41:586-93. [PMID: 18023788 DOI: 10.1016/j.jadohealth.2007.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 06/01/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Little is known about predictors of human immunodeficiency virus (HIV) testing among sexually active adolescents, who account for a large proportion of new HIV infections. This study sought to determine predictors of HIV testing among a large community-based sample of adolescents in three cities who had recent unprotected sexual intercourse. METHODS Sexually active adolescents (N = 1222) completed baseline and 3-month assessments of sexual behavior, substance use and HIV testing behaviors as part of a larger, multi-site, brief HIV prevention program. RESULTS Approximately half of the adolescents reported having previously been tested for HIV, and of those one third were tested in the next 3 months without a specific intervention. Adolescents who received HIV testing were more likely at baseline to have ever been tested, to have a STI diagnosis, to have not used substances during sex and to have been assertive about condom use with a partner. CONCLUSIONS Health care models encouraging more widespread, universal testing may be an important public health initiative to curb the spread of HIV. Regular HIV screenings provide an opportunity to enhance awareness of behavioral risk and HIV status, as well as provide opportunities for early detection and care.
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Affiliation(s)
- Marina Tolou-Shams
- Bradley Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
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Obermeyer CM, Osborn M. The utilization of testing and counseling for HIV: a review of the social and behavioral evidence. Am J Public Health 2007; 97:1762-74. [PMID: 17761565 PMCID: PMC1994175 DOI: 10.2105/ajph.2006.096263] [Citation(s) in RCA: 272] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2006] [Indexed: 01/31/2023]
Abstract
Against the background of debates about expanding HIV testing and counseling, we summarize the evidence on the social and behavioral dimension of testing and its implications for programs. The discrepancy between acceptance of testing and returning for results and the difficulties of disclosure are examined in light of research on risk perceptions and the influence of gender and stigma. We also summarize the evidence on the provision of testing and counseling, the implementation of practices regarding confidentiality and consent, and the results of interventions. We demonstrate that social factors have a considerable impact on testing, show that the services linked to testing are key determinants of utilization, and consider the implications of these findings for HIV testing programs.
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Abstract
GOAL The purpose of this study was to examine time trends of failure to return for HIV test results among a mobile van population in Los Angeles. STUDY DESIGN This study examined administrative records from 9340 patients of the Mobile HIV Testing van between January 1997 and December 2004. RESULTS Between 1997 and 2004, a worsening trend was found in the percentage of clients who failed to return for HIV test results. Multivariate analyses showed that the adjusted odds of returning for test results significantly increased relative to 1997, the first year tested. The odds of returning for test results ranged from 1.56 (95% CI = 1.21, 2.00) in 1998 to 2.46 (95% CI = 1.89, 3.19) in 2004. CONCLUSION The proportion of MoHOP clients failing to return for test results was high and increased substantially between 1997 and 2004. Given the importance of identifying HIV-infected persons, understanding ways to improve return rates for test results is critical, especially for public health officials, clinicians, and researchers implementing and evaluating HIV prevention strategies.
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Affiliation(s)
- Janni J Kinsler
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
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Owens DK, Sundaram V, Lazzeroni LC, Douglass LR, Tempio P, Holodniy M, Sanders GD, Shadle VM, McWhorter VC, Agoncillo T, Haren N, Chavis D, Borowsky LH, Yano EM, Jensen P, Simberkoff MS, Bozzette SA. HIV testing of at risk patients in a large integrated health care system. J Gen Intern Med 2007; 22:315-20. [PMID: 17356961 PMCID: PMC1824727 DOI: 10.1007/s11606-006-0028-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Early identification of HIV infection is critical for patients to receive life-prolonging treatment and risk-reduction counseling. Understanding HIV screening practices and barriers to HIV testing is an important prelude to designing successful HIV screening programs. Our objective was to evaluate current practice patterns for identification of HIV. METHODS We used a retrospective cohort analysis of 13,991 at-risk patients seen at 4 large Department of Veterans Affairs (VA) health-care systems. We also reviewed 1,100 medical records of tested patients. We assessed HIV testing rates among at-risk patients, the rationale for HIV testing, and predictors of HIV testing and of HIV infection. RESULTS Of the 13,991 patients at risk for HIV, only 36% had been HIV-tested. The prevalence of HIV ranged from 1% to 20% among tested patients at the 4 sites. Approximately 90% of patients who were tested had a documented reason for testing. CONCLUSION One-half to two-thirds of patients at risk for HIV had not been tested within our selected VA sites. Among tested patients, the rationale for HIV testing was well documented. Further testing of at-risk patients could clearly benefit patients who have unidentified HIV infection by providing earlier access to life-prolonging therapy.
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