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Kadye T, Jamil MS, Johnson C, Baggaley R, Barr-DiChiara M, Cambiano V. Country uptake of WHO recommendations on differentiated HIV testing services approaches: a global policy review. BMJ Open 2024; 14:e058098. [PMID: 38485173 PMCID: PMC10941124 DOI: 10.1136/bmjopen-2021-058098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/03/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES In 2015 and 2016, WHO issued guidelines on HIV testing services (HTS) highlighting recommendations for a strategic mix of differentiated HTS approaches. The policy review examines the uptake of differentiated HTS approaches recommendations in national policies. METHODS Data were extracted from national policies published between January 2015 and June 2019. The WHO-recommended HTS approaches included facility-based testing, community-based testing, HIV self-testing and provider-assisted referral (or assisted partner notification). Other supportive recommendations include pre-test information, post-test counselling, lay provider testing and rapid testing. Descriptive analyses were conducted to examine inclusion of recommendations in national policies. RESULTS Of 194 countries worldwide, 65 published policies were identified; 24 WHO Africa region (AFR) countries (51%, 24/47), 21 WHO European region (EUR) (40%, 21/53), 6 WHO Eastern Mediterranean region (EMR) (29%, 6/21), 5 Pan-American region (AMR) (14%, 5/35), 5 Western Pacific Region (WPR) (19%, 5/27) and 4 WHO South East Asia Region (SEAR) (36%, 4/11). Only five countries included all recommendations. 63 included a minimum of one. 85% (n=55) included facility-based testing for pregnant women, 75% (n=49) facility-based testing for key populations, 74% (n=48) community-based testing for key populations, 69% (n=45) rapid testing, 57% (n=37) post-test counselling, 45% (n=29) lay provider testing, 38% (n=25) HIV self-testing, 29% (n=19) pre-test information and 25% (n=16) provider-assisted referral. The proportion in each region that included at least one recommendation were: 100% AFR (24/47), 100% EMR (6/6), 100% AMR (5/5), 100% WPR (5/5), 100% SEAR (4/4) and 95% EUR (20/21). AFR followed by EMR included the highest number of reccomendations. CONCLUSION There was substantial variability in the uptake of the WHO-differentiated HTS recommendations. Those in EMR included the most WHO-differentiated HTS recommendation followed by AFR. Countries within AMR included the least number of recommendations. Ongoing advocacy and efforts are needed to support the uptake of the WHO-differentiated HTS recommendations in country policies as well as their implementation.
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Affiliation(s)
| | | | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Magdalena Barr-DiChiara
- Department of Global Programmes of HIV, Hepatitis and HIV, World Health Organization, Geneva, Switzerland
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Vujcich D, Reid A, Brown G, Durham J, Guy R, Hartley L, Mao L, Mullens AB, Roberts M, Lobo R. HIV-Related Knowledge and Practices among Asian and African Migrants Living in Australia: Results from a Cross-Sectional Survey and Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4347. [PMID: 36901357 PMCID: PMC10002009 DOI: 10.3390/ijerph20054347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Australian HIV notification rates are higher for people born in Northeast Asia, Southeast Asia and sub-Saharan Africa compared to Australian-born people. The Migrant Blood-Borne Virus and Sexual Health Survey represents the first attempt to build the national evidence base regarding HIV knowledge, risk behaviors and testing among migrants in Australia. To inform survey development, preliminary qualitative research was conducted with a convenience sample of n = 23 migrants. A survey was developed with reference to the qualitative data and existing survey instruments. Non-probability sampling of adults born in Northeast Asia, Southeast Asia and sub-Saharan Africa was undertaken (n = 1489), and descriptive and bivariate analyses of data were conducted. Knowledge of pre-exposure prophylaxis was low (15.59%), and condom use at last sexual encounter was reported by 56.63% of respondents engaging in casual sex, and 51.80% of respondents reported multiple sexual partners. Less than one-third (31.33%) of respondents reported testing for any sexually transmitted infection or blood-borne virus in the previous two years and, of these, less than half (45.95%) tested for HIV. Confusion surrounding HIV testing practices was reported. These findings identify policy interventions and service improvements critically needed to reduce widening disparities regarding HIV in Australia.
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Affiliation(s)
- Daniel Vujcich
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Alison Reid
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Graham Brown
- Centre for Social Impact, UNSW, Sydney, NSW 2052, Australia
| | - Jo Durham
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia
| | - Lisa Hartley
- Centre for Human Rights Education, Curtin University, Bentley, WA 6102, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
| | - Amy B. Mullens
- School of Psychology & Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Qld, Ipswich, QLD 4305, Australia
| | - Meagan Roberts
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Roanna Lobo
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
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3
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Idris AM, Crutzen R, Van den Borne HW. Hiv testing and counseling services in Kassala State, Sudan: what are the relevant beliefs of private healthcare providers? AIDS Care 2023; 35:316-323. [PMID: 36449717 DOI: 10.1080/09540121.2022.2148625] [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: 12/05/2022]
Abstract
HIV testing and counseling (HTC) services are essential for all HIV prevention and treatment interventions. Evidence is limited on the role of private healthcare providers in providing HTC services. This study assessed the relevant beliefs for intervention to enhance the intention to offer HTC services among private healthcare providers. A cross-sectional study included 387 private healthcare providers who completed a questionnaire about beliefs and intentions regarding offering HTC services. A Confidence Interval Based Estimation of Relevance (CIBER) approach was used to identify the most relevant beliefs. The behavioral belief "Offering HTC services would cause patients to feel worries" and the normative belief "My managers believe that I should offer HTC services to patients" were relevant beliefs for intervention. The control beliefs "If I offer HTC services, I spend more time with the patients" and "Patients are at low risk of HIV, and they would not need HTC services" were significantly associated with intention and important intervention candidates. The belief "If I offer HTC services, I would be concerned about HIV test results confidentiality" was a relevant belief to target with intervention. The beliefs of private service providers differ in their association with relevance to their intention to offer HTC services. More relevant beliefs need to be selected to increase the potential effectiveness of the interventions to promote the private healthcare providers' intentions to offer HTC services.
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Affiliation(s)
- Almutaz M Idris
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, Netherlands
- College of Applied Medical Science, Buraydah Colleges, Buraydah, Saudi Arabia
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, Netherlands
| | - H W Van den Borne
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, Netherlands
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Zhao P, Wang J, Hall BJ, Sakyi K, Rafiq MY, Bodomo A, Wang C. HIV testing uptake, enablers, and barriers among African migrants in China: A nationwide cross-sectional study. J Glob Health 2022; 12:11015. [PMID: 36527361 PMCID: PMC9758700 DOI: 10.7189/jogh.12.11015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background African migrants in China face social, structural, and cultural barriers to human immunodeficiency virus (HIV) testing with scarce information on their HIV testing behaviours. This study estimated the prevalence of HIV testing and its social and behavioural correlates to understand how to better provide HIV testing services for African migrants living in China. Methods We conducted a national cross-sectional survey among adult African migrants who lived in China for more than one month between January 19 to February 7, 2021. The survey was disseminated online through six African community organizations and via participant referrals. We collected data on HIV testing behaviours and history of HIV testing, social, and cultural factors and applied univariate and multivariable logistic regression to identify testing correlates. Results Among a total of 1305 participants, 72.9% (n = 951/1305) tested for HIV during their stay in China and yielded a self-reported HIV prevalence of 0.4% (n = 4/951). The most common reason for HIV testing was to comply with Chinese residence policy requirements (88.5%, n = 842/951); for not testing was "no need to be tested" (79.4%, n = 281/354). We found most African migrants have experienced low acculturation stress (54.5%, n = 750/1305), low social discrimination (65.6%, n = 856/1305), have a moderate stigma towards HIV (54.3%, n = 709/1305), and low community engagement around sexual health and HIV topics. In multivariable analysis, African migrants who were students (adjusted odds ratio (aOR) = 3.36, 95% CI = 2.40-4.71), living in student dormitories (aOR = 3.86, 95% CI = 1.51-9.84), received health services in China in past year (aOR = 1.67, 95% CI = 1.25-2.23), had lifetime sexually transmitted infections (STI) testing (aOR = 1.95, 95% CI = 1.23-3.10), had HIV testing before coming to China (aOR = 13.56, 95% CI = 9.36-19.65), and those engaged in community discussions of HIV and sexual health (aOR = 2.77, 95% CI = 1.31-5.83) were more likely to test for HIV in China. Conclusions Despite 73% of African migrants having tested for HIV in China, there are unmet needs and barriers identified in our study, such as language barriers. Access to HIV knowledge and testing services were the most important enablers for testing, including studentship, past STI/HIV testing, and community discussion on sexual health. Culturally appropriate and community-based outreach programs to provide information on HIV and testing venues for African migrants might be helpful to promote testing uptake.
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Affiliation(s)
- Peizhen Zhao
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, China,Southern Medical University Institute for Global Health, Guangzhou, China
| | - Jiayu Wang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian J Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Kwame Sakyi
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, Michigan, USA,Center for Learning and Childhood Development, Accra, Ghana
| | | | - Adams Bodomo
- School of Liberal Arts, Xi'an University, Xi'an, China,African Studies Department, University of Vienna, Vienna, Austria
| | - Cheng Wang
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, China,Southern Medical University Institute for Global Health, Guangzhou, China
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Who falls between the cracks? Identifying eligible PrEP users among people with Sub-Saharan African migration background living in Antwerp, Belgium. PLoS One 2021; 16:e0256269. [PMID: 34407146 PMCID: PMC8372948 DOI: 10.1371/journal.pone.0256269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/03/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction This study produces an estimate of the proportion of eligible PrEP users among people of Sub-Saharan African background based on the Belgian PrEP eligibility criteria and examines associations with socio-economic and demographic characteristics. Methods We performed logistic regression analysis on data of a representative community-based survey conducted among Sub-Saharan African communities (n = 685) living in Antwerp. Results Almost a third (30.3%) of the respondents were eligible to use PrEP. Those who were male, single, lower educated, undocumented, and had experienced forced sex were more likely to be eligible for PrEP use. The findings highlight the importance of taking intra-, interpersonal and structural HIV risk factors into account. Conclusions The study shows high unmet PrEP needs in this population, especially among those with high vulnerability for HIV acquisition. A better understanding of barriers to PrEP use in this population group is needed to allow for equitable access.
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Lee MJ, Curtis H, van Halsema C, Chadwick DR. Evaluating a pilot process for reviewing late HIV diagnoses in England and Wales. Clin Med (Lond) 2021; 20:189-195. [PMID: 32188657 DOI: 10.7861/clinmed.2019-0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Late HIV diagnosis is associated with significant mortality in people living with HIV (PLWH) and high numbers of missed opportunities (MO) for earlier testing have been identified. A pilot of a national late diagnosis review process (LDRP) was undertaken in 15 HIV services evaluating the feasibility of LDRP implementation, as a patient safety initiative. All newly diagnosed PLWH with CD4 counts <200 cells/mm3 were included, and healthcare episodes within 5 years of presentation reviewed. Of 127 patients identified, 40 (31.5%) had MO and were more often white, UK-born and suffered more serious harm around diagnosis. Of these, four were designated serious incidents (undergoing root cause analysis) and eight were serious learning events. Engagement with services where MO occurred was challenging, however 75% of services found the LDRP sustainable. Widespread implementation of the LDRP should enable progress with training and policy changes within external services, enabling earlier HIV diagnosis and preventing deaths.
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Affiliation(s)
- Ming Jie Lee
- Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
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Apers H, Nöstlinger C, Van Beckhoven D, Deblonde J, Apers L, Verheyen K, Loos J. Identifying key elements to inform HIV-testing interventions for primary care in Belgium. Health Promot Int 2020; 35:301-311. [PMID: 31056680 PMCID: PMC7250498 DOI: 10.1093/heapro/daz037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
General practitioners (GPs) play a key role in reducing the hidden HIV-epidemic, but many diagnostic opportunities are missed in primary care. This study aimed at informing the development of an HIV-testing intervention for GPs in Flanders (Belgium) using formative research with a participatory approach. Through the active involvement of an advisory board and 16 group discussions with 122 Flemish GPs, GPs’ current HIV-testing practices and perceived practical relevance of 2 distinct HIV-testing strategies (i.e. provider-initiated testing of key populations and indicator condition-based testing) were explored in terms of their relevance and feasibility in routine primary care. Self-reported HIV-testing practices revealed that most tests performed were patient-initiated, pretest counseling was rarely done, and post-test counseling was offered mainly for patients with an HIV-diagnosis. GPs reported multiple barriers to provider-initiated HIV-testing, i.e. personal discomfort, fear of offending their patient, limited knowledge of benefits of early HIV-diagnosis, misconceptions about HIV-risks, lack of guidelines and time. Difficulties to identify patient’s sexual orientation or ethical concerns were mentioned as barriers for target group-based HIV testing. GPs assessed the current list of 64 indicator conditions as too difficult to integrate in routine care, deeming a reduced list of GP-relevant conditions as more feasible. Combined strategies (i.e. target group- and indicator-based testing) supported by official screening recommendations were perceived as successful strategies for provider-initiated HIV-testing in primary care. This formative research delivered qualitative evidence for the development of an HIV-testing intervention for primary care settings.
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Affiliation(s)
- Hanne Apers
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Corresponding author. E-mail:
| | - Christiana Nöstlinger
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dominique Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Jessika Deblonde
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Ludwig Apers
- HIV/STI clinic, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Katleen Verheyen
- General Practitioner, Opglabbeek, Belgium
- ELIZA - Center for General Practice, Department of Primary & Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - Jasna Loos
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Duracinsky M, Thonon F, Bun S, Ben Nasr I, Dara AF, Lakhdari S, Coblentz-Baumann L, Lert F, Dimi S, Chassany O. Good acceptability of HIV, HBV, and HCV screening during immigration medical check-up amongst migrants in France in the STRADA study. PLoS One 2020; 15:e0235260. [PMID: 32589652 PMCID: PMC7319329 DOI: 10.1371/journal.pone.0235260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The prevalence of HIV, hepatitis B, and hepatitis C amongst migrants in France is high. Thus, effective screening and follow-up is needed. The mandatory medical check-up for residency application is an opportunity to offer rapid HIV and hepatitis testing. The main objective of the STRADA study is to create a feasible and acceptable screening strategy for migrants. Within the STRADA study, this qualitative research examined the acceptability of conducting screening tests in the context of residency application. Methods We conducted a qualitative study amongst legal migrants over 18 years of age with sufficient knowledge of the French, English, or Arabic language. Interviews were performed following a semi-structured interview guide of open-ended questions. Interviews were transcribed verbatim and subsequently analyzed through thematic analysis. Results We interviewed 34 migrants. Mean age was 32.6 (min-max: 19, 59) years. The participants’ region of origin was mostly Sub-Saharan Africa and the main reason for migrating to France was family reunification. Migrants' acceptability of HIV and hepatitis testing was high. Participants who accepted testing indicated a benefit for individual health and to avoid transmission. Most preferred rapid tests; reluctance was related to anxiety about the immediate results and the perceived reliability of rapid tests. Migrants' knowledge about HIV was satisfactory, but inadequate for hepatitis. Screening in the context of a compulsory medical visit did not present an obstacle for acceptability. Some expressed concern in the case of HIV but when explained, the independence between obtaining the residence permit along with screening and access to medical care was well understood. Discussion Medical check-ups at immigration centers is an opportunity to screen for HIV and hepatitis which is considered acceptable by migrants. Informing migrants that test results do not affect residency applications, and incorporating their preferences, are all important to optimize the acceptability of screening.
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Affiliation(s)
- Martin Duracinsky
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- Hôpital Bicêtre, Service d’infectiologie, Le Kremlin Bicêtre, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
- * E-mail:
| | - Frédérique Thonon
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sonia Bun
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Imène Ben Nasr
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Aïchata Fofana Dara
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sabrina Lakhdari
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | | | - France Lert
- Agence nationale de recherche sur le sida et les hépatites virales (ANRS), Paris, France
| | - Svetlane Dimi
- Hôpital Foch, Service d’Hépatologie, Suresnes, France
| | - Olivier Chassany
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
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Desai S, Tavoschi L, Sullivan AK, Combs L, Raben D, Delpech V, Jakobsen SF, Amato‐Gauci AJ, Croxford S. HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review. HIV Med 2020; 21:163-179. [PMID: 31729150 PMCID: PMC7065119 DOI: 10.1111/hiv.12809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010-2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014-2017). Two reviewers independently performed study selection, data extraction and critical appraisal. RESULTS One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9-94% in primary care compared to 3.9-66% in emergency departments. HIV test positivity was lower in emergency departments (0-1.3%) and antenatal services (0-0.05%) than in other hospital departments (e.g. inpatients: 0-5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9-72% before to 12-85% after their implementation, with most studies reporting a 10-20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77-93%). CONCLUSIONS This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.
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Affiliation(s)
- S Desai
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
| | - L Tavoschi
- European Centre for Disease Prevention and ControlSolnaSweden
- University of PisaPisaItaly
| | - AK Sullivan
- Directorate of HIV and Sexual HealthChelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - L Combs
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - D Raben
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - V Delpech
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
| | - SF Jakobsen
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - AJ Amato‐Gauci
- European Centre for Disease Prevention and ControlSolnaSweden
| | - S Croxford
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
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Determinants and Outcomes of Late Presentation of HIV Infection in Migrants in Catalonia, Spain: PISCIS Cohort 2004-2016. J Immigr Minor Health 2020; 21:920-930. [PMID: 30377891 DOI: 10.1007/s10903-018-0834-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study using the Catalan PISCIS cohort explores risk factors of migrants' late presentation and the impact of late presentation on their health outcomes. We analyse 9590 new HIV diagnoses enrolled in the cohort between 2004 and 2016. Univariate and multivariate logistic regression models are used to identify risk factors associated with late presentation among migrants, giving crude and adjusted odds ratios and their 95% confidence intervals. Cox regression models are estimated to identify risk factors associated with AIDS/death, and crude and adjusted hazard ratios and 95% confidence intervals are reported. Late presentation is higher in migrants than non-migrants. Among migrants, region of origin is associated with late presentation and AIDS/death during follow-up. The results highlight persisting inequalities in HIV diagnosis and care among migrants in Catalonia. Targeted interventions addressed to specific subgroups in the migrant population are needed.
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Koschollek C, Kuehne A, Müllerschön J, Amoah S, Batemona-Abeke H, Dela Bursi T, Mayamba P, Thorlie A, Mputu Tshibadi C, Wangare Greiner V, Bremer V, Santos-Hövener C. Knowledge, information needs and behavior regarding HIV and sexually transmitted infections among migrants from sub-Saharan Africa living in Germany: Results of a participatory health research survey. PLoS One 2020; 15:e0227178. [PMID: 31986162 PMCID: PMC6984683 DOI: 10.1371/journal.pone.0227178] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A total of 3,419 new HIV diagnoses were reported in Germany in 2016, with migrants from sub-Saharan Africa (misSA) accounting for 14.1%. To understand the driving factors behind the epidemiological situation, we conducted a quantitative cross-sectional survey on knowledge, attitudes, behavior, and practices regarding HIV and sexually transmitted infections (STIs) among misSA living in six German cities utilizing participatory health research. METHODS Participants were recruited by peer researchers. Levels of knowledge, information needs, and preferred methods of information dissemination were analyzed to inform future prevention planning. Additionally, we analyzed sexual behavior and other risk factors for contracting HIV and STIs. The results may facilitate the formulation of targeted prevention messages in the future. RESULTS We included 2,432 participants in the analysis. General knowledge about HIV was adequate, as 86.9% were aware of the presented information. Statements about HIV co-infections were prior knowledge for 53.4% of the participants and about German HIV policies and HIV testing for 54.7%. Knowledge about other STIs differed, ranging from 69.6% who have ever heard of gonorrhea to 23.8% who have ever heard of genital warts. Groups with particular knowledge gaps were i) younger misSA, ii) recent migrants, iii) misSA without regular access to the German health care system, iv) misSA of lower socioeconomic status, and v) misSA with Muslim religious affiliation. The majority of participants reported information needs (72.8%), and 71.3% wanted to obtain this information from health professionals. Male misSA were more likely to report five or more sexual partners compared to females. Less than half of participants reported always using condoms with non-steady sexual partners (46.8%). Reasons for not using condoms differed between males and females. A considerable proportion of females (16.3%) and males (6.8%) experienced sexualized violence. More than one fourth of women (26.9%) were affected by female genital mutilation/cutting. DISCUSSION Future prevention planning should focus on sub-groups with particular knowledge gaps, recognizing their preferred methods of information dissemination. Prevention messages for male misSA should focus on their own risk perception and for female misSA on empowerment, e.g. to negotiate condom use.
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Affiliation(s)
- Carmen Koschollek
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
- Charité University Medicine, Berlin, Germany
- * E-mail:
| | - Anna Kuehne
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
| | - Johanna Müllerschön
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
| | - Stephen Amoah
- Charité University Medicine, Berlin, Germany
- Afrikaherz Berlin, Verband für interkulturelle Arbeit, Regionalverband Berlin/Brandenburg e.V., Berlin, Germany
| | | | | | | | - Adama Thorlie
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
| | | | | | - Viviane Bremer
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
| | - Claudia Santos-Hövener
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
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12
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Agbata EN, Padilla PF, Agbata IN, Armas LH, Solà I, Pottie K, Alonso-Coello P. Migrant Healthcare Guidelines: A Systematic Quality Assessment. J Immigr Minor Health 2019; 21:401-413. [PMID: 29785690 DOI: 10.1007/s10903-018-0759-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Significant international and cross-border migration has led to a growing availability of migrant healthcare guidelines (MHGs), which we systematically reviewed for quality. PubMed, MEDLINE, CINHAL, PsychINFO and guideline developer/guideline databases were searched for MHGs published 2006-2016. Three independent reviewers assessed eligible MHGs using the Appraisal of Guidelines, Research and Evaluation II instrument (AGREE II). MHGs were identified as high quality if they had a score of ≥ 60% in at least three of the six domains, including "rigour of development", and overall quality was assessed on a seven-point Likert scale. We included 32 MHGs. Overall agreement between reviewers was very good. Mean scores for each AGREE II domain were as follows: 85 ± 19.0% for "scope and purpose"; 51 ± 30.5% for "stakeholder involvement"; 34 ± 31.9% for "rigour of development"; 86 ± 7.3% for "clarity of presentation"; 40 ± 23.6% for "applicability"; and 27 ± 38.5% for "editorial independence". Nine and six MHGs were deemed "recommended" or "recommended with modifications", respectively, and 17 were "not recommended". Our review of MHGs has highlighted critical deficiencies in rigour of development, applicability, editorial independence and stakeholder involvement that point to the need for improvements in future MHGs.
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Affiliation(s)
- Eric Nwachukwu Agbata
- Faculty of Health and Psychology, Master of Public Health (MPH) programme, University of Roehampton, London, UK. .,Methodology of Biomedical Research and Public Health, Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Paulina Fuentes Padilla
- Iberoamerican Cochrane Centre, Barcelona, Spain.,Faculty of Medicine and Dentistry, Universidad de Antofagasta, Antofagasta, Chile
| | - Ifeoma Nwando Agbata
- The Wicklow Mental Health Service, Newcastle Hospital, Greystones, Wicklow, Ireland
| | | | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Kevin Pottie
- Centre for Global Health Institute of Population Health, University of Ottawa, Ottawa, ON, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Biomedical Research Institute, Sant Pau (IIB Sant Pau), Barcelona, Spain
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13
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Deblonde J, Van Beckhoven D, Loos J, Boffin N, Sasse A, Nöstlinger C, Supervie V. HIV testing within general practices in Europe: a mixed-methods systematic review. BMC Public Health 2018; 18:1191. [PMID: 30348140 PMCID: PMC6196459 DOI: 10.1186/s12889-018-6107-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. METHODS The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. RESULTS The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. CONCLUSIONS GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.
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Affiliation(s)
- Jessika Deblonde
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | | | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Nicole Boffin
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - André Sasse
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Virginie Supervie
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, 56 Bd. Vincent Auriol, CS 81393, 75646 Paris Cedex 13, France
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14
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Demorat H, Lopes A, Chopin D, Delcey V, Clevenbergh P, Simoneau G, Evans J, Mouly S, Bergmann JF, Sellier P. Acceptability and feasibility of HIV testing in general medicine by ELISA or rapid test from finger-stick whole blood. Presse Med 2018; 47:e15-e23. [PMID: 29478794 DOI: 10.1016/j.lpm.2017.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 10/01/2017] [Accepted: 11/27/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Guidelines recommend routine universal HIV testing in adults to reduce the pool of infected patients unaware of their status, without specific recommendations concerning the method. We compared acceptability and feasibility of HIV testing by ELISA tests or rapid tests from finger-stick whole blood. METHODS Prospective randomized multi-center study comparing acceptability and feasibility of routine universal HIV testing by ELISA tests, with a charge, subsequently reimbursed by Social Security for affiliated patients, or rapid tests from finger-stick whole blood, without any charge from the patients or the general practitioner for the study. A single investigator performed all interventions. After consent, all adults (18-70 years old) consulting their general practitioner in Paris, France, unaware of their status, were enrolled. Testing was performed immediately for the patients in the rapid test arm; a prescription was given for testing in a lab for the patients in the ELISA arm. The primary endpoint was acceptability of each method. The secondary endpoint was feasibility of each method, assessed one month after the consultation. RESULTS Two hundred and seventy patients were enrolled: 133 patients in the ELISA arm, 137 in the rapid test arm. Acceptability of the rapid test (92%) was higher than that of the ELISA (63.9%), P<0.0001. Feasibility of the rapid test (100%) was higher than that of the ELISA (50.5%), P<0.0001. A center effect was shown concerning feasibility of ELISA but not concerning feasibility of rapid tests. CONCLUSION Rapid testing from finger-stick whole blood is more acceptable and feasible than ELISA for routine universal HIV testing. A larger use of rapid tests, ideally free of charge, by general practitioners could reduce the pool of infected patients unaware of their status.
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Affiliation(s)
- Hubert Demorat
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Amanda Lopes
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - Dorothée Chopin
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - Véronique Delcey
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Philippe Clevenbergh
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Guy Simoneau
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - John Evans
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Stéphane Mouly
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - Jean-François Bergmann
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France.
| | - Pierre Sellier
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France.
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15
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Fakoya I, Álvarez-Del Arco D, Copas AJ, Teixeira B, Block K, Gennotte AF, Volny-Anne A, Bil JP, Touloumi G, Del Amo J, Burns FM. Factors Associated With Access to HIV Testing and Primary Care Among Migrants Living in Europe: Cross-Sectional Survey. JMIR Public Health Surveill 2017; 3:e84. [PMID: 29109072 PMCID: PMC5696579 DOI: 10.2196/publichealth.7741] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background There is a heavy and disproportionate burden of human immunodeficiency virus (HIV) infection among migrant communities living in Europe. Despite this, the published evidence related to HIV testing, prevention, and treatment needs for migrants is sparse. Objective The aim of this study was to identify the factors associated with access to primary care and HIV testing among migrant groups living in Europe. Methods A Web-based survey (available in 14 languages) was open to all people aged 18 years and older, living outside their country of birth in the World Health Organization (WHO) European area. Community organizations in 9 countries promoted the survey to migrant groups, focusing on those at a higher risk of HIV (sub-Saharan Africans, Latin Americans, gay or bisexual men, and people who inject drugs). Multivariable analysis examined factors associated with access to primary care and previous history of an HIV test. Results In total, 559 women, 395 heterosexual men, and 674 gay or bisexual men were included in the analysis, and 68.1% (359/527) of women, 59.5% (220/371) of heterosexual men, and 89.6% (596/664) of gay or bisexual men had tested for HIV. Low perceived risk was the reason given for not testing by 62.3% (43/69) of gay or bisexual men and 83.3% (140/168) of women and heterosexual men who reported never having tested for HIV. Access to primary care was >60% in all groups. Access to primary care was strongly positively associated with living in Northern Europe compared with Southern Europe (women: adjusted odds ratio, aOR 34.56 [95% CI 11.58-101]; heterosexual men: aOR 6.93 [95% CI 2.49-19.35], and gay or bisexual men: aOR 2.53 [95% CI 1.23-5.19]), whereas those with temporary residency permits were less likely to have access to primary care (women: aOR 0.41 [95% CI 0.21-0.80] and heterosexual men: aOR 0.24 [95% CI 0.10-0.54] only). Women who had experience of forced sex (aOR 3.53 [95% CI 1.39-9.00]) or postmigration antenatal care (aOR 3.07 [95% CI 1.55-6.07]) were more likely to have tested for HIV as were heterosexual men who had access to primary care (aOR 3.13 [95% CI 1.58-6.13]) or reported “Good” health status (aOR 2.94 [95% CI 1.41-5.88]). Conclusions Access to primary care is limited by structural determinants such as immigration and health care policy, which varies across Europe. For those migrants who can access primary care and other health services, missed opportunities for HIV testing remain a barrier to earlier testing and diagnosis for migrants in Europe. Clinicians should be aware of these potential structural barriers to HIV testing as well as low perception of HIV risk in migrant groups.
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Affiliation(s)
- Ibidun Fakoya
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Débora Álvarez-Del Arco
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Network on Epidemiology and Public Health, Faculty of Political Science and Sociology, Universidad Complutense de Madrid, Madrid, Spain
| | - Andrew J Copas
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Koen Block
- European AIDS Treatment Group, Brussels, Belgium
| | - Anne-Francoise Gennotte
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | - Janneke P Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunology Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Julia Del Amo
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Network on Epidemiology and Public Health, Faculty of Political Science and Sociology, Universidad Complutense de Madrid, Madrid, Spain
| | - Fiona M Burns
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom.,Royal Free London National Health Service Foundation Trust, London, United Kingdom
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16
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Aung E, Blondell SJ, Durham J. Interventions for Increasing HIV Testing Uptake in Migrants: A Systematic Review of Evidence. AIDS Behav 2017; 21:2844-2859. [PMID: 28710710 DOI: 10.1007/s10461-017-1833-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Migrants have been identified as being at greater risk for late HIV testing and diagnosis. Late diagnosis is of concern because timely diagnosis and initiation of treatment can both optimise health outcomes and reduce transmission. We reviewed and evaluated interventions that aimed to increase HIV testing uptake in migrant populations. Of 6511 papers retrieved, 10 met the inclusion criteria and were included in the review. Three types of interventions were identified (exposure to HIV prevention messages, HIV education programs, and direct offer of testing). All interventions were based on individual models of behaviour change targeting migrants or GPs. While important, interventions that also address broader health system and structural factors that contribute to late HIV-diagnosis in at-risk members of migrant populations are needed. Integrating PITC into existing primary healthcare settings shows promise of creating an enabling environment within patient-doctor relationships that can encourage HIV testing uptake among migrant populations.
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17
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Loos J, Manirankunda L, Platteau T, Albers L, Fransen K, Vermoesen T, Namanya F, Nöstlinger C. Acceptability of a Community-Based Outreach HIV-Testing Intervention Using Oral Fluid Collection Devices and Web-Based HIV Test Result Collection Among Sub-Saharan African Migrants: A Mixed-Method Study. JMIR Public Health Surveill 2016; 2:e33. [PMID: 27493067 PMCID: PMC4990717 DOI: 10.2196/publichealth.5519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/11/2016] [Accepted: 06/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background Late human immunodeficiency virus (HIV) diagnosis is common among sub-Saharan African migrants. To address their barriers to HIV testing uptake and improve timely HIV diagnoses and linkage to care, the outreach HIV testing intervention, “swab2know,” was developed. It combined a community-based approach with innovative testing methods: oral fluid self-sampling and the choice between Web-based HIV test result collections using a secured website or post-test counseling at a sexual health clinic. The sessions included an informational speech delivered by a physician of sub-Saharan African origin and testimonies by community members living with HIV. Objectives The objectives of this study were to evaluate the intervention’s acceptability among sub-Saharan African migrants and its potential to reach subgroups at higher risk for HIV infection and to identify facilitators and barriers for HIV testing uptake. Methods This mixed-method study combined qualitative (participant observations and informal interviews with testers and nontesters) and quantitative data (paper–pencil survey, laboratory data, and result collection files). Data were analyzed using a content analytical approach for qualitative and univariate analysis for quantitative data. Results A total of 10 testing sessions were organized in sub-Saharan African migrant community venues in the city of Antwerp, Belgium, between December 2012 and June 2013. Overall, 18.2% of all people present (N=780) underwent HIV testing; 29.8% of them tested for HIV for the first time, 22.3% did not have a general practitioner, and 21.5% reported 2 or more sexual partners (last 3 months). Overall, 56.3% of participants chose to collect their HIV test results via the protected website. In total, 78.9% collected their results. The qualitative analysis of 137 participant observation field notes showed that personal needs and Internet literacy determined the choice of result collection method. Generally, the oral fluid collection devices were well accepted mainly because sub-Saharan African migrants dislike blood taking. For some participants, the method raised concerns about HIV transmission via saliva. The combination of information sessions, testimonies, and oral fluid collection devices was perceived as effectively reducing thresholds to participation. Acceptability of the intervention differed between individual participants and settings. Acceptance was higher among women, in churches and settings where community leaders were engaged in HIV awareness raising. Higher preventive outcomes were observed in settings with lower acceptance. The presence of the intervention team visualized the magnitude of the HIV epidemic to the public and promoted HIV testing uptake at large, for example, those who declined indicated they would take up testing later. Conclusions When accompanied by tailored provision of information, outreach HIV testing interventions adopting a community-based approach and innovative methods such as Web-based result collection and oral fluid collection devices are acceptable and reduce thresholds for HIV testing uptake. The swab2know intervention was able to reach sub-Saharan African migrants at risk of HIV infection, and with limited access to regular HIV testing. Among nontesters, the intervention contributed to awareness raising and therefore has a place in a multipronged HIV test promotion strategy.
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Affiliation(s)
- Jasna Loos
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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18
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Nannozi V, Wobudeya E, Gahagan J. Fear of an HIV positive test result: an exploration of the low uptake of couples HIV counselling and testing (CHCT) in a rural setting in Mukono district, Uganda. Glob Health Promot 2016; 24:33-42. [PMID: 27235411 DOI: 10.1177/1757975916635079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Couples HIV counselling and testing (CHCT) is a key preventive strategy used to reduce the spread of HIV. In Uganda, HIV prevalence among married or cohabiting couples is 5.6%, compared to 2.2% among those never married. CHCT can help ease disclosure of HIV positive status, which in turn may help increase opportunities to obtain social supports and reduce new infections. The purpose of this study was aimed at exploring the possible reasons for the low uptake of CHCT in Mukono district, a rural in setting in Uganda. METHODS The study was conducted in two sub-counties in a rural district (Mukono district) using a descriptive qualitative research design. Specifically, we conducted four focus group discussions and 10 key informant interviews. We also interviewed 53 individuals in couple relationships. Data were collected mainly in the local language Luganda and English, all data were transcribed into English and coded for emergent themes. Ethical clearance for this study was obtained from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. RESULTS Fear of a positive HIV test result emerged strongly as the most significant barrier to CHCT. To a lesser extent, perceptions and knowledge of CHCT, mistrust in marriages and culture were also noted by participants as important barriers to the uptake of CHCT among couples. Participants offered suggestions on ways to overcome these barriers, including peer couple counselling, offering incentives to couples that test together and door-to-door CHCT testing. CONCLUSION In an effort to improve the uptake of CHCT, it is crucial to involve both females and males in the planning and implementation of CHCT, as well as to address the misconceptions about CHCT and to prioritise CHCT within health care systems management.
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Affiliation(s)
| | - Eric Wobudeya
- 2. Mulago National Referral Hospital, Kampala, Uganda
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Deblonde J, Sasse A, Del Amo J, Burns F, Delpech V, Cowan S, Levoy M, Keith L, Pharris A, Amato-Gauci A, Noori T. Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA. BMC Public Health 2015; 15:1228. [PMID: 26654427 PMCID: PMC4676131 DOI: 10.1186/s12889-015-2571-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022] Open
Abstract
Background In the European Union/European Economic Area (EU/EEA), migrants from high-endemic countries are disproportionately affected by HIV. Between 2007 and 2012, migrants represented 39 % of reported HIV cases. There is growing evidence that a significant proportion of HIV acquisition among migrant populations occurs after their arrival in Europe. Discussion Migrants are confronted with multiple risk factors that shape patterns of population HIV susceptibility and vulnerability, which simultaneously affect HIV transmission. Undocumented migrants incur additional risks for contracting HIV due to limited access to adequate health care services, protection and justice, alongside insecure housing and employment conditions. All EU/EEA countries have ratified a number of international and regional human rights instruments that enshrine access to health care as a human right that should be available to everyone without discrimination. From a clinical and public health perspective, early HIV care and treatment is associated with viral suppression, improved health outcomes and reductions in transmission risks. A current challenge of the HIV epidemic is to reach the highest proportion of overall viral suppression among people living with HIV in order to impact on HIV transmission. Although the majority of EU/EEA countries regard migrants as an important sub-population for their national responses to HIV, and despite the overwhelming evidence of the individual and public health benefits associated with HIV care and treatment, a significant number of EU/EEA countries do not provide antiretroviral treatment to undocumented migrants. Summary HIV transmission dynamics in migrant populations depend on the respective weight of all risk and vulnerability factors to which they are exposed, which act together in a synergistic way. People who are not linked to HIV care will continue to unwillingly contribute to the on-going transmission of HIV. Following the recommendations of the European Union Agency for Fundamental Rights, ensuring access to HIV-care for all sub-populations, including undocumented migrants, would fulfil the human rights of those populations and also strengthen the control of HIV incidence among those not currently able to access HIV care.
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Affiliation(s)
- Jessika Deblonde
- Scientific Institute of Public Health, Epidemiology of Infectious Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - André Sasse
- Scientific Institute of Public Health, Epidemiology of Infectious Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Julia Del Amo
- Institute of Health Carlos III, National Center for Epidemiology, C/Sinesio Delgado 6, 28029, Madrid, Spain.
| | - Fiona Burns
- University College London, Research Department of Infection & Population Health, London, WC1E 6JB, UK. .,Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
| | - Valerie Delpech
- Public Health England, PHIV & STI Department, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Susan Cowan
- Statens Serum Institut, Department of Infectious Medicine Epidemiology, Artillerivej 5, 2300, Copenhagen S, Denmark.
| | - Michele Levoy
- PICUM- Platform for International Cooperation on Undocumented Migrants, Rue du Congrès 37-41 / 5, Brussels, 1000, Belgium.
| | - Lilana Keith
- PICUM- Platform for International Cooperation on Undocumented Migrants, Rue du Congrès 37-41 / 5, Brussels, 1000, Belgium.
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavagen 11A, 171 83, Stockholm, Sweden.
| | - Andrew Amato-Gauci
- European Centre for Disease Prevention and Control, Office of the Chief Scientist, Tomtebodavagen 11A, 171 83, Stockholm, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavagen 11A, 171 83, Stockholm, Sweden.
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Leidel S, Wilson S, McConigley R, Boldy D, Girdler S. Health-care providers' experiences with opt-out HIV testing: a systematic review. AIDS Care 2015; 27:1455-67. [PMID: 26272473 DOI: 10.1080/09540121.2015.1058895] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV is now a manageable chronic disease with a good prognosis, but early detection and referral for treatment are vital. In opt-out HIV testing, patients are informed that they will be tested unless they decline. This qualitative systematic review explored the experiences, attitudes, barriers, and facilitators of opt-out HIV testing from a health-care provider (HCP) perspective. Four articles were included in the synthesis and reported on findings from approximately 70 participants, representing diverse geographical regions and a range of human development status and HIV prevalence. Two synthesized findings emerged: HCP attitudes and systems. The first synthesized finding encompassed HCP decision-making attitudes about who and when to test for HIV. It also included the assumptions the HCPs made about patient consequences. The second synthesized finding related to systems. System-related barriers to opt-out HIV testing included lack of time, resources, and adequate training. System-related facilitators included integration into standard practice, support of the medical setting, and electronic reminders. A common attitude among HCPs was the outdated notion that HIV is a terrible disease that equates to certain death. Some HCPs stated that offering the HIV test implied that the patient had engaged in immoral behaviour, which could lead to stigma or disengagement with health services. This paternalism diminished patient autonomy, because patients who were excluded from opt-out HIV testing could have benefited from it. One study highlighted the positive aspects of opt-out HIV testing, in which participants underscored the professional satisfaction that arose from making an HIV diagnosis, particularly when marginalized patients could be connected to treatment and social services. Recommendations for opt-out HIV testing should be disseminated to HCPs in a broad range of settings. Implementation of system-related factors such as electronic reminders and care coordination procedures should be considered, and a social-justice commitment among HCPs should be encouraged.
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Affiliation(s)
- Stacy Leidel
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Sally Wilson
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Ruth McConigley
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Duncan Boldy
- a School of Nursing and Midwifery , Curtin University , Perth , Australia
| | - Sonya Girdler
- b School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
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